神经管缺陷相关危险因素的病例对照研究

目的:探讨神经管缺陷(NTDs)发生的危险因素,为进一步采取干预措施提供科学依据.方法:采用1∶1配比的病例对照研究,对157例NTDs患儿的母亲和157例非患儿的母亲进行回顾性调查,并将结果进行Logistic回归分析.结果:多因素Logistic回归分析显示,孕产妇年龄(OR=2.850)、流产史(OR=1.453)、接触职业危险因素(OR =3.120)、流感(OR=2.272)及丈夫吸烟(OR=2.072)可能是NTDs发病的危险因素;孕前及孕早期服用叶酸(OR =0.237)为NTDs的保护因素.结论:孕产妇年龄、流产史、接触职业危险因素、流感和丈夫吸烟可能使NTDs发生的危险性增加.     

川崎病发生冠状动脉病变危险因素的Logistic回归分析

目的探讨川崎病(KD)发生冠状动脉病变(CAL)的危险因素。方法回顾性分析2000年1月至2004年12月期间942例住院KD患儿的临床资料，对发生CAL(170例)和未发生CAL(772例)的病例进行组间对照研究，对13种影响CAL发生的因素进行Logistic回归分析。结果Logistic回归分析结果表明，热程大于10d(X1)的OR值为1.203(95%CI=1.104~1.312,P<0.001)、血红蛋白(Hb)小于100g/L(X2)的OR值为0.658(95%CI=0.472~0.995,P<0.05)。建立KD发生CAL的危险因素主效应模型是Logit(P)=β0(-2.995)+0.185X1+(-0.378)X2(χ2＝16.920，P=0.031)。结论热程大于10d、Hb<100g/L是KD发生CAL的高危因素。     

潍坊地区外阴阴道假丝酵母菌病相关危险因素研究

目的:探讨外阴阴道假丝酵母菌病(vulvovaginalcandidiasis,VVC)的相关危险因素。方法:采用1∶1病例-对照研究设计,对200例真菌培养阳性的VVC患者及200例真菌培养阴性者或真菌培养阳性无症状的带菌者进行问卷调查,用Logistic回归分析方法筛选主要危险因素,并评估它们在VVC发病中的相对重要性。结果:Logistic回归分析提示非经期用护垫、VVC病史、口交、阴道冲洗、避孕套、近1个月应用抗生素、心情抑郁、口服避孕药、糖尿病等在VVC发病因素中具有统计学意义,且对VVC发病的相对影响依次减弱。结论:Logistic回归分析提示在VVC发病中具有统计学意义的因素,可能是外阴阴道假丝酵母菌病危险因素。     

被动吸烟和宫颈疾病的相关研究

目的:探讨被动吸烟与宫颈癌、宫颈上皮内瘤变(CIN Ⅰ~Ⅱ)发病的相关性。方法:回顾性研究被确诊并收治的原发性浸润性宫颈癌新发病例192例(宫颈癌组),CIN Ⅰ~Ⅱ 142例(CIN组),正常对照组254例(对照组),进行一对一的问卷调查,运用χ2检验和Logistic回归分析对被动吸烟与宫颈疾病发病的相关性进行分析。结果:无论是距诊断或就诊前近10年内还是10年以前,患病组和对照组是否被动吸烟、被动吸烟的持续时间、接触强度都有显著差别(P<0.01)。Logistic回归分析结果显示10年内被动吸烟时间是宫颈癌和CIN Ⅰ~Ⅱ发病危险因素,分娩次数和肿瘤家族史是CIN Ⅰ~Ⅱ的危险因素,高教育程度和年龄低是保护因素。结论:被动吸烟及接触时间、强度是宫颈疾病发病的相关危险因素。     

