青海省儿童先天性心脏病影响因素的调查研究

张书勤; 杨惠莲; 戚继荣

doi:10.16462/j.cnki.zhjbkz.2023.09.005

青海省儿童先天性心脏病影响因素的调查研究

doi: 10.16462/j.cnki.zhjbkz.2023.09.005

张书勤¹,
杨惠莲^2, ,,
戚继荣^{3, 4, ,}

1.
徐州医科大学附属宿迁医院，宿迁 223800
2.
青海大学医学部公共卫生系，西宁 810001
3.
青海大学附属医院心脏血管外科，西宁 810001
4.
南京医科大学附属儿童医院心胸外科，南京 211166

基金项目:

青海省卫生健康委员会重点课题 2021-wjzd-04

详细信息

通讯作者:
杨惠莲，E-mail: yanghuilian7005@163.com

戚继荣，E-mail: qjr7@163.com

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-18
- 修回日期: 2022-09-18
- 网络出版日期: 2023-10-12
- 刊出日期: 2023-09-10

Investigation of factors influencing congenital heart disease among children in Qinghai Province

ZHANG Shuqin¹,
YANG Huilian^{2
, ,},
QI Jirong^{3, 4
, ,}

1.
Suqian Hospital of Xuzhou Medical University, Suqian 223800, China
2.
Department of Public Health, Medical College, Qinghai University, Xining 810001, China
3.
Department of Cardiovascular Surgery, Affiliated Hospital of Qinghai University, Xining 810001, China
4.
Department of Cardiothoracic Surgery, Children′s Hospital of Nanjing Medical University, Nanjing 211166, China

Funds:

Qinghai Provincial Health Commission Key Projects 2021-wjzd-04

More Information

Corresponding author: YANG Huilian, E-mail: yanghuilian7005@163.com; QI Jirong, E-mail: qjr7@163.com

摘要

摘要: 目的分析青海省儿童先天性心脏病(congenital heart disease, CHD)的影响因素。方法采用病例对照研究，按性别和年龄相差＜1岁进行1∶2个体匹配，纳入315名＜6岁的儿童(病例组105名，对照组210名)，影响因素采用条件logistic回归分析模型分析。结果单因素条件logistic回归分析模型筛选出14个差异均有统计学意义的CHD影响因素(均P<0.001)，包括居住地海拔、民族、出生体重、母亲文化程度、家庭收入、孕期接受宣教、首次妊娠、孕期补充维生素、孕期主要饮用水、孕期食用蔬菜水果、孕期食用油炸腌制品、孕期体育锻炼、孕期饲养动物、孕期定期体检；多因素条件logistic回归分析模型分析筛选出6个有统计学意义的CHD影响因素，包括海拔>2 500 m(OR=4.84, 95% CI: 1.17~20.08, P=0.030)、出生体重≥2.5 kg(OR=0.10, 95% CI: 0.01~0.81, P=0.031)、母亲有大学及以上文化程度(OR=0.23, 95% CI: 0.07~0.76, P=0.016)、家庭人均月收入>1 500元(OR=0.03, 95% CI: 0.01~0.21, P=0.001)、孕期补充维生素(OR=0.06, 95% CI: 0.01~0.40, P=0.004)、孕期饮用纯净水(OR=0.05, 95% CI: 0.01~0.35, P=0.003)。结论与低海拔地区相比，居住在高海拔地区发生CHD的危险会高出4.84倍。家庭收入、母亲文化程度、母亲孕期生活方式与CHD的发生可能有关。
- 先天性心脏病 /
- 危险因素 /
- 儿童 /
- 流行病学研究
Abstract: Objective This study aimed to analyze the factors influencing congenital heart disease (CHD) in children within Qinghai Province. Methods A 1∶2 sex- and age-matched (age difference less than 1 year) case-control study was employed, incorporating 315 children under 6 years (105 in the case group, 210 in the control group). Conditional logistic regression models were utilized to analyze influencing factors. Results Univariate conditional logistic regression model identified 14 significant factors (P<0.001) influencing congenital heart disease, including altitude of residence, ethnicity, birth weight, maternal education, family income, receiving missionary education during pregnancy, first pregnancy, vitamin supplementation during pregnancy, main drinking water during pregnancy, consumption of vegetables and fruits during pregnancy, consumption of fried foods during pregnancy, have physical exercise during pregnancy, keeping animals during pregnancy, and regular medical checkups during pregnancy. Multivariate conditional logistic regression identified six significant factors, including altitude >2500 m (OR=4.84, 95% CI: 1.17-20.08, P=0.030), birth weight ≥2.5 kg (OR=0.10, 95% CI: 0.01-0.81, P=0.031), maternal education level of university or above (OR=0.23, 95% CI: 0.07-0.76, P=0.016), monthly per capita household income >1 500 yuan (OR=0.03, 95% CI: 0.01-0.21, P=0.001), vitamin supplementation during pregnancy (OR=0.06, 95% CI: 0.01-0.40, P=0.004), and consumption of purified water during pregnancy (OR=0.05, 95% CI: 0.01-0.35, P=0.003). Conclusions The risk of CHD was found to be 4.84 times higher in high-altitude residences compared to low-altitude ones. Furthermore, family income, maternal education, and maternal lifestyle during pregnancy may be linked with the occurrence of CHD.
- Congenital heart disease /
- Risk factors /
- Children /
- Epidemiological studies

