广西七城市围产儿先天畸形危险因素的病例对照研究
|
摘要
目的：为了解广西先天畸形的现状，并探讨广西城区围产儿先天畸形的危险因素，为先天畸形防治措施的制定及开展优生优育工作提供依据。方法：2000年在广西南宁、柳州、桂林、玉林、梧州、钦州、北海七个城市所属62所医院(不包括郊区、县医院)出生41539例围产儿，其中畸形儿共513例，对其中资料较全的281例畸形儿进行了病例对照研究，以单因素、多因素非条件Logistic回归进行分析。结果：七个城市先天畸形总检出率为12.35‰，其中男性为13.32‰，女性为10.48‰，男女之比为1.3:1；七个城市中以梧州市、玉林市检出率较高，北海市较低；城镇先天畸形检出率为12.20‰，乡村(指常住乡村来城市分娩的产妇)检出率为11.55‰，两者标准化检出率无显著性差异；产妇不同年龄组先天畸形标准化检出率无显著性差异；在所检出的各类先天畸形中，以巴氏水肿综合征为最多。单因素及多因素分析结果提示先天畸形的主要危险因素是：胎儿出生体重低(OR=0.999)；多产次(OR=2.6)；有妊娠合并症(OR=3.2)；母亲妊娠前后接触化学制剂(OR=3.0)；孕期服过镇静药(OR=10.2)、激素类药(OR=9.4)、中成药(OR=2.5)；母亲血红蛋白量低(OR=0.985)；父亲接触噪声(OR=5.7)、有慢性病(OR=2.8)；母亲血型为AB型其后代发生先天畸形的危险性是O型的3倍多，A型的是O型的2倍多，B型的是O型的1倍多；母亲孕期情绪紧张、忧郁其后代发生先天畸形的危险性是情绪愉快的2倍多，情绪一般的是情绪愉快的1倍多；母亲
毕业论义；广M七城市闲产儿冗天畸形危险冈素的拖例对照研究
职业为工人其后代发生先大畸形的危险性是干部的3倍多，职
业为农民的是干部的2倍多，职业为个体的与干部的无显著性
差异。结论：对具有或接触以上先天畸形危险因素的重点人群
应加强孕期保健，普及优生优育知识，调整饮食结构，孕期尽
量避免服一些不利于妊娠的中西药及接触化学制剂，还应保持
愉快的心情。所发现的危险因素值得今后深入研究，并可提供
优生学保健指导参考。
Objective: To investigate the incidence and the possible risk factors of congenital malformations in cities of Guangxi and provide basis for preventing congenital malformations and promoting birth quality. Methods: In 2000, 41539 perinatals were born in 62 hospitals of Nanning, Liuzhou, Guilin, Yulin, Wuzhou, Qinzhou and Beihai city, in which 513 cases of congenital malformations were diagnosed. A case-control study with 281 cases was carried out. Analysis of simple factor and multiple factors unconditional logistic regression was taken. Results: In all seven cities the total incidence of congenital malformations was 12.35%o, 13.32%o in male and 10.48%o in female with the sex ratio of 1.3 to 1.0 . The incidence of congenital malformations was higher in Wuzhou city and Yulin city, and lower in Beihai city. The incidence was 12.20%o in all city residents, and 11.55%o in villagers. But no significance was found between them. No significance was found either among the incidence of offspring from different matern
al age group. In all types of congenital malformations the number of Bart's syndrome was the most. The analysis of simple factor and multiple factors showed that main risk factors of congenital malformations included following: low birth-weight(OR=0.999), multiple pregnancy(OR=2.6), pregnancy complications (OR=3.2),
exposure to chemical substances before or during pregnancy(OR=3.0), taking sedatives(OR=10.2), hormone drug(OR=9.4) and Chinese herb medicine(OR=2.5) during the early stage of pregnancy,low content of hemoglobin(OR=0.985), fathers' exposure to noise(OR=5.7) or suffering from chronic diseases(OR=2.8). The risk of congenital malformations of offspring whose mothers' blood type was AB, A, B was respectively three times, two times, one time more than that of offspring whose mothers' blood type was type O. If mothers' emotion was nervous and melancholy, their offspring's risk was respectively two times, one time more than that of offspring whose mothers' emotion was pleasant. If mothers' occupation was workers and peasants , their offspring's risk was respectively three times, two times more than that of offspring whose mothers' occupation was staff,. No significance was found between staff and individual job. Conclusions: Enhancing pregnancy health care in high-risk group who having or exposing to above risk fac
tors. Propagating extensively the knowledge of eugenics. Adjusting food composition. Avoiding taking some traditional Chinese medicine and western medicine that are harmful to pregnancy. Avoiding of exposure to some chemical substances. Keeping pleasant feeling. Risk factors that we have discovered deserve further research and will provide guidance reference for eugenics.
