孕期环境暴露因素与先天性心脏病关系

目的 探讨母亲孕期环境暴露因素与子代先天性心脏病(CHD)之间的关系,为CHD的干预防治提供科学依据.方法 采用1:1配对病例对照研究,分析115对CHD患儿与对照组父母的环境暴露因素,对CHD可能的危险因素进行单因素及多因素条件Logistic回归分析.结果 母亲怀孕早期接触农药(OR=7.316,95%CI=1.196~44.731)、孕早期感冒(OR=4.806,95%CI=2.092~11.04)、妊娠合并症(OR=2.851,95%CI=1.189~6.838)、孕期情绪状况(OR=3.318,95%CI=1.829~6.018)4个因素为子代发生CHD的危险因素.结论 母亲怀孕早期接触农药、孕早期感冒、孕期患妊娠合并症、孕期情绪紧张或忧郁可能增加子代发生CHD的危险.     

孕早期室内空气污染物暴露与胎儿复杂性先天性心脏病的相关性研究

目的探讨孕早期室内空气污染物暴露与胎儿复杂性先天性心脏病的相关性,指导复杂性先天性心脏病的预防,降低其发病率。方法以2016年1月-2017年12月在上海交通大学医学院附属新华医院经胎儿超声心动图检查确诊为胎儿复杂性先天性心脏病并最终在医院分娩或引产的产妇为病例组(50例)。对照组为通过多阶段整群抽样法收集的通过胎儿超声心动图排除了胎儿复杂性先天性心脏病和(或)其他先天性疾病的孕妇(100例)。利用调查表采集流行病学资料,同时对研究对象所处的室内环境进行现况检测,回顾分析孕早期室内空气污染物暴露对子代复杂性先天性心脏病的影响。结果孕早期室内空气污染物暴露与胎儿复杂性先天性心脏病呈显著正相关(P0. 05)。吸烟/被动吸烟是复杂性先天性心脏病的独立危险因素。多种不良生活习惯(包括吸烟/被动吸烟、使用煤炉、频繁使用电子设备)在累积后与复杂性先天性心脏病显著相关;新家具购置、居室近期装修、通风不良这3项不良居室环境因素在累积后与复杂性先天性心脏病显著相关。结论孕早期是胎儿心脏发育的重要时期,室内空气污染物暴露均可不同程度地增加罹患先天性心脏病的风险。     

妇女孕前期及孕期环境暴露与儿童先天性心脏病的关系探究

目的探讨妇女孕前期及孕期环境暴露情况与儿童先天性心脏病的关系。方法选择2012年10月-2015年9月在该院确诊的77例先天性心脏病儿童的母亲作为观察组,77例同期出生的健康儿童的母亲作为对照组,使用调查问卷对两组儿童的母亲基本情况、生育年龄、教育情况、工作情况、孕产史、家族史、药物接触史等情况进行调查分析。结果女童发生先天性心脏病的几率明显高于男童,差异有统计学意义(P0.05);母亲年龄、先天性心脏病家族史、孕前期孕妇患病、孕前期胎儿存在异常、流产和不良妊娠、药物和农药接触情况等因素会导致儿童先天性心脏病的发病率明显升高(P0.05)。结论妇女孕前期及孕期环境暴露的多种因素与儿童先天性心脏病的发生具有密切的关系,改善和控制各项危险因素对防控儿童先天性心脏病发生具有重要的作用。     

母亲围孕期焦虑与子代先天性心脏病关系的病例对照研究

目的:研究母亲围孕期焦虑与子代先天性心脏病（CHD）的关系。方法:数据来源于2014年1月至2016年12月在陕西省开展的CHD相关危险因素病例对照研究,通过焦虑自评表对母亲围孕期焦虑情绪进行评分,新生儿相关信息通过专业医院或机构提供。通过调整混杂因素的logistic回归分析母亲围孕期焦虑对新生儿CHD的影响,并进行...     

