基于病例对照和剂量反应关系的0~6岁儿童先天性心脏病影响因素

闫欢; 曹永文; 叶佳欣; 沈燕飞; 戈小洁; 杨娜; 刘倩倩; 吴杨昊天; 韩雪梅

doi:10.16462/j.cnki.zhjbkz.2021.05.012

基于病例对照和剂量反应关系的0~6岁儿童先天性心脏病影响因素

doi: 10.16462/j.cnki.zhjbkz.2021.05.012

1.
730000 兰州，兰州大学公共卫生学院社会医学与卫生事业管理研究所
2.
730000 兰州，甘肃省妇幼保健院计划财务部
3.
730000 兰州，甘肃省人民医院法律事务办公室

闫欢和曹永文为共同第一作者

基金项目:

甘肃省自然科学基金 18JR3RA054

甘肃省卫生行业科研计划项目 GSWSKY2017-43

详细信息

通讯作者:
韩雪梅，E-mail: xmhan@lzu.edu.cn

中图分类号: R174.6
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- 被引次数: 0
出版历程
- 收稿日期: 2020-07-16
- 修回日期: 2020-10-22
- 网络出版日期: 2021-06-16
- 刊出日期: 2021-05-10

Study on influencing factors of congenital heart disease in children aged 0-6 years based on case-control and dose-esponse relationship

1.
Institute of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou 730000, China
2.
Department of Planning Finance, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou 730000, China
3.
Legal Affairs Office of Gansu Provincial People's Hospital, Lanzhou 730000, China

YAN Huan and CAO Yong-wen contributed equally to this article

Funds:

Gansu Natural Science Foundation Project 18JR3RA054

Gansu Health Industry Scientific Research Plan Project GSWSKY2017-43

More Information

Corresponding author: HAN Xue-mei, E-mail: xmhan@lzu.edu.cn

摘要

摘要: 目的分析甘肃省0~6岁儿童先天性心脏病(congenital heart disease, CHD)的非遗传影响因素，为预防儿童CHD提出建议。方法采用分层等距抽样方法，在甘肃全省抽取并筛查5个区县0~6岁儿童29 566例。将从中筛查出的106名CHD患儿作为病例组并随机抽取同年龄、同性别、相同生活环境下的健康儿童318名，作为对照组进行1∶3病例对照匹配；应用Cox比例风险模型拟合Logistic回归分析模型分析儿童CHD的影响因素；应用限制性立方样条模型分析儿童出生体重与CHD患病的剂量反应关系。结果多因素分析结果表明：儿童出生体重、母亲文化程度、食用腌晒食品、药物流产史、孕前服用排卵药物、孕期食用鱼肉、经常体育锻炼与儿童CHD的患病风险均存在相关性(均有P＜0.05)。限制性立方样条反应分析结果显示：儿童出生体重与CHD患病的关联强度呈线性剂量—反应关系(总趋势P＜0.001，非线性P=0.246)。结论建议育龄妇女做好孕前检查，合理使用促排卵药物；孕期妇女要做好孕期保健和筛查，多食用鱼虾等海产品，不食用腌晒食品，适当进行体育锻炼，加强妇幼保健知识的学习降低儿童CHD的患病风险。
- 儿童 /
- 先天性心脏病 /
- 影响因素 /
- 病例对照研究 /
- 剂量反应关系
Abstract: Objective By analyzing the non-genetic factors of congenital heart disease (CHD) in children aged 0 to 6 years in Gansu Province, suggestions were put forward to prevent CHD in children. Methods We chose 29 566 children aged 0 to 6 from 5 districts and counties in Gansu Province from September to December 2016 by stratified isometric sampling method. We selected 106 children with CHD as the case group, and randomly selected 318 children of the same age, gender and living environment from healthy children as the control group for 1∶3 case-control matching. Then, we used logistic regression analysis method fitted by Cox proportional hazard model to analyze the influencing factors of CHD in children. At the same time, the dose-response relationship between birth weight and CHD disease in children was analyzed using a restrictive cubic spline model. Results Low birth weight (P= 0.028), low educational level of the mother (P=0.035), consumption of salted food (P=0.007), medical abortion history (P=0.001), ovulation medication before pregnancy (P < 0.001), consumption of fish during pregnancy (P=0.020) and appropriate physical exercise (P < 0.001) were related to the risk of CHD in children. The results of restrictive cubic spline response analysis showed a linear dose-response relationship between birth weight and congenital heart disease (overall trend P < 0.001, non-linear P=0.246). Conclusions It is suggested that women of childbearing age should take pre-pregnancy examination and rationally use ovulatory drugs. Pregnant women should pay attention to health care and screening during pregnancy, eat more fish, shrimp and other seafood, not eat salted and dried food, take physical exercise appropriately and strengthen the study of maternal and child health care knowledge to reduce the risk of congenital heart disease in children.
- Children /
- Congenital heart disease /
- Influencing factors /
- Case control study /
- Dose-response relationship