毕业论义；广M七城市闲产儿冗天畸形危险冈素的拖例对照研究
职业为工人其后代发生先大畸形的危险性是干部的3倍多，职
业为农民的是干部的2倍多，职业为个体的与干部的无显著性
差异。结论：对具有或接触以上先天畸形危险因素的重点人群
应加强孕期保健，普及优生优育知识，调整饮食结构，孕期尽
量避免服一些不利于妊娠的中西药及接触化学制剂，还应保持
愉快的心情。所发现的危险因素值得今后深入研究，并可提供
优生学保健指导参考。
Objective: To investigate the incidence and the possible risk factors of congenital malformations in cities of Guangxi and provide basis for preventing congenital malformations and promoting birth quality. Methods: In 2000, 41539 perinatals were born in 62 hospitals of Nanning, Liuzhou, Guilin, Yulin, Wuzhou, Qinzhou and Beihai city, in which 513 cases of congenital malformations were diagnosed. A case-control study with 281 cases was carried out. Analysis of simple factor and multiple factors unconditional logistic regression was taken. Results: In all seven cities the total incidence of congenital malformations was 12.35%o, 13.32%o in male and 10.48%o in female with the sex ratio of 1.3 to 1.0 . The incidence of congenital malformations was higher in Wuzhou city and Yulin city, and lower in Beihai city. The incidence was 12.20%o in all city residents, and 11.55%o in villagers. But no significance was found between them. No significance was found either among the incidence of offspring from different matern
al age group. In all types of congenital malformations the number of Bart's syndrome was the most. The analysis of simple factor and multiple factors showed that main risk factors of congenital malformations included following: low birth-weight(OR=0.999), multiple pregnancy(OR=2.6), pregnancy complications (OR=3.2),
exposure to chemical substances before or during pregnancy(OR=3.0), taking sedatives(OR=10.2), hormone drug(OR=9.4) and Chinese herb medicine(OR=2.5) during the early stage of pregnancy,low content of hemoglobin(OR=0.985), fathers' exposure to noise(OR=5.7) or suffering from chronic diseases(OR=2.8). The risk of congenital malformations of offspring whose mothers' blood type was AB, A, B was respectively three times, two times, one time more than that of offspring whose mothers' blood type was type O. If mothers' emotion was nervous and melancholy, their offspring's risk was respectively two times, one time more than that of offspring whose mothers' emotion was pleasant. If mothers' occupation was workers and peasants , their offspring's risk was respectively three times, two times more than that of offspring whose mothers' occupation was staff,. No significance was found between staff and individual job. Conclusions: Enhancing pregnancy health care in high-risk group who having or exposing to above risk fac
tors. Propagating extensively the knowledge of eugenics. Adjusting food composition. Avoiding taking some traditional Chinese medicine and western medicine that are harmful to pregnancy. Avoiding of exposure to some chemical substances. Keeping pleasant feeling. Risk factors that we have discovered deserve further research and will provide guidance reference for eugenics.