围孕期空气污染物暴露与妊娠期贫血的关联研究

目的 探讨孕前期和孕早期主要空气污染物暴露与孕中期贫血发生风险间的关系。方法 在合肥市3家医院招募3 427名孕中期产检的孕妇作为研究对象。通过问卷调查收集人口学特征、健康状况和生活方式等信息,常规检查获得血红蛋白(hemoglobin, Hb)浓度并诊断贫血。结果 孕中期贫血发生率为35.5%。多因素logistic回归分析结果显示,在单污染物模型中,孕前期NO2（OR = 1.45, 95%CI:1.33～1.57）及孕早期O3和NO2暴露均与孕期贫血风险增加显著相关,但在双污染物模型中,仅孕前期NO2与贫血风险仍存在统计学关联。多因素线性回归分析结果显示,在单污染物模型中,孕前期NO2（β = - 2.02, 95%CI:- 2.34～- 1.70）及孕早期O3（β = - 2.61, 95%CI:- 3.23～- 2.00）和NO2（β = - 1.59, 95%CI:- 2.04～- 1.15）暴露与Hb浓度呈显著负相关,在双污染物模型中,上述统计学关联仍存在。多项式曲线拟合结果显示,孕前期和孕早期NO2暴露浓度与Hb浓度之间均存在负性线性关系（P＜0.05）。结论 围孕期NO2暴露与Hb浓度降低有关,并增加妊娠期贫血风险。     

围孕期暴露与后代先天性心脏病发生风险的关系

目的 探讨孕母围孕期的暴露与后代先天性心脏病发生风险之间的关系.方法 采用成组病例对照研究方法.病例组为妊娠满28周及以上的孕产妇,其后代于妊娠期至出生后30天内确诊为先天性心脏病者,共42例;对照组通过多阶段整群抽样的方法,随机抽取在西安地区与病例组同时期分娩活产正常婴儿的妇女221例.采用多因素Logistic回归模型控制人口学影响因素后,估计各类围孕期相关因素与后代先天性心脏病发生的关联强度.结果 在研究的围孕期因素中:①优生检查(包括婚检、孕前检查及产检)是先天性心脏病发生的保护因素,OR值(95%CI)分别为0.90(0.24~0.95)、0.29(0.07~0.32)及0.14(0.02~0.32);②母亲孕期不良的周围环境如孕妇居住区1 000m内有排放废物的工厂、孕前或孕期工作中有毒物接触史,均可显著增加后代患先天性心脏病的风险,OR值(95%CI)分别为1.36(1.01~1.56),1.98(1.03~3.57);③不良的生活习惯如孕期接触电脑电视每天1小时以上、经常使用微波炉、睡眠不规律(每周1次以上)、被动吸烟均是导致后代患先天性心脏病的危险因素,OR值(95%CI)分别为1.77(1.47~2.65)、1.34(1.08~1.43)、1.09(1.02~1.43)、1.36(1.11~1.58);④母亲孕期患病如糖尿病、高血压等慢性疾病者其后代罹患先天性心脏病的风险最高(OR=2.80,95%CI为1.62~4.81),孕早期发热、孕早期感冒也是导致后代患先天性心脏病的危险因素,OR值(95%CI)分别为1.67(1.36~4.93)、1.59(1.44~5.84);⑤孕期服用药物如感冒药、避孕药及消炎药与后代患先天性心脏病的风险之间未得出有意义的结论.结论 优生检查对于先天性心脏病的发生具有明显的保护作用,不良环境、生活方式及孕期疾病是先天性心脏病发生的危险因素.     

孕期妇女膳食指南依从性指数与子代先天性心脏病的关系

目的 研究孕期妇女膳食指南依从性指数（CDGCI_PW）与子代先天性心脏病（先心病）的关系。方法 在陕西省西安市开展以医院为基础的病例对照研究,采用半定量食物频率问卷调查孕妇整个孕期的饮食情况。应用修订的CDGCI_PW评分评估孕期膳食质量,运用logistic回归分析其与子代先心病的关系,采用受试者工作特征曲线（ROC）构建CDGCI_PW对子代先心病患病的预测模型。结果 共纳入1 422名研究对象,病例组474名,对照组948名。病例组CDGCI_PW评分M（Q₁,Q₃）为46.0（26.0,65.0）分低于对照组60.0（40.0,77.0）分,两组间差异有统计学意义（P<0.001）。与CDGCI_PW评分Q₁组相比,CDGCI_PW评分Q₂、Q₃和Q₄组的子代总先心病发生风险均降低（OR=0.60,95%CI：0.43~0.83;OR=0.64,95%CI：0.45~0.89;OR=0.29,95%CI：0.19~0.44）（趋势检验P<0.001）。CDGCI_PW评分每增加10分,子代总先心病的发生风险降低17%（OR=0.83,95%CI：0.79~0.88）。构建ROC预测的曲线下面积为0.793（95%CI：0.768~0.818）,约登指数最大处的灵敏度为0.740、特异度为0.725。结论 本研究提示改善妇女孕期膳食质量可降低子代先心病的发生风险。     

