母体乙肝病毒、沙眼衣原体、念珠菌感染与出生缺陷关系的队列研究
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摘要
目的探讨母体乙肝病毒、生殖道沙眼衣原体和念珠菌感染对胎儿出生缺陷的影响。方法以东莞市孕前筛查项目为基础,收集受检妇女基本资料和临床结果,随访获取研究对象妊娠结局,采用Logistic回归分析探讨乙肝病毒、生殖道沙眼衣原体和念珠菌感染与胎儿出生缺陷的关系。结果共纳入研究对象72 515例,有出生缺陷者996例,发病率为137.35/万人,其中心血管疾病发病率最高,为48.47/万人。乙肝病毒阳性(RR=1.28,95%CI:1.04～1.59)、生殖道沙眼衣原体阳性(RR=1.82,95%CI:1.23～2.69)为出生缺陷的影响因素。进一步分析发现:乙肝病毒感染是染色体异常(RR=2.39,95%CI:1.15～4.93)、消化系统疾病(RR=2.89,95%CI:1.33～6.28)的危险因素;生殖道沙眼衣原体感染是中枢神经系统疾病(RR=4.29,95%CI:1.31～14.06)、心血管系统疾病(RR=1.93,95%CI:1.05～3.54)、染色体异常(RR=5.27,95%CI:1.87～14.85)的危险因素。念珠菌感染则暂未发现对各类出生缺陷有影响。结论母体乙肝病毒感染、生殖道沙眼衣原体感染对胎儿出生缺陷发生有影响,但仍需更大样本的调查予以证实。
Objective To investigate the effects of maternal hepatitis B virus,genital Chlamydia trachomatis and Candida infection on fetal birth defects. Methods The study was based on the pre-pregnancy screening program in Dongguan. The basic data and clinical examination results of the women were collected. The pregnancy outcomes of the subjects were followed up. The relationship between hepatitis B virus,genital Chlamydia trachomatis and Candida infection and fetal birth defects was analyzed by logistic regression analysis. Results A total of 72 515 subjects were enrolled,with 996 birth defects,and the incidence rate was 137.35 per 10 000 people. The incidence of cardiovascular disease was the highest,at48.47/10 000. Hepatitis B virus positive(RR=1.28,95%CI:1.04～1.59)and genital Chlamydia trachomatis positive(RR=1.82,95%CI:1.23～2.69)were the influencing factors of birth defects. Further analysis found that hepatitis B virus infection was a risk factor for chromosomal abnormalities(RR=2.39,95%CI:1.15～4.93)and digestive diseases(RR=2.89,95%CI:1.33～6.28);genital Chlamydia trachomatis infection was a risk factor for central nervous system diseases(RR=4.29,95%CI:1.31～14.06),cardiovascular diseases(RR=1.93,95%CI:1.05～3.54)and chromosomal abnormalities(RR=5.27,95%CI:1.87～14.85). Candida infection had not been found to have an impact on various birth defects. Conclusion Maternal hepatitis B virus infection and genital Chlamydia trachomatis infection were the factors influencing birth defects,but the results require larger sample of cohort studies to confirm.
Objective To investigate the effects of maternal hepatitis B virus,genital Chlamydia trachomatis and Candida infection on fetal birth defects. Methods The study was based on the pre-pregnancy screening program in Dongguan. The basic data and clinical examination results of the women were collected. The pregnancy outcomes of the subjects were followed up. The relationship between hepatitis B virus,genital Chlamydia trachomatis and Candida infection and fetal birth defects was analyzed by logistic regression analysis. Results A total of 72 515 subjects were enrolled,with 996 birth defects,and the incidence rate was 137.35 per 10 000 people. The incidence of cardiovascular disease was the highest,at48.47/10 000. Hepatitis B virus positive(RR=1.28,95%CI:1.04～1.59)and genital Chlamydia trachomatis positive(RR=1.82,95%CI:1.23～2.69)were the influencing factors of birth defects. Further analysis found that hepatitis B virus infection was a risk factor for chromosomal abnormalities(RR=2.39,95%CI:1.15～4.93)and digestive diseases(RR=2.89,95%CI:1.33～6.28);genital Chlamydia trachomatis infection was a risk factor for central nervous system diseases(RR=4.29,95%CI:1.31～14.06),cardiovascular diseases(RR=1.93,95%CI:1.05～3.54)and chromosomal abnormalities(RR=5.27,95%CI:1.87～14.85). Candida infection had not been found to have an impact on various birth defects. Conclusion Maternal hepatitis B virus infection and genital Chlamydia trachomatis infection were the factors influencing birth defects,but the results require larger sample of cohort studies to confirm.