引文
1．董兆文．预防遗传病的重要措施—优生咨询．大众优生，1999，43：12
2．耿贯一主编．流行病学，第二版．北京：人民卫生出版社．1984：115
3．安笑兰，钱宇平主编．出生缺陷监察，第一版．北京：人民卫生出版社．1984：17
4．张思霖，唐孝达，张思仲等．四川省遗传病及先天畸形流行病学调查研究．遗传与疾病，1990，7(3)：172-181
5．李国庆，田俊峰，胡秀芬等．神经管缺陷危险因素的探讨．中华预防医学杂志，1996，30(1)：17-19
6．刘雪玲，孙文霞．新生儿先天畸形291例分析．中国优生与遗传杂志，1999，7(6)：85-86
7．蔡旭报导．出生缺陷发生率农村高于城市．健康报，第一版，2000年11月3日
8．何祖国，姚宏．11451例围产儿出生缺陷的回顾分析．中国实用妇科和产科杂志，1996，12(1)：55
9．朱坤仪．出生缺陷儿209例临床分析．中华妇产科杂志，1991，26(6)：380
10．张波，张毓洪，李劣等．宁夏部分农村对婴幼儿先天畸形流行病学调查．中国公共卫生，1995，11(2)：63-64
11．刘敏，初清，李宁．33例围产儿神经管畸形临床分析．中国优生与遗传杂志，1996，4(4)：76
12. Melntosh GC, Olshan AK, Baird PA. Paternal age and the risk of birth defects in offspring. Epidemiology, 1995,6(3):282
13．赵小平，郭萍．4300例围产儿出生缺陷监测及预防对策研究．中国计划生育学杂志，1998，(4)：164
14．王兴玲，马葆靖，孙利环等．河南省出生缺陷监测研究．中国优生优育，1998，9(4)：164
15.Regemorter NV. Congenital malformations in 10000 consecutive birth in an university hospital:need for geneti counseling and penatal diagnosis. J pediatr, 1984,104(3):386
16.Orioli IM, Castilla EE. Thumb/hallux duplication and preaxial polydactyly type I. Am-J-Med-Gene, 1999,82(3):219-224
17.Rhoury MJ, Erickson JD. Recurrent pregnancy loss as an indicator for increased risk of birth defects: a population-based case-control study. Paediatrperinat Epidemiol, 1993,7(4):404
18．吴卫平，张莉莉，陈友梅等．妇女职业与子代先天畸形的关系．中华劳动卫生职业病杂志，1989，7(2)：68
19.Olshan AF, Teschke K, Bairal PA. Birth defects among offspring of firemen. AM-J-Epidemiol, 1990,131(2):312-321
20.Schnitzer PG, Olshan AF, Erickson JD. Paternal occupation and risk of birth defects in offspring. Epidemiology, 1995,6(6):577
21．陈树华，陈江，何力．福建省唇腭裂流行病学研究．中华口腔医学杂志，1998，33(1)：33
22．付豫川．化学致畸与先天性唇腭裂．国外医学口腔医学分册，1992，26(6)：386
23．沈启芳，张忠恕，方可娟等．药物及化学物与出生缺陷的病
例对照研究．生殖与避孕，1993，13(1)：49-55
24. Torfs CP, Katz EA, Bateson TF, et al. Maternal medications and environmental exposures as risk factors for gastroschisis. Teratology, 1996,54(2):84-92
25．于恩庶主编．弓形虫病学，第一版．福州：福建科学技术出版社，1992：102-103
26. Boppana SB, Pass RF, Bertt WT, et al. Symptomatic congenital cytomegalovirs infection:neonatal morbiolity and motality. Pediatr Infect Dis J, 1992,11:93
27．杨道南．先天畸形的病因分析及优生咨询．中国计划生育学杂志，1999，(11)：524
28．张晋起，刘永华，白华民等．包头市先天性出生缺陷危险因素的条件Logistic回归分析．中华预防医学杂志，1993，27(1)：29
29．张波，刘天锡，贾江云等．87例新生儿先天性畸形配比研究．中华流行病学杂志，1993，14(2)：92
30. Petridou E, Koussouri M, Toupadaki N, et al. Risk factors for cerebralpalsy:a case-control study in Greece. Scand-J-Soc-Med, 1996,24(1):14-26
31．王昆润．先天性唇腭裂的发生率取决于血型．国外医学口腔医学分册，1990，17(3)：193
32．王钢，李再南．广东省儿童先天性心脏病与ABO血型关系的探讨．数理医药杂志，1998，11(4)：351-352
33. Allan TM. ABO blood-group and ischemic heart disease in men. Brit Heart J, 1968,30:377
