山西省神经管缺损高发区危险因素病例对照研究
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摘要
目的：分析山西省神经管缺损(以下简称NTDs)高发的危险因素，为制定预防措施提供依据。
方法：以2001年3月到2002年1月间在山西省27个NTDs高发县中分娩NTDs儿的152例产妇作为病例组，选择同期分娩正常儿的152例产妇作为对照组进行NTDs危险因素的病例对照研究。对七类32项因素逐一进行logistic单因素分析(α=0.05)。将单因素分析有意义的因素引入多因素logistic回归模型分析，并对引入方程的可分级因素用趋势x~2检验进行线形回归分析。
结果：将单变量引入logistic回归模型，在α-0.05水平上有意义的保护因素有文化程度高、经常摄入新鲜蔬菜、水果。有意义的危险因素：直系亲属分娩出生缺陷儿、孕次、产次、发热、出疹性疾病、妊娠巨吐、先兆流产、贫血、农药、化肥、噪声、磺胺类药物、抗生素、避孕药、止吐药、发芽土豆、丈夫吸烟，P＜0.05。将单因素分析有意义的因素引入logistic多元回归模型，在α=0.05水平引入回归方程的因素为发热、出疹性疾病、农药、经常摄入新鲜蔬菜和丈夫吸烟，OR分别为7.251，7.840，5.952，0.370，2.209。可分级因素经常摄入新鲜蔬菜和丈夫吸烟
山西医科大学
硕士学位论文
经趋势xZ检验，p<0.05，说明上述因素与NTDS存在剂量一反应
关系。
结论:山西省NTDs的危险因素为发热、出疹性疾病、农药
和丈夫吸烟，经常摄入新鲜蔬菜对预防NTDs的发生有一定的保
护作用。
Objectives: To understand the risk factors of neural tube defects (NTDs ) and make a effective measure for protection.
Methods: A case-control study was conducted. 152 puerpeants with NTDs as a case group and 152 puerperants with normal newborns as a control group, were collected from 27 counties of higher incidence of NTDs in Shanxi. The risk factors of NTDs were analyzed using the logistic regression.
Results: Single variable logistic analysis showed that protecting factors were high educational level, fresh vegetable and fruits, and risk factors were the parental relatives with NTDs, gravidities, parities, fever, viral disease, hyperemesis grvidarum, threatened abortion, hypoemia, agricultural chemicals, fertilizer, yawp, sulfnamids, antibiotics, contraceptives, meclizine, budding potato, husband smoking. The multi-variables logistic regression analysis showed that fever, viral disease, agricultural chemical, fresh vegetables, husband smoking were associated with NTDs.(OR= 7.251, 7.840, 5.952, 0.370, 2.209). The statistics analysis also showed that there was dose-response relationship between fresh vegetables and husband smoking with NTDs.
Conclusion: Risk factors of NTDs were fever, viral diseases, agricultural chemical and husband smoking, fresh vegetables is a protecting factor.
方法：以2001年3月到2002年1月间在山西省27个NTDs高发县中分娩NTDs儿的152例产妇作为病例组，选择同期分娩正常儿的152例产妇作为对照组进行NTDs危险因素的病例对照研究。对七类32项因素逐一进行logistic单因素分析(α=0.05)。将单因素分析有意义的因素引入多因素logistic回归模型分析，并对引入方程的可分级因素用趋势x~2检验进行线形回归分析。
结果：将单变量引入logistic回归模型，在α-0.05水平上有意义的保护因素有文化程度高、经常摄入新鲜蔬菜、水果。有意义的危险因素：直系亲属分娩出生缺陷儿、孕次、产次、发热、出疹性疾病、妊娠巨吐、先兆流产、贫血、农药、化肥、噪声、磺胺类药物、抗生素、避孕药、止吐药、发芽土豆、丈夫吸烟，P＜0.05。将单因素分析有意义的因素引入logistic多元回归模型，在α=0.05水平引入回归方程的因素为发热、出疹性疾病、农药、经常摄入新鲜蔬菜和丈夫吸烟，OR分别为7.251，7.840，5.952，0.370，2.209。可分级因素经常摄入新鲜蔬菜和丈夫吸烟
山西医科大学
硕士学位论文
经趋势xZ检验，p<0.05，说明上述因素与NTDS存在剂量一反应
关系。
结论:山西省NTDs的危险因素为发热、出疹性疾病、农药
和丈夫吸烟，经常摄入新鲜蔬菜对预防NTDs的发生有一定的保
护作用。
Objectives: To understand the risk factors of neural tube defects (NTDs ) and make a effective measure for protection.
Methods: A case-control study was conducted. 152 puerpeants with NTDs as a case group and 152 puerperants with normal newborns as a control group, were collected from 27 counties of higher incidence of NTDs in Shanxi. The risk factors of NTDs were analyzed using the logistic regression.
Results: Single variable logistic analysis showed that protecting factors were high educational level, fresh vegetable and fruits, and risk factors were the parental relatives with NTDs, gravidities, parities, fever, viral disease, hyperemesis grvidarum, threatened abortion, hypoemia, agricultural chemicals, fertilizer, yawp, sulfnamids, antibiotics, contraceptives, meclizine, budding potato, husband smoking. The multi-variables logistic regression analysis showed that fever, viral disease, agricultural chemical, fresh vegetables, husband smoking were associated with NTDs.(OR= 7.251, 7.840, 5.952, 0.370, 2.209). The statistics analysis also showed that there was dose-response relationship between fresh vegetables and husband smoking with NTDs.
Conclusion: Risk factors of NTDs were fever, viral diseases, agricultural chemical and husband smoking, fresh vegetables is a protecting factor.