小儿肺炎继发腹泻相关因素分析及微生态制剂的预防作用

目的探讨小儿肺炎继发腹泻的危险因素及应用微生态制剂(培菲康)预防的效果。 方法调查2002年1月至2004年5月在福建医科大学附属第一医院住院治疗的小儿肺炎314例，以住院期间抗生素治疗同时应用微生态制剂(培菲康)的患儿为病例组，仅使用抗生素治疗或住院72h后因出现继发腹泻才开始应用微生态制剂(培菲康)的患儿为对照组，对肺炎患儿的临床特征、微生态制剂的应用情况与继发腹泻的关系进行单因素卡方分析和非条件Logistic回归模型多因素分析。 结果病例组114例，住院治疗期间继发腹泻病21例，发生率为184%；对照组200例，继发腹泻79例，发生率395%。单因素卡方分析显示：患儿发病年龄、住院天数、住院后有无侵入性操作、微生态制剂的应用、居住地、病情严重程度、血中性粒细胞、血红蛋白数量、激素应用与小儿肺炎继发腹泻有关联。非条件Logistic多因素回归分析筛选出3个危险因素，即患儿年龄(χ2=14120,P=0000)、住院天数(χ2=11532,P=0001)、入院后接受侵入性操作(χ2=6827,P=0009)和1个保护因素：微生态制剂应用(χ2=12943,P=0000)。 结论肺炎患儿年龄越小、住院时间越长或进行侵入性操作可增加继发腹泻的发生率；微生态制剂能够降低小儿肺炎继发腹泻的发生率，提示具有预防作用。     

自然流产前患者阴道微生态评价与诱病危险因素分析

目的探究自然流产患者阴道分泌物微生态特征及其诱病危险因素。方法回顾性分析行早孕期阴道微生态检查的1 147例孕妇临床资料,将孕28周前自然流产者纳入观察组(n=537),其余继续妊娠者纳入对照组(n=610)。对两组基线资料、阴道微生态指标进行单因素比较,就单因素差异存在统计学意义的项目进行非条件Logistic回归分析,筛选出影响自然流产的独立危险因素。结果非条件Logistic回归分析结果显示,有分娩史及阴道分泌物细菌性阴道病(BV)Nugent评分较高、念珠菌阳性、白细胞酯酶(LET)阳性均是影响自然流产发生的独立危险因素(P0.05)。结论分娩史及阴道分泌物确诊BV、念珠菌感染、LET阳性均可独立诱发自然流产,可为产科临床防治工作提供参考与指导。     

天津市子宫内膜癌发病危险因素的调查分析

应用配对病例对照研究方法，对天津市妇女子宫内膜癌危险因素进行研究，结果表明，初婚年龄、生育年龄、妊娠次数、分娩次数、哺乳时间、绝经前月经周期、绝经年龄、体重指数、家族肿瘤史、Ｘ线暴露史、高血压与子宫内膜癌的发病有关。通过多因素条件Ｌｏｇｉｓｔｉｃ回归分析，体重指数与ｘ线暴露史为子宫内膜癌的主要危险因素；而妊娠次数与哺乳时间为主要保护性因素。     

脐带绕颈的社会心理因素研究200例分析

目的：探讨脐带绕颈的危险因素,尤其社会心理因素在脐带绕颈中的作用。方法：以有台儿脐带绕颈的200例产妇为病例组,无脐带绕颈的165例产妇为对照组,进行病例对照研究,采用非条件对数优势回归模型（unconditional logistic regression model)对研究因素进行多因素分析。结果：按α＝0．05水平,脐带长度,妊娠期发生的精神刺激,住房类型等因素入选非条件对数优势回归多因素模型。结论：脐带过长,妊娠期出现精神刺激,居住高层楼房等是脐带绕颈的主要危险因素,在脐带绕颈的预防策略中,应重视社会心理因素作用。     

内质网氨肽酶2基因rs2549782多态性与妊娠期高血压发病的相关性

目的:探讨内质网氨肽酶2(ERAP2)基因rs2549782多态性与淮安地区汉族女性妊娠期高血压发病的关系。方法:应用病例对照研究,收集2013年6月—2016年4月江苏省淮安市妇幼保健院确诊的汉族妊娠期高血压疾病患者100例为研究对象(病例组),同期住院分娩正常孕妇310例为对照(对照组),应用MassARRAY-IPLEX技术和基质辅助激光解吸离子飞行时间质谱(MALDI-TOF-MS)对ERAP2基因rs2549782位点进行基因分型。结果:2组中rs2549782位点等位基因分布差异无统计学意义(P=0.089),而基因型分布差异有统计学意义(P=0.045)。经校正混杂因素后,Logistic回归分析提示G等位基因(OR=1.64,95%CI:1.09~2.47)以及GT基因型(OR=2.23,95%CI:1.01~4.07)和GG基因型(OR=2.96,95%CI:1.20~7.31)为妊娠期高血压发生的危险因素。结论:ERAP2基因rs2549782位点单核苷酸多态性与淮安汉族妊娠期高血压疾病的发生具有相关性,G等位基因、GT和GG基因型均为妊娠期高血压的危险因素。     

065遗传可能为卵巢皮样囊肿发病机制中的一种可能因素

卵巢皮样囊肿(ODC)是最常见的卵巢肿瘤,占所有卵巢肿瘤的24%～40%,年发病率为8.9/100 000或更高,家庭一级亲属(嫡堂,嫡表姐妹)发病提示遗传因素可能在其发病机理中有一定的作用,该研究采用病例对照,利用多变量逐步逻辑回归的方法评价遗传因素与其发病的相关性.     

