孕母全血中硒浓度与子代先天性心脏病发生的关系

目的 探讨孕母全血中硒（selenium，Se）浓度与子代先天性心脏病（congenital heart disease，CHD）发生的关系。方法 本病例对照研究选取怀有CHD胎儿的孕母为病例组（n=120），怀有心脏结构正常胎儿的孕母作为对照组（n=108），并抽取外周静脉血对孕母全血中Se元素进行检测。以LnSe浓度三分位将全血中Se浓度分为低、中、高水平。运用单因素和多因素Logistic回归分析孕母全血中LnSe含量与子代CHD发生的关系。结果 病例组中孕母高中以下学历、具有不良妊娠史以及吸烟比例高于对照组，差异有统计学意义（均有P<0.05）；单因素Logistic分析显示，中浓度和高浓度的Se相对于低浓度Se，对CHD及间隔缺损、圆锥干畸形和右室流出道畸形亚型有保护作用。校正孕母年龄、孕前体质指数（body mass index，BMI）、是否吸烟、样本收集孕周以及是否服用叶酸等因素后，回归分析结果显示，相对于低浓度Se组，高浓度Se组发生CHD以及间隔缺损、圆锥干畸形和右室流出道畸形亚型的矫正的优势比（adjusted OR，aOR）分别为0.29（95%CI:0.14~0.61）、0.37（95%CI:0.17~0.82）、0.22（95%CI:0.07~0.64）和0.11（95%CI:0.03~0.44），而且高浓度Se的保护作用强于中浓度Se。结论 孕母血清Se水平升高与子代CHD的发生风险降低相关。

Association between maternal blood selenium concentration and congenital heart disease in offspring

Objective To investigate the association of selenium (Se) concentration in the whole blood from pregnant women with congenital heart disease (CHD) in the offspring.Methods This case-control study enrolled pregnant women whose fetus were diagnosed with CHD by fetal echocardiography as cases (n =120),while those mothers with fetus without detected abnormality as controls (n =108).Maternal peripheral venous blood from all studied pregnant women were extracted and stored at the time of enrollment.The Se concentration was determined,and natural logarithm converted to LnSe to decrease the dispersion of distribution.LnSe level was divided into low,medium and high levels.Univariable and multivariable non-conditioned logistic models were used to explore the association of LnSe level and fetus CHD.Results The proportion of maternal education lower than high school,history of adverse pregnancy and smoking was higher in cases and controls with statistical significance(all P ＜ 0.05).Non-conditioned univariable logistic models showed that the medium and high level LnSe were significantly associated with decreased odd ratios(OR) of CHD and subtypes,compared with low level of LnSe.Adjusting for the factors of maternal age,prepregnant-BMI,maternal smoking,gestational week of samples collection and intake of folic acid,multivariable logistic regression analysis demonstrated that the adjusted OR for the high level LnSe was 0.29(95％ CI:0.14-0.61),0.37 (95％ CI:0.17-0.82),0.22(95％ CI:0.07-0.64) and 0.11 (95％ CI:0.03-0.44) in CHD,septal defects,conotrucal defects and right ventricular outflow obstruction defects.The protective effect was stronger in high level LnSe than in medium level LnSe.Conclusions The High concentration of selenium in maternal whole blood is associated with decreased CHD in offspring.