【作者】 杨振华；

【导师】 陈亚琼；

【作者基本信息】 河北医科大学 ， 妇产科学， 2008， 硕士

【摘要】 目的:调查导致稽留流产及血铅水平升高的相关因素,分析血铅水平与稽留流产之间的关系,寻找天津市大气铅浓度与稽留流产之间的相关趋势。方法:本研究分为以医院为基础的病例对照研究和以社区为基础的病例对照研究两部分。以医院为基础的病例对照研究:于2006年11月至2007年11月从天津市武警医院的门诊就诊病例中,通过配对研究的方法按照纳入标准随机选取94名稽留流产患者,及94名正常孕妇作为对照,对她们进行问卷调查并抽血检测血铅(检测血铅方法采用石墨炉原子吸收光谱法),将孕妇调查问卷内容及血铅值进行统计学分析寻找导致血铅升高和稽留流产的相关因素。以社区为基础的病例对照研究:从2001～2006年天津市城区15家社区医院门诊就诊病例中按纳入标准随机选取稽留流产患者2658例及配对的正常孕妇2658例,根据孕妇个人资料结合天津市2001～2006年天津市大气铅水平,分析大气铅水平与稽留流产的关系。数据分析采用SPSS 10.0软件。结果:一、血铅与稽留流产关系:以医院为基础的病例对照研究显示孕妇的血铅水平升高与其稽留流产明显相关,稽留流产组、对照组孕妇血铅水平分别为( x±s)87.17±28.98μg/L,59.51±13.63μg/L,P<0.05,有统计学差异。二、影响孕妇血铅的相关因素:单因素分析与孕妇血铅水平升高有关的因素为孕妇职业铅暴露、学历、孕期接触毒物、家庭燃料、平均每日交通时间、家距马路距离、孕前及孕期补钙情况、补维生素情况、吸烟(包括被动吸烟、主动吸烟)。将上述影响因素进行多元线性回归分析,影响因素为孕前孕期补充叶酸等维生素、家距马路距离、孕前孕期补充钙,B值分别为-18.445,-16.303,-9.700。三、影响稽留流产的相关因素:单因素分析与孕妇稽留流产有关的因素为孕妇及丈夫职业铅暴露、孕妇学历、孕期孕妇及丈夫接触毒物、孕妇平均每日交通时间、近期装潢史、家距马路距离、吸烟(包括被动吸烟、主动吸烟)、家庭燃料、孕前及孕期补钙情况、补维生素情况。将上述影响因素进行logistic回归分析,按影响程度影响因素依次为近期装潢史、孕妇职业铅暴露、孕期补充维生素、丈夫的毒物接触、家距马路距离等五个因素,其影响系数B值分别为为1.598,1.411,-1.391,1.271,-1.098,其中近期装潢史、孕妇的职业铅暴露、丈夫的毒物接触史均为危险性因素,孕前孕期补充维生素、家距马路距离大于60米为保护性因素。三、天津市大气铅与稽留流产:以社区为基础的病例对照研究显示天津市城区2001-2006年六站环境监测数据大气中铅颗粒呈现先上升后下降的趋势,X2 =12.463,P<0.05。两两比较结果2001、2002、2005、2006年度无差别,并且明显低于2003、2004年。与之相应天津城区2001-2006年的门诊稽留流产百分比2005年最低,2003年最高,分别为42.3%,55.9%(X~2 =47.183,P<0.01)。分析天津市2001-2006年城区六站点1、7月份的大气铅资料显示7月份大气铅浓度明显低于1月份,t=2.342,P<0.05,有统计学差异,大气铅水平分别为0.345±0.182μg/M3、0.553±0.488μg /M~3。而2005年10月-2006年9月各月份稽留流产百分比9月最低为34.1%,11月、3月最高为64.9%,61.3%,存在明显差别(X~2=29.412, P<0.01),卡方分割显示:5、7、8、9、2、10月份稽留流产百分比无明显差异并低于1、3、4、6、12、11月份。提示各年度大气中铅污染程度与该年度稽留流产情况呈一致性趋势,年度内季节性的大气中铅浓度与稽留流产情况也呈相似趋势。结论:孕妇血铅水平的升高与稽留流产相关,导致血铅升高及稽留流产的保护性因素为孕前孕期补充叶酸等维生素及家距马路距离大于60米。并发现稽留流产发生的百分比与大气中的铅浓度相关。更多还原

