中国出生队列研究进展

出生队列研究历经100余年发展,在探讨孕前及孕期环境暴露对婴儿、儿童、青少年、成年人及老年人健康的影响中发挥了巨大的作用。我国出生队列研究起步较晚,但发展迅速。近年来,中国大陆以及香港地区、台湾地区先后建立起一批大型出生队列研究。本文将针对中国目前已开展的出生队列研究进行简要综述。     

妊娠意愿与孕中晚期妊娠相关焦虑关联的队列研究

目的 探讨妊娠意愿与孕中、晚期妊娠相关焦虑关联及其强度。方法 在马鞍山优生优育队列（MABC）中,将孕周≤ 14周、符合纳入标准的3 474名孕妇纳入队列。在首次产检时收集孕妇的一般人口学信息,并在孕中期和孕晚期收集妊娠相关焦虑量表。采用logistic回归分析妊娠意愿对孕中期和孕晚期妊娠相关焦虑的影响。结果 最终3 083人纳入分析,意外妊娠检出率为15.00%（n=461）。孕中期和孕晚期妊娠相关焦虑检出率分别为29.13%（n=898）、30.36%（n=936）。控制潜在的混杂因素后,与有充分思想准备的孕妇相比,意外妊娠的孕妇孕中期出现妊娠相关焦虑的风险增加（OR=1.85,95%CI：1.44~2.38）;孕晚期出现妊娠相关焦虑的风险也增加（OR=1.84,95%CI：1.44~2.35）;顺其自然怀孕的孕妇在孕中、晚期未增加妊娠相关焦虑发生风险。结论 意外妊娠是孕中、晚期妊娠相关焦虑危险因素。     

孕前体重指数和孕期增重对不良妊娠结局影响的出生队列研究

目的探讨孕前体重指数(BMI)和孕期增重与早产、低出生体重、小于胎龄儿3种不良妊娠结局的关联。方法选取2014年6月—2015年2月在扬州市妇幼保健院分娩的3 943名孕妇,纳入出生队列,分析不同孕前BMI分组下的孕期增重状况与3种不良妊娠结局的关系。结果多因素logistic回归分析结果显示:孕前体重过低组中,孕期增重不足是发生早产的危险因素(RR=3.043,95%CI=1.104~8.387);孕前体重正常组中,孕期增重不足是发生早产与低出生体重的危险因素(RR=1.987,95%CI=1.146~3.444;RR=3.657,95%CI=1.905~7.021),孕期增重过度是发生小于胎龄儿的保护因素(RR=0.343,95%CI=0.180~0.652)。结论不同孕前BMI分组的孕期增重状况与不良妊娠结局有关联,保持适宜的孕前体重和孕期合理增重对改善出生结局具有重要意义。     

孕前体重指数和孕中期体重增加对妊娠期糖尿病发病影响的队列研究

目的 探讨孕前BMI和孕中期体重增加对妊娠期糖尿病(GDM)患病的影响。方法 采用以孕妇人群作为基础的队列研究, 在安徽省马鞍山市妇幼保健院围生期门诊选取首次孕期体检、孕周≤14周、马鞍山市常住户口的孕妇, 首次、孕中期和孕晚期体检时分别填写问卷、测量身高和体重, 在24～28周接受75 g口服糖耐量试验(OGTT)进行GDM诊断, 并追踪记录分娩结局。使用t检验、方差分析、χ²检验和logistic回归模型进行分析。结果 孕妇GDM的发生率为14.73%, 孕前BMI与孕中期增重呈负相关(r=-0.085, P<0.01)。GDM孕妇孕中期增重多于正常孕妇。孕妇年龄≥35岁、孕前超重和肥胖及孕早期血糖水平升高是GDM的危险因素, OR值(95%CI)分别为3.06(1.68～5.58)、2.08(1.38～3.13)、3.73(1.84～7.56)和2.17(1.57～3.00)。结论 孕前超重和肥胖以及孕期体重增加是GDM的危险因素.     

中国国家出生队列孤独症谱系障碍亚队列建设概况

孤独症谱系障碍作为儿童神经发育障碍的代表性疾病,发病率呈现不断上升的趋势,给家庭和社会带来巨大压力和经济负担,探讨其病因及发病机制意义重大。本研究依托中国国家出生队列开展孤独症谱系障碍亚队列建设,并利用该出生队列采用的辅助生殖和自然妊娠同期纳入并随访的平行设计,评价辅助生殖技术对子代神经行为发育的影响,并结合队列采集的...     