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表 1 儿童先天性心脏病基线水平的比较

Table 1. Comparison of baseline levels of congenital heart disease in children

变量Variable	病例组^① Case group ^① (n=105)	对照组^① Control group ^① (n=210)	χ²值 value	P值 value
性别Sex			0.001	1.000
男性Male	48(45.71)	96(45.71)
女性Female	57(54.29)	114(54.29)
年龄组/岁Age group/years			1.400	1.920
＜1	29(27.62)	63(30.00)
1~＜2	10(9.52)	15(7.14)
2~＜3	6(5.71)	15(7.14)
3~＜4	15(14.29)	24(11.43)
4~＜5	13(12.38)	23(10.95)
5~6	33(31.43)	70(33.33)
注：①以[人数(占比/%)]表示。 Note: ① [Number of people (proportion/%)].

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表 2 儿童先天性心脏病影响因素的单因素条件logistic回归分析模型

Table 2. Univariate conditional logistic regression analysis of influencing factors of congenital heart disease in children

变量Variable	病例组^⑤ Case group ^⑤(n=105)	对照组^⑤ Control group ^⑤(n=210)	χ²值 value	OR值value (95% CI)	P值 value
居住地海拔/m Altitude of residence /m
2 230~2 500	42(40.00)	181(86.19)		1.00
>2 500	63(60.00)	29(13.81)	43.93	4.86(2.92~8.09)	<0.001
民族Nationality
汉族Han	33(31.43)	157(74.76)		1.00
少数民族Minority	72(68.57)	53(25.24)	54.92	6.46(3.8~10.83)	<0.001
出生体重/kg ^① Birth weight/kg ^①
<2.5	17(20.98)	9(4.37)	1.00
≥2.5	64(79.02)	197(95.63)	19.49	0.17(0.07~0.40)	<0.001
出生胎龄/周Gestational age/week
早产或过期产Premature or postterm delivery	7(6.67)	13(6.19)	1.00
足月Full-term delivery	98(93.33)	197(93.81)	0.03	0.92(0.36~2.39)	0.870
母亲文化程度Mother′s education
高中及以下High school and below	84(80.00)	46(21.90)		1.00
大学及以上University and above	21(20.00)	164(78.10)	97.47	0.07(0.04~0.13)	<0.001
家庭月均收入/元Average monthly household income/yuan
<1 500	60(57.14)	43(20.48)		1.00
≥1 500	45(42.86)	167(79.52)	42.76	0.19(0.12~0.32)	<0.001
母亲孕期接受宣教Pregnant mothers receive fertility education during pregnancy
无No	81(77.14)	83(39.52)		1.00
有Yes	24(22.86)	127(60.48)	39.69	0.19(0.11~0.33)	<0.001
首次妊娠First pregnancy
否No	65(61.90)	86(40.95)		1.00
是Yes	40(38.10)	124(59.05)	12.31	0.43(0.26~0.69)	<0.001
孕期补充维生素Vitamin supplements during pregnancy
否No	34(32.38)	11(5.24)		1.00
是Yes	71(67.62)	199(94.7)	42.12	0.12(0.06~0.24)	<0.001
孕期生病Sickness during pregnancy
无No	71(67.62)	154(73.33)		1.00
有Yes	34(32.38)	56(26.67)	1.12	1.32(0.79~2.19)	0.290
孕期服药Taking medication during pregnancy
无No	90(85.71)	186(88.57)		1.00
有Yes	15(14.29)	24(11.43)	0.53	1.25(0.69~2.28)	0.470
孕期居室(办公室)装修Decoration of the living room (office) during pregnancy
无No	100(95.23)	199(94.76)		1.00
有Yes	5(4.77)	11(5.24)	0.03	0.91(0.32~2.55)	0.860
孕期主要饮用水Main drinking water during pregnancy
纯净水Purified water	11(10.48)	112(53.33)	45.81	0.23(0.13~0.40)	<0.001
自来水Piped water	79(75.24)	94(44.76)		1.00
湖、井水Lake or well water	15(14.28)	4(1.91)	7.59	3.91(1.35~11.5)	0.006
