【作者】 卫英；

【导师】 有风芝；

【作者基本信息】 郑州大学 ， 儿少卫生与妇幼保健学， 2012， 硕士

【摘要】 研究背景：先天性心脏病(congenital heart disease,CHD)简称先心病,是最常见的出生缺陷,在各种出生缺陷中占首位,是一种严重危害婴幼儿健康的先天畸形。是导致婴幼儿和儿童死亡的主要原因,给个人、家庭和社会造成了严重的经济、精神和医疗负担。国内外很多文献报道了CHD的风险因素,但CHD的病因不明确,其发生是基因、染色体异常和环境致畸物等相互作用相互影响的结果。近年来,随着分子生物学技术的飞速发展,先心病在遗传方面取得了很大进展,因此国内外学者开始给予环境因素更多的关注。心脏形成开始于胚胎期第2周,约于第4周起循环作用,至第8周房室间隔完全形成,所以胚胎心脏发育的关键期是在第2-8周,即怀孕后前3个月是胎儿心脏发育的关键时期,也是CHD形成的风险时期,因此,在怀孕后前3个月内这段敏感期,孕妇暴露于不良环境因素,胎儿可能出现心血管畸形。研究目的：探讨孕妇怀孕前3个月及怀孕后前3个月环境因素暴露与胎儿先天性心脏病的关系,为预防和控制胎儿先天性心脏病的发生提供科学依据。对象与方法：采用1：1配对病例对照研究设计,在郑州大学第三附属医院选择超声心动图诊断为胎儿先天性心脏病的孕妇,进行面对面问卷访谈,填写孕前及孕期环境因素暴露情况调查问卷,并在门诊选择年龄相差不超过1岁、孕周相差不超过1周胎儿超声心动图正常的孕妇作为对照。采用问卷调查法：问卷内容包括：一般情况(年龄、文化程度、民族、居住地、家庭经济收入、职业、孕妇孕前及调查日体重、调查日时孕周等)、孕前3个月及怀孕后前3个月内的生活工作环境危险因素暴露(是否嘈杂、房子是否装修、是否接触电子产品、是否吸烟喝酒、是否存在农药、有机物、重金属暴露)、孕产史、疾病史及服药史(孕早期服药史、异常生育史、孕早期感冒史、孕早期先兆流产史、)、孕前3个月及怀孕后前3个月内营养饮食状况(各种食物、叶酸及多种维生素的补充)、孕早期的精神状态(是否紧张、烦躁、抑郁)及负性生活事件(夫妻感情不好、重要亲人病重或死亡、生活压力大)等。调查共收回有效问卷160份,其中病例80份,对照80份。应用统计描述方法分析一般情况,采用x2检验、单因素和多因素Logistic回归分析方法探讨孕前3个月及孕后前3个月环境危险因素与胎儿先天性心脏病发生的关系。首先对33个可疑危险因素进行单因素分析,然后将单因素分析有统计学意义的变量和统计学无意义但专业上有意义的变量均纳入多因素模型的拟合。所有资料均采用EpiDate3.1软件录入,使用SPSS16.0进行统计分析。结果：1.病例组与对照组孕妇年龄分别为27.59±4.58岁、27.72±4.47岁,P值为0.848；差异无统计学意义(P>0.05)。2.病例组和对照组在民族、文化程度、经济收入、居住地差异无统计学意义(P>0.05),提示两组资料的均衡性较好,有较好的可比性。3.单因素Logistic回归分析表明怀孕后前3个月内孕妇接触噪音、其配偶孕前3个月饮酒、孕妇孕前半年宠物接触史、异常孕产史、孕后前3个月感冒、孕早期经历重大生活负性事件是胎儿CHD的危险因素,而母亲孕前及孕早期经常食用牛奶、肉类,及时补充叶酸和多种维生素是胎儿CHD的保护因素。4.多因素Logistic回归分析表明：孕后前3个月内孕妇接触噪音(AOR=7.57)、孕期负性生活事件(AOR=6.15)、异常孕产史(AOR=8.40)、孕早期感冒(AOR=8.84)可增加胎儿患CHD的风险性,而孕早期补充叶酸及多种维生素(AOR=0.13)及经常食用各种肉类(AOR=0.48)可减少胎儿CHD的风险。结论：1.孕期接触噪音、经历负性生活事件、异常孕产史、孕早期感冒可能是CHD发生的危险因素,而孕早期补充叶酸及多种维生素、经常食用各种肉类可能是CHD的保护因素。2.减少或控制孕妇生活工作中有害环境因素的暴露,对预防和降低胎儿先天性心脏病的发生有重要意义。更多还原