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图 1 儿童出生体重与CHD患病关联的限制性立方样条图

Figure 1. Restrictive cubic spline diagram of the association between birth weight and CHD disease in children

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图 2 男性儿童出生体重与CHD患病关联的限制性立方样条图

Figure 2. Restrictive cubic spline diagram of the association between birth weight and CHD disease in male children

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图 3 女性儿童出生体重与CHD患病关联的限制性立方样条图

Figure 3. Restrictive cubic spline diagram of the association between birth weight and CHD disease in female children

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表 1 病例组和对照组儿童和母亲基本情况[n(%)]

Table 1. Basic information of children and mothers in case group and control group [n(%)]

基本特征	病例组(n=106)	对照组(n=318)	t/χ²值	P值
儿童
性别			0.000	1.000
男	51(48.1)	153(48.1)
女	55(51.9)	165(51.9)
年龄(岁)			0.000	1.000
0~＜1	21(19.8)	63(19.8)
1~＜2	21(19.8)	63(19.8)
2~＜3	15(14.2)	45(14.2)
3~＜4	25(23.6)	75(23.6)
4~＜5	12(11.3)	36(11.3)
5~6	12(11.3)	36(11.3)
出生体重(kg)			6.180	0.045
＜2.50	16(15.1)	23(7.2)
2.50~4.00	88(83.0)	285(89.6)
＞4.00	2(1.9)	10(3.1)
母亲
文化程度			7.408	0.025
初中及以下	85(80.2)	248(78.0)
高中或中专或技校	20(18.9)	45(14.2)
大专及以上	1(0.9)	25(7.9)
职业			0.138	0.933
农民	94(88.7)	279(87.7)
家庭主妇	5(4.7)	18(5.7)
其他	7(6.6)	21(6.6)
月收入(元)			7.928	0.019
＜2 000	67(63.2)	151(47.5)
2 000~＜4 000	32(30.2)	140(44.0)
≥4 000	7(6.6)	27(8.5)
本次生育年龄(x±s), 岁)	26.35±5.57	26.94±4.73	-1.071	0.285
分娩孕周(x±s), 周)	39.30±1.63	39.24±1.14	0.416	0.677

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表 2 儿童CHD影响因素的单因素Logistic回归分析模型分析

Table 2. Single factor Logistic regression analysis of CHD influencing factors in children