母亲孕期铁营养与子代先天性心脏病关系的病例对照研究

目的  探讨母亲孕期铁营养与子代先天性心脏病(congenital heart disease,CHD)的关系。方法  数据来源于陕西省2014年1月―2016年12月开展的CHD病例对照研究,对纳入孕妇进行膳食营养问卷调查。采用条件logistic回归分析模型分析母亲孕期铁营养与子代CHD及其各亚型的关系,并进行亚组分析探索其稳定性。结果  在调整了混杂因素后,母亲孕期增补铁剂降低了子代CHD的发生风险(< 30 d：OR=0.54, 95% CI: 0.37~0.79;≥30 d：OR=0.25, 95% CI: 0.16~0.38),孕期膳食铁摄入量较高(≥29 mg/d)降低了子代CHD的发生风险(OR=0.69, 95% CI: 0.54~0.88),亚组分析结果显示,母亲孕期铁营养和子代CHD的关系稳定。此外,母亲孕期增补铁剂≥30 d子代在室间隔缺损(ventricular septal defect, VSD)、房间隔缺损(atrial septal defect, ASD)、动脉导管未闭(patent ductus arteriosus, PDA)、法洛四联症(tetralogy of fallot, TOF)上发生风险均降低,增补铁剂 < 30 d子代在ASD发生风险降低,孕期膳食铁摄入量较高(≥29 mg/d)子代在VSD、PDA发生风险均降低。结论  母亲孕期铁营养水平升高降低了子代CHD的发生风险,孕妇孕期应注意机体铁营养的摄入和补充,促进母婴健康。     

早孕期超声筛查胎儿严重先天性心脏病的应用价值

目的 分析超声心动图对早孕期胎儿筛查严重先天性心脏病（CHD）的应用价值。方法 选取2017年10月至2019年10月在某三甲医院进行产前筛查的2 360例单胎妊娠孕妇,在11～13+6孕周对胎儿行超声心动图,并在中孕期及新生儿期行超声心动图随访,分析早孕期胎儿超声心动图诊断严重CHD的价值。结果 单胎妊娠的2 360例产妇中,早孕期有25例（1.06%）胎儿初筛拟诊为严重CHD;中孕期及对新生儿行超声心动图检查随访,确诊29例（1.23%）为严重CHD。分析显示,早孕期超声筛查胎儿严重CHD,有4例漏诊和5例误诊,诊断符合率为69.0%(20/29)。结论 早孕期超声检查对诊断胎儿严重CHD有重要临床价值。     

Ambient air pollution and congenital heart disease: a register-based study

Maternal exposure to ambient air pollution has increasingly been linked to adverse pregnancy outcomes. The evidence linking this exposure to congenital anomalies is still limited and controversial. This case–control study investigated the association between maternal exposure to ambient particulate matter with aerodynamic diameter less than 10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide, nitric oxide (NO), ozone (O₃), and carbon monoxide (CO) and the occurrence of congenital heart disease in the population of Northeast England (1993–2003). Each case and control was assigned weekly average (weeks 3–8 of pregnancy) of pollutant levels measured by the closest monitor to the mother’s residential postcode. Using exposure as both continuous and categorical variables, logistic regression models were constructed to quantify the adjusted odds ratios of exposure to air pollutants and the occurrence of each outcome group. We found exposure to CO and NO to be associated with ventricular septal defect and cardiac septa malformations. CO was also associated with congenital pulmonary valve stenosis and NO with pooled cases of congenital heart disease and tetralogy of Fallot. Findings for SO₂, O₃ and PM₁₀ were less consistent.     

孕期室外空气污染与早产关系的Meta分析

目的 探讨孕期室外空气污染与早产的关系,为减少早产的发生提供循证医学证据。方法 收集国内外已发表的有关孕期空气污染与早产关系的病例对照研究,采用Stata 12.0软件进行Meta分析。结果 共纳入10篇文献,包括病例48556例,对照548495例。Meta分析显示,整个孕期二氧化氮(NO₂)、PM₁₀、一氧化碳(CO)、PM_2.5、氮氧化物(NO)暴露与早产的合并效应OR值分别为0.960(95%CI:0.935~0.985)、1.068(95%CI:1.035~1.103)、1.122(95%CI:1.078~1.168)、1.110(95%CI:1.043~1.181)、0.994(95%CI:0.973~1.016)。空气污染物NO₂、PM₁₀、二氧化硫(SO₂)暴露时期不同对早产的影响不同,在孕早期暴露其合并效应OR值分别为1.117(95%CI:1.052~1.186)、0.968(95%CI:0.812~1.153)、1.258(95%CI:0.758~2.089);孕中期暴露其合并效应OR值分别为1.000(95%CI:0.982~1.019)、1.127(95%CI:0.896~1.416)、0.977(95%CI:0.711~1.342);孕晚期暴露其合并效应OR值分别为1.006(95%CI:1.002~1.010)、1.053(95%CI:0.973~1.139)、1.003(95%CI:1.000~1.006)。结论 整个孕期暴露于PM₁₀、CO和PM_2.5,孕早期暴露于NO₂,孕晚期暴露于NO₂和SO₂可能与早产的发生有关。     