引文
[1]王红,何晓燕,王静.产前筛查和产前诊断对预防出生缺陷的影响[J].热带医学杂志,2018,18(1):47-50.
[2] Chung MH,Shin CO,Lee J. TORCH(toxoplasmosis,rubella,cytomegalovirus,and herpes simplex virus)screening of small for gestational age and intrauterine growth restricted neonates:efficacy study in a single institute in Korea[J]. Korean J Pediatr,2018,61(4):114-120.
[3] Jackel D, Lai K. Candida glabrata sepsis associated with chorioamnionitis in an in vitro fertilization pregnancy:case report and review[J]. Clin Infect Dis,2013,56(4):555-558.
[4] Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis Infection in Pregnancy:The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in SubSaharan Africa and Asia[J]. Biomed Res Int,2016,2016:9315757.
[5] Liu J,Zhang S,Liu M,et al. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth:a populationbased cohort study[J]. Lancet Glob Health,2017,5(6):e624-e632.
[6] Liu QG,Sun J,Xiao XW,et al. Birth defects data from surveillance hospitals in Dalian city,China,2006-2010[J]. J Matern Fetal Neonatal Med,2016,29(22):3615-3621.
[7] Liu S,Rouleau J,Leon JA,et al. Impact of pre-pregnancy diabetes mellitus on congenital anomalies,Canada,2002-2012[J]. Health Promot Chronic Dis Prev Can,2015,35(5):79-84.
[8] Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013:findings from the Global Burden of Disease Study 2013[J]. Lancet,2016,388(10049):1081-1088.
[9] Yang Y,Jin L,Tian Z,et al. The association of adverse outcomes in the mother with disease progression in offspring in families with clusters of hepatitis B virus infection andunfavorable prognoses in Northwest China[J]. Medicine(Baltimore),2018,97(38):e12266.
[10] Wang S, Tao Y, Jiang J, et al. Epidemiological study of hepatitis B and hepatitis C infections in Northeastern China and the beneficial effect of the vaccination strategy for hepatitis B:a cross-sectional study[J]. BMC Public Health,2018,18(1):1088.
[11] Bajema KL, Stankiewicz Karita HC, Tenforde MW, et al.Maternal Hepatitis B Infection and Pregnancy Outcomes in the United States:A Population-Based Cohort Study[J]. Open Forum Infect Dis,2018,5(6):ofy134.
[12] Keramat A,Younesian M,Gholami Fesharaki M,et al. Inactive Hepatitis B Carrier and Pregnancy Outcomes:A Systematic Review and Meta-analysis[J]. Iran J Public Health,2017,46(4):468-474.
[13] Cui AM,Cheng XY,Shao JG,et al. Maternal hepatitis B virus carrier status and pregnancy outcomes:a prospective cohort study[J]. BMC Pregnancy Childbirth,2016,16:87.
[14] Sirilert S, Traisrisilp K, Sirivatanapa P, et al. Pregnancy outcomes among chronic carriers of hepatitis B virus[J]. Int J Gynaecol Obstet,2014,126(2):106-110.
[15]张振林,赵喜元,黄琳,等.珠海地区沙眼衣原体感染的检测[J].热带医学杂志,2017,17(7):966-969.
[16]李蔓.宫颈沙眼衣原体感染与不良妊娠结局关系的Meta分析[J].中国妇幼健康研究,2018,29(4):448-453.
[17] Rours GI,De Krijger RR,Ott A,et al. Chlamydia trachomatis and placental inflammation in early preterm delivery[J]. Eur J Epidemiol,2011,26(5):421-428.
[18] Balla E,Petrovay F,Erdosi T,et al. Distribution of Chlamydia trachomatis genotypes in neonatal conjunctivitis in Hungary[J].J Med Microbiol,2017,66(7):915-918.
[19] Farr A,Kiss H,Holzer I,et al. Effect of asymptomatic vaginal colonization with Candida albicans on pregnancy outcome[J].Acta Obstet Gynecol Scand,2015,94(9):989-996.
[20] Holzer I,Farr A,Kiss H,et al. The colonization with Candida species is more harmful in the second trimester of pregnancy[J].Arch Gynecol Obstet,2017,295(4):891-895.
[21] Leli C,Mencacci A,Meucci M,et al. Association of pregnancy and Candida vaginal colonization in women with or without symptoms of vulvovaginitis[J]. Minerva Ginecol,2013,65(3):303-309.
[22] Hershko-Klement A,Sukenik-Halevy R,Biron Shental T,et al.Intracytoplasmic morphologically selected sperm injection and congenital birth defects:a retrospective cohort study[J].Andrology,2016,4(5):887-893.