2．耿贯一主编．流行病学，第二版．北京：人民卫生出版社．1984：115
3．安笑兰，钱宇平主编．出生缺陷监察，第一版．北京：人民卫生出版社．1984：17
4．张思霖，唐孝达，张思仲等．四川省遗传病及先天畸形流行病学调查研究．遗传与疾病，1990，7(3)：172-181
5．李国庆，田俊峰，胡秀芬等．神经管缺陷危险因素的探讨．中华预防医学杂志，1996，30(1)：17-19
6．刘雪玲，孙文霞．新生儿先天畸形291例分析．中国优生与遗传杂志，1999，7(6)：85-86
7．蔡旭报导．出生缺陷发生率农村高于城市．健康报，第一版，2000年11月3日
8．何祖国，姚宏．11451例围产儿出生缺陷的回顾分析．中国实用妇科和产科杂志，1996，12(1)：55
9．朱坤仪．出生缺陷儿209例临床分析．中华妇产科杂志，1991，26(6)：380
10．张波，张毓洪，李劣等．宁夏部分农村对婴幼儿先天畸形流行病学调查．中国公共卫生，1995，11(2)：63-64
11．刘敏，初清，李宁．33例围产儿神经管畸形临床分析．中国优生与遗传杂志，1996，4(4)：76
12. Melntosh GC, Olshan AK, Baird PA. Paternal age and the risk of birth defects in offspring. Epidemiology, 1995,6(3):282
13．赵小平，郭萍．4300例围产儿出生缺陷监测及预防对策研究．中国计划生育学杂志，1998，(4)：164
14．王兴玲，马葆靖，孙利环等．河南省出生缺陷监测研究．中国优生优育，1998，9(4)：164
15.Regemorter NV. Congenital malformations in 10000 consecutive birth in an university hospital:need for geneti counseling and penatal diagnosis. J pediatr, 1984,104(3):386
16.Orioli IM, Castilla EE. Thumb/hallux duplication and preaxial polydactyly type I. Am-J-Med-Gene, 1999,82(3):219-224
17.Rhoury MJ, Erickson JD. Recurrent pregnancy loss as an indicator for increased risk of birth defects: a population-based case-control study. Paediatrperinat Epidemiol, 1993,7(4):404
18．吴卫平，张莉莉，陈友梅等．妇女职业与子代先天畸形的关系．中华劳动卫生职业病杂志，1989，7(2)：68
19.Olshan AF, Teschke K, Bairal PA. Birth defects among offspring of firemen. AM-J-Epidemiol, 1990,131(2):312-321
20.Schnitzer PG, Olshan AF, Erickson JD. Paternal occupation and risk of birth defects in offspring. Epidemiology, 1995,6(6):577
21．陈树华，陈江，何力．福建省唇腭裂流行病学研究．中华口腔医学杂志，1998，33(1)：33
22．付豫川．化学致畸与先天性唇腭裂．国外医学口腔医学分册，1992，26(6)：386
23．沈启芳，张忠恕，方可娟等．药物及化学物与出生缺陷的病
例对照研究．生殖与避孕，1993，13(1)：49-55
24. Torfs CP, Katz EA, Bateson TF, et al. Maternal medications and environmental exposures as risk factors for gastroschisis. Teratology, 1996,54(2):84-92
25．于恩庶主编．弓形虫病学，第一版．福州：福建科学技术出版社，1992：102-103
26. Boppana SB, Pass RF, Bertt WT, et al. Symptomatic congenital cytomegalovirs infection:neonatal morbiolity and motality. Pediatr Infect Dis J, 1992,11:93
27．杨道南．先天畸形的病因分析及优生咨询．中国计划生育学杂志，1999，(11)：524
28．张晋起，刘永华，白华民等．包头市先天性出生缺陷危险因素的条件Logistic回归分析．中华预防医学杂志，1993，27(1)：29
29．张波，刘天锡，贾江云等．87例新生儿先天性畸形配比研究．中华流行病学杂志，1993，14(2)：92
30. Petridou E, Koussouri M, Toupadaki N, et al. Risk factors for cerebralpalsy:a case-control study in Greece. Scand-J-Soc-Med, 1996,24(1):14-26
31．王昆润．先天性唇腭裂的发生率取决于血型．国外医学口腔医学分册，1990，17(3)：193
32．王钢，李再南．广东省儿童先天性心脏病与ABO血型关系的探讨．数理医药杂志，1998，11(4)：351-352
33. Allan TM. ABO blood-group and ischemic heart disease in men. Brit Heart J, 1968,30:377