宫颈癌致病危险因素的流行病学研究

以1:1配对病例对照研究的方法,对125对宫颈癌和对照病人进行了流行病学调查。经单因素分析,以37个研究因素中初筛出宫颈癌的12个可疑危险因素,多元逐步回归分析又进一步筛选出宫颈糜烂、初婚年龄、外阴不常洗和平时就诊医院差五个高危因素。基于上述结果,作者对目前宫颈癌的一级预防提出了建议。     

Induced abortions, contraceptive practices, and tobacco smoking as risk factors for ectopic pregnancy in Athens, Greece

A case-control study of the role of induced abortion and other factors on the subsequent occurrence of ectopic pregnancy was undertaken in 1986-1987 in Athens, Greece, where a similar study 20 years ago found a tenfold risk of ectopic pregnancy among women with one or more illegal induced abortions. Seventy women residents of Athens, consecutively admitted to the major state maternity hospital with a diagnosis of ectopic pregnancy, were individually matched with women with a newly diagnosed pregnancy of the same order as the ectopic index pregnancy. Two control women were found for each of 63 cases, but only one control for each of the remaining seven cases. All cases and controls were interviewed by the same qualified obstetrician. Statistical analysis was undertaken with stratification of individual matched triplets and pairs, as well as through conditional multiple regression procedures. The relative risk of recurrence of an ectopic pregnancy was 6.39 with 95% confidence interval (CI) 1.96-21.04. Miscarriages did not increase the risk of ectopic pregnancy. The relative risk for subsequent ectopic pregnancy among women with one or more induced abortion, compared to women without such abortions, was 1.87 (CI 0.84-4.16) controlling only for the matching factors, and 1.71 (CI 0.69-4.27) when marital status (a possible selection factor) was also accounted for in the conditional logistic regression. There was no evidence for increasing risk with increasing number of induced abortions. Past use of an intrauterine device (IUCD) was associated with a relative risk of 3.89 (0.72-21.02); the relative risk increased with the duration of use of the IUCD.(ABSTRACT TRUNCATED AT 250 WORDS)     

Induced abortions, contraceptive practices, and tobacco smoking as risk factors for ectopic pregnancy in Athens, Greece

Summary. A case-control study of the role of induced abortion and other factors on the subsequent occurrence of ectopic pregnancy was undertaken in 1986–1987 in Athens, Greece, where a similar study 20 years ago found a tenfold risk of ectopic pregnancy among women with one or more illegal induced abortions. Seventy women residents of Athens, consecutively admitted to the major state maternity hospital with a diagnosis of ectopic pregnancy, were individually matched with women with a newly diagnosed pregnancy of the same order as the ectopic index pregnancy. Two control women were found for each of 63 cases, but only one control for each of the remaining seven cases. All cases and controls were interviewed by the same qualified obstetrician. Statistical analysis was undertaken with stratification of individual matched triplets and pairs, as well as through conditional multiple regression procedures. The relative risk of recurrence of an ectopic pregnancy was 6.39 with 95% confidence interval (CI) 1.96–21.04. Miscarriages did not increase the risk of ectopic pregnancy. The relative risk for subsequent ectopic pregnancy among women with one or more induced abortion, compared to women without such abortions, was 1.87 (CI 0.84–4.16) controlling only for the matching factors, and 1.71 (CI 0.69–4.27) when marital status (a possible selection factor) was also accounted for in the conditional logistic regression. There was no evidence for increasing risk with increasing number of induced abortions. Past use of an intrauterine device (IUCD) was associated with a relative risk of 3.89 (0.72–21.02); the relative risk increased with the duration of use of the IUCD. Tobacco smoking significantly increased the risk of an ectopic pregnancy, the relative risk being 2.35 (CI 1.19–4.67). Legalized induced abortions, as currently practised in Greece, do not appear to increase the relative risk of ectopic pregnancy to a substantial degree.     