引文
1．国务院办公厅．关于做好提高出生人口素质的意见．1999，15号
2．严仁英．实用优生学．第二版．北京：人民卫生出版社，1997，157
3．安笑兰，符绍莲．环境优生学．第一版．北京：北京医科大学中国协和医科大学联合出版社，1995，246
4．全国妇幼卫生监测办公室．全国妇幼卫生监测年会会议资料．成都：华西医科大学，2000，11
5．董志忠．热的致畸作用．国外医学卫生学分册，1994，21(3)：147
6．史元杰．母体发热与神经管缺损．国外医学妇产科分册，1982，2：100
7．曹泽毅．中华妇产科学．第一版．北京：人民卫生出版社，1999，605
8. Northrup H, VolcikKh. Spina bifida and other neural tube defects. Curr Probl Pediatr, 2000,30(10):313
9．饶惠玲．山西省中枢神经系统畸形的流行病学分析．山西省出生缺陷监测，1990，19
10．黄幸纾．环境致畸因素与优生．见：秦文清．实用优生手册．第一版．北京：北京医科大学中国协和医科大学联合出版社，1992，263
11．吴艳乔，张讯，包广泽，等．我国南北方神经管缺陷病因学初
探．中华医学遗传学杂志．1994，11(4)：210
12. SmithellsRB. Possible prevention of neural tube defects by periconceptional vitmin supplementation. The Lancet,1980, 339
13. Laurence KM. Increased risk of recurrence of pregnancies complicated by fetal neural tube defects in mothers receiving poor diets, and possible benefit of dietary ciunselling. Br Med J, 1990, 218:1592
14．凌秀凤．神经管缺陷的研究进展．国外医学妇女保健分册，2000，11(3)：97
15. Molly AM. Maternal serum folate and vitamin B_(12) Concentration on pregnancies associated with neural tube defects. Arth Dis Child, 1985,60(2): 660
16. Richter B, Stegmann K, Roddeker J, et al. Interaction of Folate and Homocysteine Pathway Genotypes Evaluated in susceptibility to Neural Defects in a German Population. J Hum Genet, 2001,46(3): 105
17. Gross SM, Caufield LA, Kinsman SL, et al. Inadequate folic acid intakes are prevalent among young woman with neural tube defects. J Am Diet Assoc, 2001,101(3):342
18．李燕琴．围产期补充叶酸预防神经管缺陷．国外医学妇女保健分册，1999，10(2)：68
19. Kallen K. Maternal Smoking, Body Mass Index, and Neural
Tube Defects, Am J Epidemiol. 1998, 147(12):1103
20. Oven TJ, Halliday JL, Stone CA. Neural tube defection Victoria, hustralia: potential predictors of neural tube defects. Aust N Z J Public Health, 2000, 24(6):584
21. Forrester MB, Merz RD. Epidemiology of neural tube defects. Hawaaii Med J, 2000, 59(8):323
2．严仁英．实用优生学．第二版．北京：人民卫生出版社，1997，157
3．安笑兰，符绍莲．环境优生学．第一版．北京：北京医科大学中国协和医科大学联合出版社，1995，246
4．全国妇幼卫生监测办公室．全国妇幼卫生监测年会会议资料．成都：华西医科大学，2000，11
5．董志忠．热的致畸作用．国外医学卫生学分册，1994，21(3)：147
6．史元杰．母体发热与神经管缺损．国外医学妇产科分册，1982，2：100
7．曹泽毅．中华妇产科学．第一版．北京：人民卫生出版社，1999，605
8. Northrup H, VolcikKh. Spina bifida and other neural tube defects. Curr Probl Pediatr, 2000,30(10):313
9．饶惠玲．山西省中枢神经系统畸形的流行病学分析．山西省出生缺陷监测，1990，19
10．黄幸纾．环境致畸因素与优生．见：秦文清．实用优生手册．第一版．北京：北京医科大学中国协和医科大学联合出版社，1992，263
11．吴艳乔，张讯，包广泽，等．我国南北方神经管缺陷病因学初
探．中华医学遗传学杂志．1994，11(4)：210
12. SmithellsRB. Possible prevention of neural tube defects by periconceptional vitmin supplementation. The Lancet,1980, 339
13. Laurence KM. Increased risk of recurrence of pregnancies complicated by fetal neural tube defects in mothers receiving poor diets, and possible benefit of dietary ciunselling. Br Med J, 1990, 218:1592
14．凌秀凤．神经管缺陷的研究进展．国外医学妇女保健分册，2000，11(3)：97
15. Molly AM. Maternal serum folate and vitamin B_(12) Concentration on pregnancies associated with neural tube defects. Arth Dis Child, 1985,60(2): 660
16. Richter B, Stegmann K, Roddeker J, et al. Interaction of Folate and Homocysteine Pathway Genotypes Evaluated in susceptibility to Neural Defects in a German Population. J Hum Genet, 2001,46(3): 105
17. Gross SM, Caufield LA, Kinsman SL, et al. Inadequate folic acid intakes are prevalent among young woman with neural tube defects. J Am Diet Assoc, 2001,101(3):342
18．李燕琴．围产期补充叶酸预防神经管缺陷．国外医学妇女保健分册，1999，10(2)：68
19. Kallen K. Maternal Smoking, Body Mass Index, and Neural
Tube Defects, Am J Epidemiol. 1998, 147(12):1103
20. Oven TJ, Halliday JL, Stone CA. Neural tube defection Victoria, hustralia: potential predictors of neural tube defects. Aust N Z J Public Health, 2000, 24(6):584
21. Forrester MB, Merz RD. Epidemiology of neural tube defects. Hawaaii Med J, 2000, 59(8):323
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