变量	β值	s_x	Wald	OR(95% CI)值	P值
母亲文化程度
初中级以下				1.000
高中或中专	0.267	0.306	0.760	1.306(0.717~2.378)	0.383
大专及以上	-2.217	1.033	4.604	0.109(0.014~0.825)	0.032
母亲月收入(元)
＜2 000				1.000
2 000~＜4 000	-0.654	0.245	7.126	0.520(0.322~0.840)	0.008
≥4 000	-0.538	0.457	1.391	0.584(0.239~1.428)	0.238
新鲜蔬菜(斤/周)
从不吃				1.000
＜5	-0.576	0.498	1.336	0.562(0.212~1.493)	0.248
≥5	-1.192	0.545	4.790	0.304(0.104~0.883)	0.029
新鲜水果(斤/周)
从不吃				1.000
＜2.5	-0.555	0.591	0.880	0.574(0.108~1.829)	0.348
≥2.5	-1.241	0.626	3.927	0.289(0.085~0.987)	0.048
食用粗粮(500 g/周)
从不吃				1.000
＜1	-0.645	0.451	2.052	0.524(0.217~1.268)	0.152
≥1	-1.171	0.535	4.798	0.310(0.109~0.884)	0.028
食用鱼肉(50 g/周)
从不吃				1.000
≤7	-0.327	0.322	1.032	0.721(0.384~1.355)	0.310
＞7	-1.825	0.662	7.596	0.161(0.044~0.590)	0.006
腌晒食品
从不				1.000
有时	0.392	0.316	1.537	1.480(0.796~2.749)	0.215
经常	1.631	0.526	9.619	5.111(1.823~14.332)	0.002
饮水方式
纯净水				1.000
自来水	0.194	0.471	0.171	1.215(0.483~3.057)	0.680
井水	-0.159	0.570	0.077	0.853(0.279~2.607)	0.781
溪、河水	0.274	0.684	0.161	1.315(0.344~5.025)	0.689
沟塘湖水	1.934	0.985	3.856	6.920(1.004~47.726)	0.050
取暖方式
集中暖气				1.000
用电	0.197	0.792	0.073	1.218(1.098~4.329)	0.787
太阳能	-11.751	511.497	0.001	0.000(0.000~0.000)	0.982
烧煤	0.779	0.350	4.958	2.180(1.098~4.329)	0.026
燃料类型
天燃气				1.000
煤	0.935	0.630	2.201	2.547(0.741~8.761)	0.138
电磁炉	1.566	0.642	5.954	4.787(1.361~16.839)	0.015
柴	1.045	0.653	2.565	2.844(0.791~10.222)	0.109
其他	1.383	0.846	2.674	3.986(0.760~20.903)	0.102
被动吸烟
否				1.000
偶尔	0.247	0.267	0.857	1.281(0.759~2.162)	0.354
经常	1.292	0.408	10.050	3.641(1.638~8.096)	0.002
儿童出生体重(kg)	-1.016	0.235	18.761	0.362(0.229~0.573)	＜0.001
2.50~4.00				1.000
＜2.50	0.553	0.272	4.144	1.739(1.021~2.962)	0.042
＞4.00	-0.348	0.715	0.236	0.706(0.174~2.869)	0.627
月经初潮年龄(岁)	0.135	0.074	3.361	1.145(0.991~1.324)	0.067
人工流产史(是=0, 否=1)	0.970	0.507	3.653	2.637(0.976~7.130)	0.056
药物流产史(是=0, 否=1)	-1.946	0.690	7.952	0.143(0.037~0.552)	0.005
哺乳史(是=0, 否=1)	1.281	0.606	4.475	3.600(1.099~11.796)	0.034
经常体育锻炼(是=0, 否=1)	1.214	0.293	17.148	3.366(1.895~5.980)	＜0.001
婚前体检(是=0, 否=1)	0.426	0.237	3.230	1.531(0.962~2.438)	0.072
孕前服用排卵药物(是=0, 否=1)	-2.485	1.118	4.940	0.083(0.009~0.746)	0.026
孕期服用叶酸(是=0, 否=1)	0.584	0.228	6.590	1.794(1.148~2.802)	0.010
孕期先兆流产(是=0, 否=1)	-1.792	0.866	4.281	0.167(0.031~0.910)	0.039
严重早孕反应(是=0, 否=1)	-0.584	0.304	3.704	0.558(0.308~1.011)	0.054
妊娠合并症(是=0, 否=1)	-2.351	0.802	8.601	0.095(0.020~0.458)	0.003
母亲慢性呼吸系统疾病(是=0, 否=1)	-2.015	0.837	5.800	0.133(0.026~0.687)	0.016

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表 3 儿童CHD影响因素的多因素Logistic回归分析模型分析

Table 3. Multivariate Logistic regression analysis of CHD influencing factors in children

变量	β值	s _x	Wald	OR(95% CI)值	P值
母亲文化程度
大专及以上				1.000
初中级以下	1.892	1.010	3.508	6.635(0.667~3.753)	0.061
高中或中专	2.176	1.033	4.440	8.812(0.003~0.445)	0.035
儿童出生体重(kg)
2.50~4.00				1.000
＜2.50	0.616	0.279	4.859	1.851(1.071~3.201)	0.028
＞4.00	-0.378	0.720	0.275	0.685(0.176~2.810)	0.600
食用鱼肉(50 g/周)
从不吃				1.000
≤7	-0.098	0.269	0.132	0.907(00.536~1.536)	0.716
＞7	-1.461	0.629	5.386	0.232(0.068~0.797)	0.020
食用腌晒食品
从不				1.000
有时	0.337	0.294	1.316	1.401(0.787~2.493)	0.251
经常	1.081	0.403	7.195	2.949(1.338~6.498)	0.007
药物流产史(是=0, 否=1)	-1.350	0.407	10.986	0.259(0.117~0.576)	0.001
孕前服用排卵药物(是=0, 否=1)	-1.934	0.525	13.586	0.145(0.052~0.404)	＜0.001
经常体育锻炼(是=0, 否=1)	0.982	0.224	19.203	2.671(1.721~4.144)	＜0.001
注：模型采用逐步向前分析法，调整了母亲文化程度、儿童出生体重、食用鱼肉、食用腌晒食品、药物流产史、孕前服用排卵药物、经常体育锻炼。

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