放置IUD服务质量与IUD下移取器关系的巢式病例对照研究

目的:探讨云南省农村地区育龄妇女IUD下移取器与手术人员服务质量间的关联。方法:采用巢式病例对照研究方法,从队列中获得246例IUD下移取器病例,按1:1的比例分别匹配以末次妊娠结局、所置IUD种类相同、地区、年龄相当的对照,调查分析为此组患者施术人员的相关服务质量。结果:单因素条件logistic回归分析显示施术人员本调查置器时间点前一年(2004年)所置IUD数量、是否有计划生育手术上岗合格证、5年内IUD相关培训次数、置环、取环术熟练程度、对放置IUD绝对禁忌证的了解程度、所施行过的手术种类与IUD下移取器有统计学关联(P<0.05),进一步用多因素条件logistic回归分析,施术人员5年内IUD相关培训次数、2004年置环数量、置环、取环术熟练程度与IUD下移取器有统计学关联(P<0.05),OR值分别为0.35(95%CI:0.18～0.66)、0.50(95%CI:0.33～0.77)和2.46(95%CI:1.89～3.20),其他各因素对致育龄妇女IUD下移取器未显示有统计学意义。结论:影响IUD下移取器有关服务质量的因素包括施术人员的服务水平和培训情况,今后需进一步探讨IUD技术服务质量管理模式,提高人民的生殖健康水平。     

Occupational and socio-medical factors in preterm birth

Two hundred eighty-four women who had preterm deliveries and matched controls who had full-term deliveries were analyzed using a conditional logistic regression model to assess the effects of employment and socio-medical factors on preterm birth. In the analysis, employment outside the home, in general, turned out not to be a significant risk factor for preterm birth. Of the social factors, unmarried status (odds ratio 2.0) and current smoking (odds ratio 2.4) were associated with preterm birth, as were medical factors such as hypertension (odds ratio 7.3), intrauterine growth retardation (odds ratio 3.9), and fetal malformations (odds ratio 5.2).     

Acute acetaminophen intoxication in Taiwan: outcomes and risk factors.

BACKGROUND AND PURPOSE: There is a paucity of information about acetaminophen intoxication from Taiwan. This study investigated the outcome and risk factors for acetaminophen-induced hepatotoxicity and validated the Rumack- Matthew nomogram in Taiwanese patients with acute acetaminophen intoxication. METHODS: A total of 75 patients with acetaminophen intoxication admitted through the emergency department were included in this retrospective analysis. Patients with a serum acetaminophen concentration above the possible risk line on the nomogram were treated with oral N-acetylcysteine. The primary outcome measure was the development of major hepatotoxicity, which was defined as a serum aminotransferase concentration greater than 1000 IU/L. Patient outcomes in the possible risk group and probable risk group were plotted on the modified Rumack-Matthew nomogram for validation. The risk factors for acetaminophen-induced hepatotoxicity were identified by multiple logistic regression analysis. RESULTS: No hepatotoxicity developed in patients with an initial acetaminophen concentration below the possible risk line on the nomogram. One out of 8 patients in the possible risk group developed major hepatotoxicity; 8 out of 22 patients in the probable risk group developed major hepatotoxicity, representing an incidence of 12.5% and 36.4%, respectively. Patients in the major hepatotoxicity group were older (32.5 vs 24.2 years, p = 0.019), and had a longer time to presentation (28.1 vs 6.7 hours, p < 0.01) than those in the non/minor hepatotoxicity group. Multiple logistic regression revealed that age and time to presentation were independent risk factors for hepatotoxicity (p = 0.033 and p = 0.002, respectively). CONCLUSIONS: The results of outcome analysis confirm that the modified Rumack-Matthew nomogram has a high sensitivity for identifying Taiwanese patients at risk for acetaminophen-induced hepatoxicity. Patient age and time to presentation were independent risk factors for acetaminophen-induced hepatotoxicity.     