【Abstract】 Objective: To investigate the correlative factors resulting in missed abortion and the rising of pregnant woman’s Bpb(blood pb),analyze the relationship between Bpb and missed abortion,seek the tendency between air pb pollution and missed abortion by using air pb data of Tianjin.Methods: This study is divided into two parts: case-control study based on hospital and case-control study based on community. At first, a comparative analysis on 94 abnormal pregnant cases and 94 normal counterparts in Tianjin Armed Police Hospital and DongLi Women and Children Health-care Hospital from December 2006 to November 2007 is carried out by using paired study method. A questionnaire is done and 3 ml blood of each pregnant woman in all the cases is collected for Bpb detection by means of Graphite stove atomic absorption spectrophotomete.Seeked the effective factors of rising Bpb and missed abortion by statistic analysizing.Secondly, the effect of air pb pollution on pregnant outcome is analyzed based on the 2658cases of normal pregnancy and missed abortion respectively in early pregnancy in 15 community hospitals from 2001 to 2006 and air pb pollution data obtained from six air pollution monitor stations in Tianjin at the same time. All the Data are analyzed by SPSS 10.0 software.Results: Firstly,The relationship between Bpb level and missed abortion.the case-control study based on hospital shows that missed abortion in early pregnancy is correlated with the level of Bbp, and the Bbp level of normal pregnancy and missed abortion is 59.51±13.63μg/L,87.17±28.98μg/L respectively,P<0.05. The Bbp level of recurrent missed abortion is 87.17±21.38μg/L which is obviously higher than the normal group, and is similar to abnormal pregnancy group (no statistic significance), which shows that high Bbp level maybe one con-effect etiology factor. The effective factors concerning pregnant women’s high Bpb level are career, education, poison contacting during pregnancy, family fuel, time spending on traffic everyday, the distance from house toroad, supplement of Ca and Vit pregnancy or preceding and ETS ( Exposure to environmental tobacco smoke in pregnancy).Bring all these factors into liner regression equation. We find zhe main effective factors are supplement of Vit pregnancy,the distance from house toroad, supplement of Vit Ca pregnancy the value of B is -18.445,-16.303,-9.700.Secondly, the effective factors resulting in missed abortion. The effective factors resulting in abnormal pregnancy are career, husbands’career,education, poison contacting during pregnancy and poison contacting of the husband, family fuel, time spending on traffic everyday,recent indoor decoration, distanc from house to road, supplement of Ca and Vit pregn- ancy or preceding and ETS. Bring all these factors into Logistic regression equation. It is found that factors affecting pregnancy outcome in terms of seriousness are as follows: recent indoor decoration , vocational exposure of pregnant woman , supplement of Vit pregnancy, husband’s poison contacting, distance from home toroad, and the effect index B are 1.589,1.411,-1.391,1.271,-1.098,respectively,and the risk factors are recent indoor decoration, husband’s poison contacting , vocational exposure of pregnant woman,the proect factor are supplement of Vit pregnancy, distance from home to road.Thirdly, relationship between air pb level and missed abortion.It is showed that from 2001 to 2006 lead particles in air in downtown Tianjin rising firstly and falling lately in the retrospective cohort study: X2=12.463,P=0.02<0.05. Compared variables each other ,the level of pb in the year of 2001,2002, 2005,2006 is obviously lower than that in the year of 2003 and 2004. Accordingly, the constitutive rate of missed abortion in early pregnancy in 2005 is obviously lower than that in 2003 The rate of missed abortion is 42.3%,55.9%,(X2 =47.183 ,P<0.01). It is also observed that the level of air pb in July is obviously lower than that in January based on the air data in Tianjin, t=2.342, P<0.05. The level of air pb is 0.345±0.182μg/M3,0.553±0.488μg/M3 respectively. The rate of missed abortion shows a parallel tendency that the highest point appears in December and March, the lowest point lies in September. The rate is 64.9%,61.3%, and 34.1% respectively(X2=29.412, P<0.01). Compared variables each other, the rate in May, July, Aμgust, September, February, October are lower than that in January, March, April, June, November, and December. And the rate of missed abortion and air pb level in winter and spring are obviously higher than that in summer and autumn yearly.Conclusion: Pregnant women’s high level Bpb is correlated with missed abortion. The protected factors of rising Pregnant women’s Bpb and missed abortion are supplement of Vit pregnancy and distance from home to road exceed 60M, and we find that the precent of missed abortion is correlated with air pb level.更多还原