胎儿先天性心脏病的产前诊断

目的:探讨胎儿先天性心脏病(先心病)发生趋势、危险因素及其产前诊断情况,为早期筛查、诊断及预防提供依据。方法:选择2006～2008年间分娩的活产儿、死胎、死产和治疗性引产儿,进行先心病相关因素分析。结果:3年间共分娩38282例,发现先心病193例,35岁以上高龄孕妇胎儿先心病发生率明显增加。经过系统产检者诊断孕周为(26.86±5.32)周,较未系统产检者明显提前。合并胎儿发育受限、单脐动脉、染色体异常、其他器官发育异常者胎儿先心病发生率也较其他组明显增加。结论:孕前宣教先心病知识,孕期系统产检,特别对有高危因素的孕妇加强监测,必要时行胎儿超声心动图检查,做到早期筛查、诊断及干预,以减少先心病的发生及其不良预后,提高人口素质。     

Maternal exposure to ambient air pollutants and risk of congenital anomalies

Studies have suggested an association between maternal exposure to ambient air pollution and risk of congenital anomaly. The aim of this study is to investigate the association between exposure to black smoke (BS; particulate matter with aerodynamic diameter <4 μg/m³) and sulphur dioxide (SO₂) during the first trimester of pregnancy and risk of congenital anomalies. We used a case-control study design among deliveries to mothers resident in the UK Northern health region during 1985-1990. Case data were ascertained from the population-based Northern Congenital Abnormality Survey and control data from national data on all births. Data on BS and SO₂ from ambient air monitoring stations were used to average the total pollutant exposure during the first trimester of pregnancy over the daily readings from all monitors within 10 km of the mother's residence. Logistic regression models estimated the association via odds ratios. A significant but weak positive association was found between nervous system anomalies and BS (OR=1.10 per increase of 1000 μg/m³ total BS; 95% CI: 1.03, 1.18), but not with other anomaly subtypes. For SO₂, a significant negative association was found with congenital heart disease combined and patent ductus arteriosus: OR significantly <1 for all quartiles relative to the first quartile. The relationship between SO₂ levels and other anomaly subtypes was less clear cut: there were either no significant associations or a suggestion of a U-shaped relationship (OR significantly <1 for moderate compared to lowest levels, but not with high SO₂ levels). Overall, maternal exposure to BS and SO₂ in the Northern region had limited impact on congenital anomaly risk. Studies with detailed exposure assessment are needed to further investigate this relationship.     

Association between maternal exposure to ambient air pollution and congenital heart disease: A register-based spatiotemporal analysis

Recent studies have linked maternal exposure to air pollution with a range of adverse pregnancy outcomes. However, the available evidence linking this exposure to congenital anomalies is still limited and controversial. The present case-control study tested the hypothesis that maternal exposure to ambient black smoke and sulfur dioxide is a risk factor for the occurrence of congenital heart disease. The authors used registry-based data on congenital heart disease for the population of the northeast of England in 1985-1996. A 2-stage spatiotemporal model was developed to predict weekly black smoke and sulfur dioxide levels at each maternal place of residence. Controls were frequency-matched to cases by year of birth (control-to-case ratio of 4:1). Two sets of analyses were performed, using predicted mean values of exposure and 1,000 simulated scenarios of exposure. The analyses were adjusted for birth year, socioeconomic status, infant sex, season of conception, and degree of urbanity. The authors found a weak association between maternal exposure to black smoke and congenital malformations of cardiac chambers and connections only when using exposure as a continuous variable. When the authors used quartiles of exposure, odds ratios did not show a dose-response relation for consecutive quartiles. For sulfur dioxide, the results were not indicative of any association.     

Case report: supraventricular arrhythmia after exposure to concentrated ambient air pollution particles

Context: Exposure to air pollution can result in the onset of arrhythmias.Case presentation: We present a case of a 58-year-old woman who volunteered to participate in a controlled exposure to concentrated ambient particles. Twenty minutes into the exposure, telemetry revealed new onset of atrial fibrillation. The exposure was discontinued, and she reverted to normal sinus rhythm approximately 2 hr later. No abnormality was evident on the volunteer’s laboratory examination or echocardiography that could explain an increased risk for supraventricular arrhythmia.Discussion: Epidemiologic evidence strongly supports a relationship between exposure to air pollutants and cardiovascular disease, but population-level data are not directly relevant to the clinical presentation of individual cases. To our knowledge, this is the only case report of an individual suffering an episode of atrial fibrillation after exposure to an air pollutant. The resolution of the arrhythmia with termination of the particle exposure further supports a causal relationship between the two.Relevance to clinical practice: Exposure to air pollution, including particulate matter, may cause supraventricular arrhythmias.     