[2] Chung MH,Shin CO,Lee J. TORCH(toxoplasmosis,rubella,cytomegalovirus,and herpes simplex virus)screening of small for gestational age and intrauterine growth restricted neonates:efficacy study in a single institute in Korea[J]. Korean J Pediatr,2018,61(4):114-120.
[3] Jackel D, Lai K. Candida glabrata sepsis associated with chorioamnionitis in an in vitro fertilization pregnancy:case report and review[J]. Clin Infect Dis,2013,56(4):555-558.
[4] Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis Infection in Pregnancy:The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in SubSaharan Africa and Asia[J]. Biomed Res Int,2016,2016:9315757.
[5] Liu J,Zhang S,Liu M,et al. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth:a populationbased cohort study[J]. Lancet Glob Health,2017,5(6):e624-e632.
[6] Liu QG,Sun J,Xiao XW,et al. Birth defects data from surveillance hospitals in Dalian city,China,2006-2010[J]. J Matern Fetal Neonatal Med,2016,29(22):3615-3621.
[7] Liu S,Rouleau J,Leon JA,et al. Impact of pre-pregnancy diabetes mellitus on congenital anomalies,Canada,2002-2012[J]. Health Promot Chronic Dis Prev Can,2015,35(5):79-84.
[8] Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013:findings from the Global Burden of Disease Study 2013[J]. Lancet,2016,388(10049):1081-1088.
[9] Yang Y,Jin L,Tian Z,et al. The association of adverse outcomes in the mother with disease progression in offspring in families with clusters of hepatitis B virus infection andunfavorable prognoses in Northwest China[J]. Medicine(Baltimore),2018,97(38):e12266.
[10] Wang S, Tao Y, Jiang J, et al. Epidemiological study of hepatitis B and hepatitis C infections in Northeastern China and the beneficial effect of the vaccination strategy for hepatitis B:a cross-sectional study[J]. BMC Public Health,2018,18(1):1088.
[11] Bajema KL, Stankiewicz Karita HC, Tenforde MW, et al.Maternal Hepatitis B Infection and Pregnancy Outcomes in the United States:A Population-Based Cohort Study[J]. Open Forum Infect Dis,2018,5(6):ofy134.
[12] Keramat A,Younesian M,Gholami Fesharaki M,et al. Inactive Hepatitis B Carrier and Pregnancy Outcomes:A Systematic Review and Meta-analysis[J]. Iran J Public Health,2017,46(4):468-474.
[13] Cui AM,Cheng XY,Shao JG,et al. Maternal hepatitis B virus carrier status and pregnancy outcomes:a prospective cohort study[J]. BMC Pregnancy Childbirth,2016,16:87.
[14] Sirilert S, Traisrisilp K, Sirivatanapa P, et al. Pregnancy outcomes among chronic carriers of hepatitis B virus[J]. Int J Gynaecol Obstet,2014,126(2):106-110.
[15]张振林,赵喜元,黄琳,等.珠海地区沙眼衣原体感染的检测[J].热带医学杂志,2017,17(7):966-969.
[16]李蔓.宫颈沙眼衣原体感染与不良妊娠结局关系的Meta分析[J].中国妇幼健康研究,2018,29(4):448-453.
[17] Rours GI,De Krijger RR,Ott A,et al. Chlamydia trachomatis and placental inflammation in early preterm delivery[J]. Eur J Epidemiol,2011,26(5):421-428.
[18] Balla E,Petrovay F,Erdosi T,et al. Distribution of Chlamydia trachomatis genotypes in neonatal conjunctivitis in Hungary[J].J Med Microbiol,2017,66(7):915-918.
[19] Farr A,Kiss H,Holzer I,et al. Effect of asymptomatic vaginal colonization with Candida albicans on pregnancy outcome[J].Acta Obstet Gynecol Scand,2015,94(9):989-996.
[20] Holzer I,Farr A,Kiss H,et al. The colonization with Candida species is more harmful in the second trimester of pregnancy[J].Arch Gynecol Obstet,2017,295(4):891-895.
[21] Leli C,Mencacci A,Meucci M,et al. Association of pregnancy and Candida vaginal colonization in women with or without symptoms of vulvovaginitis[J]. Minerva Ginecol,2013,65(3):303-309.
[22] Hershko-Klement A,Sukenik-Halevy R,Biron Shental T,et al.Intracytoplasmic morphologically selected sperm injection and congenital birth defects:a retrospective cohort study[J].Andrology,2016,4(5):887-893.