骨关节炎的队列研究现状

骨关节炎（osteoarthritis,OA）是发生于关节的慢性退行性疾病,其患病率在风湿性疾病中居于首位,一直是困扰风湿科及骨科医师的重要难题,所以深入研究OA的危险因素和发病机制显得尤为重要,但目前国内关于OA的临床研究设计多局限于横断面研究,难以阐述疾病发生发展的因果关系。本文对国际上有关OA的队列研究文献进行总结和分析,阐述其研究内容、方法设计以及各自的特点,旨在提高对OA队列研究的重视,也为进一步开展OA队列研究提供方法参考。     

中国母婴队列研究特点

母婴队列在母婴健康相关研究中有着不可替代的地位。相比国外，中国的母婴队列研究起步晚，有着其独特的发展轨迹。本文对中国近25年来建立的覆盖范围较广、影响力较大的母婴队列的基本情况及特点进行综述。     

中国双生子队列研究进展

我国大型人群队列研究方兴未艾,双生子作为一种特殊人群,由于其同时出生、共享母体的宫内环境和早期家庭环境的天然对照优势,可以进行匹配的队列研究,从而很好地控制年龄、性别（同性别双生子）、遗传（同卵双生子）或早期环境（共同抚养的双生子）所带来的混杂,为慢性复杂性疾病病因研究提供不可多得的良好资源。本文将就中国双生子队列的目标、现状、挑战与机遇进行简要介绍,着重呈现双生子不同于一般人群队列的特征。     

孕前职业久站行为与妊娠并发症的因果效应研究

目的描述安徽省马鞍山地区孕妇在孕前和孕早期工作中站立时间以及长时间站立行为的分布特征,探索该职业暴露与妊娠高血压等常见并发症的相关性.方法于2008年10月至2010年10月在马鞍山市妇幼保健机构招募初次建卡孕妇,建立孕产妇队列并随访至分娩.分别于孕早、中、晚期在产检医生指导下由孕产妇自填问卷,收集相关信息.结果4644名孕妇孕前和孕早期持续站立时间百分位数P75值分别为4.0 h/d和3.0 h/d;孕前和孕早期久站行为主要分布于较低经济社会地位特征孕妇中;多因素分析结果显示,在调整可能混杂因素后,孕前久站行为与妊娠合并高血压和中度贫血均呈显著正相关,其OR值分别为2.05(95%CI:1.26～ 3.31)和1.38(95%CI:1.03～1.85).结论孕前职业暴露于较重体力负荷的工作如长时间站立,可增加妊娠高血压等疾病的危险.     

重庆妇女孕前体重、孕期增重对新生儿出生体重影响的前瞻性队列研究

目的探讨重庆地区妇女孕前体重及孕期增重对单胎活产新生儿出生体重的影响。方法 2016年1月—2017年6月,在重庆市6家二级甲等妇幼保健院招募近3个月内有生育意愿、处于备孕状态的2394例计划妊娠妇女,收集对象孕前身高、体重、各孕期体重、妊娠结局信息、孕产史及人口社会指标。采用方差分析、卡方检验和多因素非条件Logistic回归模型进行数据统计分析。结果孕前体质指数以消瘦者和正常者为主,分别占46.74%(1119人)和47.12%(1128人),孕早期消瘦者和正常者分别为34.46%(825人)和57.77%(1383人),差异有统计学意义(χ²=74.95,P<0.01)。新生儿低出生体重、巨大儿发生率为4.51%(108人)和6.89%(165人)。不同孕前体质指数组,新生儿平均体重、新生儿低出生体重、巨大儿发生率差异有统计学意义(F=24.18,P<0.01)、(χ²=66.44,P<0.01)。不同孕期增重组,新生儿平均体重、新生儿低出生体重、巨大儿发生率差异有统计学意义(F=11.27,P<0.01)、(χ...     

Cohort studies: history of the method. II. Retrospective cohort studies

Conclusion What then of the future? Cohort studies in the original sense of the generation studies introduced by Andvord in 1930³⁵ helped our understanding of the spread of tuberculosis and the aetiology of several cancers, but they are now of limited application and I doubt if they have much more to teach us. Cohort studies in the modern sense, both prospective and retrospective, have established themselves as essential tools for epidemiological research. The nested case-control study and the use of biomarkers, which will in the course of time involve the techniques of molecular biology, provide us with powerful weapons for testing hypotheses about both the genetic and environmental causes of disease and cohort studies have, I suspect, an even more important part to play in the future of medical research than they have had in the past.     