【Abstract】 Background:Congenital Heart Disease(CHD)is the most common birth defects,topped the list in a variety of birth defects,congenital malformations of a serious hazard to the health of infants and young children,cause of death of infanta and children,causing serious economic、 spiritual and medical burden to individuals、families and society. Many domestic and foreign literature of CHD risk factors but the cause of CHD is not clear.its occurrence is the result of interaction of genes、 chromosomal abnormalities and environmental. In recent years, with the rapid development of molecular biology techniques, congenital heart disease in the genetic aspects of great progress, scholars began to give environmental factors greater attention. Heart formation began in the first two weeks of the embryonic period, about four weeks from the circulation effect,up to eight weeks septal fully formed.So the critical period of embryonic heart development in the first2-8weeks after pregnancy3months is a cirtical period of fetal heart development. CHD risk period of the formation of the first threes pregnant during this sensitive period,pregnant woment exposed to adverse environmental factors and fetal cardiovascular malformations. Objective:Explore the3months prior to pregnancy of the pregnant women and pregnancy in the first3months after the environmental factors for exposure and fetal congenital heart disease and provide a scientific basis prevention and control of fetal congenital heart disease.Subjects and Methods:We used1:1matched case-control stydy design, Echocar-diographic diagnosis of fetal congental heart disease pregnant women in the Third Affiliated Hospital of ZhengZhou University face-to face questionnaire interviews fill out the pre-pregnancy and pregnancy environmental factors exposure questionnaire and in out patient select the age difference of no more than1year of age,the gestational age difference of not not more than1weeks of fetal echocardiography and normal pregnant women served as controls.Questionnaire:The questionnaire included:general(age. education level ethnicity、 residence、 family income、 occupation、 pregnant women before pregnancy and investigation of body weight、 the survey date when gestational age,etc.)3months before pregnancy and pregnancy risk factor for exposure with in the first3months living and working environment (noisy、 whether the decoration of the house、 whethe access to electronic products、 smoking and alcohol consumption、 if there are pesticides、 organic matter、 heavy metal exposure),pregnancy history,medical history and medication history(first trimester medication history、 abnormal reproductive history、 history of the cold of early pregnancy、 first trimester threatened abortion history),3months before pregnancy and after pregnancy nutrition food situation in the first three months(all kinds of food、 folic acid and multivitamins supplementary),the mental state of early pregnancy(whether the tension、 irritability、 depression)and negative life events(marital relations is not good、 serious illness or death of important relative、 life stress).Survey were recovered160valid questionnaires of which80were cases of control80copies.Describe the method of application of statistical analysis in general,using the2test, univariate and multivariate regression analysis to explore3 months before pregnancy and after pregnancy,the relationship of the first3months of environmental risk facrors for fetal congenital heart disease.First,univariate analysis of33supected risk factors,when the univariate analysis,statistically significant variables and statistically meaningless but meaningful professional variables in cluded in the multivariate model fitting.All information3.1Software entry use16.0for statistical analysis.Results:1. A case group and control group of pregnant aged27.59±4.58years,27.72±4.47years old P-value is0.848.Difference is statistically significant difference(P>0.05).2. The ethnicity、 education level、 income、 residences of tow cases and control groups is statistically significant(P>0.05),indicating that material balance of tow groups is good and have good comparability.3. Single factor logistic regression results showed that pregnancy within the first3months after prenatal exposure to noise、 their spouses3months before pregnancy drinking a history of exposure to maternal pre-pregnancy for six months pet、 abnormal pregnancy history、 the first3months pregnant after a cold、 early pregnancy experienced a major life negative events fetus for3CHD risk factors,while the mother before pregnancy and during early pregnancy regular consumption of milk、 meat and replenish the folic acid and multivitamins fetal proactive factors for CHD.4. Muitivariate logistic regression analysis showed that; the first3months after pregnancy prenatal exposure to noise(AOR=7.57)/pregnancy negative life events (AOR=6.15)、 abnormal pregnancy history(AOR=8.40)、 early pregnancy flu(AOR=8.84) increased fetal risk of CHD risk.however,supplementing folic acid and vitamins(AOR=0.13)in the early pregnancy and often using all kinds of meat (AOR=0.48)can reduce the risk of fetus CHDConclusion:1. Noise exposure during pregnancy、 experienced negative life events、abnaomal prenancu history、 early pregnancy flu may be risk factors for CHD; in early pregnancy folic acid supplements and vitamins、 regular consumption of a variety of meat may be the protection factors of CHD.2. Reduce or control exposure to harmful environmental factors in pregnant women living and working on the Prevention and Reduction of fetal congenital heart disease occur.更多还原