孕期食用蛋肉鱼水产品、牛奶及豆制品^② Consumption of eggs, meat, fish and fish products, milk and soy products during pregnancy ^②
偶尔Occasionally	31(29.52)	27(12.86)	5.81	1.61(1.09~2.38)	0.016
间常Occasionally and often	26(24.76)	53(25.24)		1.00
经常Often	48(45.72)	130(61.90)	0.94	0.91(0.75~1.11)	0.330
孕期食用蔬菜、水果^② Consumption of vegetables and fruits during pregnancy ^②
偶尔Occasionally	18(17.14)	6(2.86)	2.23	1.70(0.80~3.62)	0.140
间常Occasionally and often	19(18.10)	15(7.14)		1.00
经常Often	68(64.76)	189(90.00)	12.40	0.84(0.75~0.95)	<0.001
孕期食用油炸、腌制品^② Consumption of fried and pickled products during pregnancy ^②
偶尔Occasionally	63(60.00)	164(78.10)	14.65	0.81(0.71~0.92)	<0.001
间常Occasionally and often	22(20.95)	15(7.14)		1.00
经常Often	20(19.05)	31(14.76)	3.52	0.71(0.49~1.03)	0.061
孕期被动吸烟^③ Passive smoking during pregnancy
无No	56(53.33)	104(49.52)		1.00
有Yes	49(46.67)	106(50.48)	0.41	1.08(0.86~1.35)	0.524
孕期适当体育锻炼Appropriate physical activity during pregnancy
无No	77(73.33)	110(52.38)		1.00
有Yes	28(26.67)	100(47.62)	12.74	0.56(0.40~0.79)	<0.001
孕期饲养动物Keeping animals during pregnancy
无No	71(67.62)	193(91.90)		1.00
有Yes	34(32.38)	17(8.10)	30.43	4.00(2.35~6.82)	<0.001
孕早期情绪Emotions in early pregnancy
愉快Happy	33(31.42)	99(47.14)	6.77	0.68(0.50~0.93)	0.009
一般General	63(60.00)	97(46.19)		1.00
不愉快Unhappy	9(8.58)	14(6.67)	0	0.99(0.4~2.17)	0.982
孕早期性生活Sex during early pregnancy
无No	90(85.71)	177(84.29)		1.00
有Yes	15(14.29)	33(15.71)	0.11	1.02(0.92~1.12)	0.739
孕期定期产检Regular maternity check-ups during pregnancy
无No	38(36.19)	28(13.33)		1.00
有Yes	67(63.81)	182(86.67)	23.27	2.82(1.82~4.35)	<0.001
父亲吸烟Father smoking
否No	52(49.52)	125(59.52)		1.00
是Yes	53(50.48)	85(40.48)	2.84	0.83(0.67~1.04)	0.092
父亲饮酒Father Drinking
否No	64(60.95)	144(68.57)		1.00
是Yes	41(39.05)	66(31.43)	1.81	0.89(0.74~1.06)	0.178
母亲性格自我评价Self-assessment of mother′s character
内向Introversion	49(46.67)	92(43.81)		1.00
外向Extraversion	56(53.33)	118(56.19)	0.23	0.95(0.77~1.18)	0.631
母亲孕期情绪Mothers′ moods during pregnancy
稳定Steadiness	79(75.24)	170(80.95)		1.00
不稳定Unsteadiness	26(24.76)	40(19.05)	1.38	1.30(0.84~2.01)	0.240
母亲孕期经历负性事件^④ Experiencing negative events during pregnancy ^④
无No	86(81.90)	169(80.48)		1.00
有Yes	19(18.10)	41(19.52)	0.09	1.02(0.91~1.14)	0.761
注：①数据有缺失。②使用频次分为偶尔(0~＜3次/月)，间常(3次/周)，经常(≥4次/周)。③是指被调查者在1周内有≥1 d的时间处于被动吸烟的环境，每天吸入烟雾≥15 min。④孕妇生活事件量表。⑤以[人数(占比/%)]表示。 Note: ①There are data gaps. ②Frequency of use is categorized as occasional (0~<3 times/month), intermittent (3 times/week), frequent (≥4 times/week). ③It was defined as the respondent being in a passive smoking environment for ≥1 d in a 1-week period and inhaling smoke for ≥15 min per day. ④ Maternal Life Events Scale. ⑤[Number of people (proportion/%)].