Cohort studies: History of the method I. prospective cohort studies

The term "cohort study" was introduced by Frost in 1935 to describe a study that compared the disease experience of people born at different periods, in particular the sex and age specific incidence of tuberculosis and the method was extended to the study of non-communicable disease by Korteweg who used it 20 years later to analyse the epidemic of lung cancer in the Netherlands. Such studies are now best described as generation studies or generation cohort studies to distinguish them from the common type of study that is now carried out that consists in defining groups of individuals distinguished by some variable (such as place of residence, occupation, behaviour, or environmental exposure) and following them up to see if the incidence or mortality rates vary with the selected variable. This type of study is now one of the most important tools for epidemiological investigation. Initially called prospective studies, because the information characterising the individuals in the cohorts was recorded before the onset of disease, they are now preferably called cohort studies and distinguished as prospective cohort studies, If the information obtained relates to the subjects at the time the study is started and they are then followed, or retrospective cohort studies, if the information characterising the individuals was recorded sometime in the past (for example, the receipt of radiotherapy, or entry to a specific occupation). Studies of either type have the great advantage that they avoid all the most important sources of bias that may affect case-control-studies, but the disadvantage that because incidence rates and more specifically mortality rates are commonly low, large numbers of subjects have to be followed for several (if not many) years to obtain statistically significant results. Several early prospective studies are described: Namely, those of 34,000 male British doctors, 190,000 male and female American citizens with different smoking habits, some 5,000 middle aged residents of Framingham with different blood pressures, blood cholesterol levels, etc, and 13,000 children born in the UK in one week in 1946 with different family backgrounds.     

Allocation designs in cohort and case-control studies

Four unequal allocation designs for cohort and case-control studies that incorporate cost and power are considered and compared with the equal allocation design, with the aim of providing researchers some flexibility in planning their studies. It is found that the type of design to be adopted depends on available resources and projected needs. In the case of tight expenditure, the minimized cost design is the optimal, whereas the maximized power design may be sought if the researcher intends to ensure a high chance of detecting any clinically significant relative risk of disease.     

队列研究随访之我见

队列研究提供的病因证据在各种观察性研究设计中具有最高的质量,最重要的原因之一是其先"因"后"果"的设计原理。因此,随访是队列研究的核心要素之一,有效的随访方法是队列研究质量的重要保障。本文简要介绍了队列研究中关于随访期的考虑,随访队列的两种主要方法及其各自的优缺点。     

Efficiency gains from the addition of controls to matched sets in cohort studies

We evaluate relative efficiencies of added controls in matched cohort studies in terms of the asymptotic variance of the estimate of the log relative risk associated with a single binary exposure variable. We calculate expected contributions to the information based on the Cox proportional hazards model under the assumption that the failure times for exposed and unexposed individuals have independent exponential or Weibull distributions and that the censoring variable, when present, also has an exponential distribution or a Weibull distribution with a shape parameter common to that of the failure time distribution. With estimation of a relative risk of four or less, one gains little with an increase in the ratio of unexposed to exposed cohort members beyond five or so.     

Further results on covariate measurement errors in cohort studies with time to response data

The impact of covariate measurement errors on the estimation of relative risk regression parameters is discussed. First the dependence of the induced relative risk process on the cumulative baseline failure rate function is noted. Next induced relative risk models under some specific failure time and measurement error models are described, including the much simplified models that are appropriate under a 'rare disease' assumption. The presentation then turns to the joint estimation of relative risk parameters of primary interest along with measurement error parameters. A partial likelihood product is proposed for such estimation and asymptotic properties are indicated. Guidance is also presented as to the appropriate size of a 'validation' sample relative to the full cohort size. Finally some more general considerations are presented as to the usefulness and interpretation of deattenuated regression coefficients.     

Dietary antioxidant vitamins intake and mortality: A report from two cohort studies of Chinese adults in Shanghai

Background

Few studies have evaluated dietary antioxidant vitamins intake in relation to risk of mortality in Asia.

基于前瞻性人群队列的中国成年人排便频率与帕金森病的关联研究

目的检验成年人排便频率与随访期间确定的帕金森病的关联。方法研究对象来自于中国慢性病前瞻性研究,2004-2008年开展基线调查。在剔除基线自报患有恶性肿瘤者后,最终纳入510134人。随访截止到2016年12月31日,采用Cox比例风险回归模型计算排便频率和帕金森病的关联。结果研究对象随访(9.9±1.9)年,随访期间诊断帕金森病共808例。在全人群中,控制潜在混杂因素后,与排便频率1次/d者相比,排便频率<3次/周者、隔天1次者、>1次/d者随访期间出现帕金森病诊断的HR值(95%CI)分别为3.62(2.88~4.54)、2.13(1.74~2.60)和0.81(0.63~1.05),排便频率与帕金森病诊断之间的关联存在有统计学意义的线性趋势(P<0.001)。与排便频率≥1次/d者相比,排便频率<1次/d者的HR值(95%CI)在随访≤5年内为3.13(2.32~4.23),在随访>5年后为2.48(2.05~3.01)。分性别分析时的结果与全人群中相似。排便频率<1次/d与帕金森病诊断的关联在老年人中更强。结论基线排便频率越低的研究对象在未来平均10年的随访期内出现帕金森病诊断的风险越高。低排便频率作为一个容易识别的症状,可结合其他与帕金森病相关的早期症状,用于老年人群中帕金森病的早期发现。