湖北某地新生儿神经管畸形的病例对照研究

Risk factors of neonatal neural tube defects in a region of Hubei: a case-control study

摘要:

目的 探讨湖北省襄阳市南漳县新生儿神经管畸形（NTDs）高发的危险因素，为有效控制和降 低该地区新生儿NTDs 发病率提供科学的参考依据。方法 采用1 ∶ 1 配对病例对照研究方法，选取2013 年1 月1 日—2016 年12 月30 日湖北省襄阳市南漳县孕检并分娩的NTDs 463 例活产儿作为病例组，在相同 医院孕检、与畸形患儿性别相同、畸形诊断时孕周相差7 d 内的463 例健康无缺陷活产儿作为对照组。收 集孕妇孕前后临床资料，结合问卷调查进行多因素逐步Logistic 回归分析。结果 多因素分析显示，居住地 位于污染区域[Ol ^ R=9.404（95%CI ：2.732，32.363），P =0.000]、孕早期孕妇暴露于放射线环境[Ol ^ R=3.179 （95%CI ：1.568，6.447），P =0.001]、孕早期孕妇暴露于重金属环境[Ol ^ R=19.098（95%CI ：6.087，59.923）， P =0.000]、孕前父亲暴露于放射线环境[Ol ^ R=1.198（95%CI ：1.198，4.681），P =0.013] 是本地区NTDs 发生 的危险因素，而孕早期孕妇补充叶酸和维生素B12 为保护因素[Ol ^ R=0.018（95%CI ：0.003，0.122），P =0.000]。 结论 环境污染、暴露于重金属及放射线环境可能是该地区NTDs 患儿多发的危险因素，对该地区新生儿出 生缺陷可能造成一定的影响，控制与消除该地区的环境污染对有效控制与降低NTDs 患儿的发生具有重大的 公共卫生学意义。

Abstract:

Objective To explore the risk factors of high incidence of neonatal neural tube defects (NTDs) in a region of Hubei and to provide evidences for prevention and treatment of the diseases. Methods Patients were enrolled from hospitalized neonates in a local hospital from January 1, 2013 to December 30, 2016. A casecontrol study was performed by enrolling 463 newborns with neural tube defects and 463 neonates without defects. Questionnaires were completed by the parents of the infants. Univariate and multivariate logistic regression analyses were used to identify the risk factors of the malformations. Results Multi-factor analysis showed that living in the polluted area [Ol ^ R = 9.404 (95% CI: 2.732, 32.363), P = 0.000], exposure of pregnant women to radiation in early pregnant stage [Ol ^ R = 3.179 (95% CI: 1.568, 6.447), P = 0.001], exposure of pregnant women to environmental heavy metals [Ol^R = 19.098 (95% CI: 6.087, 59.923), P = 0.000], and pre-pregnant exposure of father to radiation environment [Ol^R = 1.198 (95% CI: 1.198, 4.681), P = 0.013] were the risk factors for the occurrence of NTDs in this area, while the early maternal supplementation of folic acid and vitamin B12 was the protective factor [Ol^R = 0.018 (95% CI: 0.003, 0.122), P = 0.000]. Conclusions Environmental pollution, environmental heavy metals and radiation exposure are the important risk factors for neonatal neural tube malformations in this area, which may have a certain impact on the birth defects in this area. Controlling and eliminating the environmental pollution in this area is of great public health significance for the effective control and reduction of neonatal neural tube malformations.