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表 3 儿童先天性心脏病影响因素的多因素条件logistic回归模型分析

Table 3. Multivariate conditional logistic regression of influencing factors of congenital heart disease in children

变量Variable	χ²值 value	OR值value (95% CI)	P值 value
居住地海拔/m Altitude of residence /m
2 230~2 500		1.00
>2 500	6.50	6.74(1.55~29.18)	0.011
出生体重/kg Birth weight/kg
<2.5		1.00
≥2.5	4.68	0.10(0.01~0.81)	0.031
母亲文化程度Mother′s education
高中及以下High school and below		1.00
大学及以上University and above	5.80	0.23(0.07~0.76)	0.016
家庭月均收入/元Average monthly household income/yuan
<1 500		1.00
≥1 500	12.07	0.03(0.01~0.21)	0.001
孕期补充维生素Vitamin supplements during pregnancy
否No		1.00
是Yes	8.41	0.06(0.01~0.40)	0.004
孕期主要饮用水Main drinking water during pregnancy
纯净水Purified water		1.00
自来水Piped water	8.70	0.05(0.01~0.35)	0.003

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参考文献(20)

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青海省儿童先天性心脏病影响因素的调查研究

doi: 10.16462/j.cnki.zhjbkz.2023.09.005

通讯作者:
杨惠莲，E-mail: yanghuilian7005@163.com

戚继荣，E-mail: qjr7@163.com

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Investigation of factors influencing congenital heart disease among children in Qinghai Province

Corresponding author: YANG Huilian, E-mail: yanghuilian7005@163.com; QI Jirong, E-mail: qjr7@163.com

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青海省儿童先天性心脏病影响因素的调查研究

doi: 10.16462/j.cnki.zhjbkz.2023.09.005

通讯作者: 杨惠莲，E-mail: yanghuilian7005@163.com 戚继荣，E-mail: qjr7@163.com

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Investigation of factors influencing congenital heart disease among children in Qinghai Province

Corresponding author: YANG Huilian, E-mail: yanghuilian7005@163.com; QI Jirong, E-mail: qjr7@163.com

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出版历程

目录

通讯作者:
杨惠莲，E-mail: yanghuilian7005@163.com

戚继荣，E-mail: qjr7@163.com