Risk factors for primary postpartum haemorrhage

The objective of the study was to determine which background factors predispose women to primary postpartum haemorrhage (PPH) at the Obafemi Awolowo University Hospital. The study consisted of 101 women who developed PPH after a normal vaginal delivery and 107 women with normal unassisted vaginal delivery without PPH Both cases and controls were investigated for sociodemographic risk factors, medical and obstetric histories, antenatal events and labour and delivery outcomes. Data were abstracted from the medical and delivery records and risks were estimated by multivariate logistic regression. The results of the unvariate analysis revealed a number of potential risk factors for PPH but after adjustment by logistic regression three factors remained significant. These were prolonged second and third stages of labour and non-use of oxytocics after vaginal delivery. Previously hypothesised risk factors for PPH such as grand multiparity, primigravidity and previous episodes of PPH were not significantly associated with PPH. We conclude that primary PPH in this population is mostly associated with prolonged second and third stages of labour and non use of oxytocics. Efforts to reduce the incidence of PPH should not only be directed at proper management of labour but also training and retraining of primary health care workers and alternative health care providers in the early referral of patients with prolonged labour.     

Weaker Masturbatory Erection May Be a Sign of Early Cardiovascular Risk Associated with Erectile Dysfunction in Young Men Without Sexual Intercourse

IntroductionAlthough increasing evidences emphasize the importance of early cardiovascular evaluation in men with erectile dysfunction (ED) of unexplained aetiology, impaired masturbation‐induced erections in young men are usually overlooked and habitually presumed to be psychological origin.AimsTo evaluate the young men presenting weaker masturbatory erection with no sexual intercourse (WME‐NS) and verify if this cohort have early cardiovascular risks associated with ED.MethodsMale subjects aged 18–40 years with WME‐NS were screened by analyzing detailed sexual intercourse and masturbatory history. The age‐matched ED and non‐ED population were identified by using International Index of Erectile Function‐5 (IIEF‐5). All subjects with acute and/or chronic diseases (including diagnosed hypertension and diabetes) and long‐term pharmacotherapy were excluded. Nocturnal penile tumescence and rigidity (NPTR), systemic vascular parameters and biochemical indicators related to metabolism were assessed.Main Outcome MeasuresComparison analysis and logistic regression analysis were conducted among WME‐NS, ED and non‐ED population.ResultsIn total, 78 WME‐NS cases (mean 28.99 ± 5.92 years), 179 ED cases (mean 30.69 ± 5.21 years) and 43 non‐ED cases (mean 28.65 ± 4.30 years) were screened for analysis. Compared with non‐ED group, WME‐NS group had higher prevalence of early ED risk factors including endothelial dysfunction, insulin resistance, high level of glycosylated serum protein and abnormal NPTR. Multivariable‐adjusted logistic regression analysis showed endothelia dysfunction (odds ratio: 8.83 vs. 17.11, both P < 0.001) was the independent risk factor for both WME‐NS and ED.ConclusionsWeaker masturbatory erection may be a sign of early cardiovascular risk associated with ED in young men without sexual intercourse. More studies are warranted to elucidate the clinical benefits by targeting these formulated strategies. Huang Y‐P, Chen B, Yao F‐J, Chen S‐F, Ouyang B, Deng C‐H, and Huang Y‐R. Weaker masturbatory erection may be a sign of early cardiovascular risk associated with erectile dysfunction in young men without sexual intercourse. J Sex Med 2014;11:1519–1526.     

Predictors of maternal mortality and near-miss maternal morbidity.

OBJECTIVE: To identify risk factors for life-threatening maternal outcomes. STUDY DESIGN: Hospital charts were reviewed for cases of maternal mortality or near-miss and for controls overmatched 1:3. Significant risk factors were identified through simple and best subsets multiple logistic regression. RESULT: Eight cases of mortality and 69 near-miss cases were found. Significant risk factors with their odds ratios and 95% confidence intervals are: age 35 to 39 years (2.3, 1.2 to 4.4) and >39 years (5.1, 1.8 to 14.4); African-American race (7.4, 2.5 to 22.0) and Hispanic ethnicity (4.2, 1.3 to 13.2); chronic medical condition (2.7, 1.5 to 4.8); obesity (3.0, 1.7 to 5.3); prior cesarean (5.2, 2.8 to 9.8) and gravidity (1.2, 1.1 to 1.5 per pregnancy). In multivariable logistic regression, race remained significant while controlling for other significant factors and markers of socioeconomic status. CONCLUSION: Some risk factors can be modified through medical care, education or social support systems. Racial disparity in outcome is confirmed and is unexplained by traditional risk factors.