Risk factors in congenital heart disease

Risk factors were studied in 801 children with congenital heart disease (CHD) coming from 105,374 consecutive births of known outcome. The incidence of CHD was 7.60 %o. Diagnosis was performed in 66.5% of the cases during the perinatal period. Two-hundred-fifty seven of the cases also had at least one non-cardiac malformation (multiply malformed). Ninety-two cardiac infants (11.47%) had recognized chromosomal and non-chromosomal syndromes. The most frequent non-cardiac malformations were renal, digestive and limb anomalies. For each case a control was studied. The following features were screened: sex ratio, parity and previous pregnancies, parental age, residency, education, ethnic origin, lenght, head circumference and weight at birth, genetic and environmental factors. Odds ratio values were calculated for the risk factors.Weight, length and head circumference at birth of cardiac infants were less than those of controls. The weight of placenta was also lower than in controls. The pregnancy with CHD was more often complicated by hydramnios and threatened abortions, except in infants with isolated CHD. Oliogoamnios was more frequent in pregnancies producing multiply malformed infants and those with recognized syndromes with CHD. One out of four children with CHD had an extracardiac malformation, which is ten times the rate of incidence of malformation in our population.The incidence of CHD in first degree relatives of these infants was 3.0%. These first degree relatives also had more non-cardiac malformations than did those of the controls.Corresponding author.     

先天性心脏病患儿围手术期能量代谢规律研究进展

先天性心脏病住院患儿营养风险比例较高,导致围手术期营养风险提高的因素包括营养不良、肺动脉高压及血流动力学不稳定等.规范化围手术期营养支持可以有效降低患儿营养风险,并已成为先天性心脏病临床治疗的重要方面,而明确围手术期能量代谢规律是其首要问题.本文通过分析先天性心脏病患儿围手术期能量代谢规律的研究成果,为先天性心脏病围手术期临床营养支持工作提供依据.     

淮安市城区大气污染与呼吸系统疾病门诊量的时间序列分析

目的 探讨淮安市城区大气污染物对日呼吸系统疾病发生的急性影响,为呼吸系统疾病的早期预防提供科学依据。方法 收集淮安地区2015全年气象,环保及城区部分医疗机构呼吸系统疾病门诊量数据,采用Poisson分布广义相加模型(GAM)分析主要大气污染物(PM2.5、PM10、SO2、NO2)与呼吸系统疾病门诊量的关系。结果 (1)Spearman等级相关分析发现PM2.5、PM10、SO2和NO2与日呼吸系统疾病门诊量发生成正相关(P<0.01);(2)单污染物模型分析显示:PM2.5、NO2对日呼吸系统疾病门诊量的影响效应均在当日达到最大值,PM10、SO2对日呼吸系统疾病门诊量的影响效应分别在滞后第4天、滞后第3天达到最大值,且日浓度每升高10 μg/m3,对呼吸系统门诊量风险增加分别为0.26%(0.076%~0.44%),2.90%(2.20%~3.60%),0.26%(0.15%~0.38%)和2.40%(1.80%~3.00%);(3)多污染物模型分析显示:SO2与NO2在引入其他污染物时对日呼吸系统疾病门诊量影响均有所下降,且均具有统计学意义。结论 淮安市城区大气污染物(PM2.5、PM10、SO2、NO2)与呼吸系统疾病门诊量密切相关,并且SO2、NO2浓度增加更易增加呼吸系统疾病的发病风险。     

142例胎儿先天性心脏病超声诊断分析

目的探讨胎儿超声心动图在诊断胎儿先天性心脏畸形中的作用及其临床意义。方法回顾性分析了142例胎儿先天性心脏畸形的产前超声诊断,对心脏的主要结构和连接关系进行全面评价。结果142例产前诊断的先天性心脏畸形胎儿中138例经引产后尸体解剖或随访确诊,其中单心房、单心室17例,法洛四联症13例,大动脉转位16例,完全性心内膜垫缺损9例,部分性心内膜垫缺损5例,三尖瓣下移畸形3例,三尖瓣裂1例,完全性肺静脉异位引流2例,左心室发育不良9例,永存动脉干6例,右室双出口7例,单纯室间隔缺损17例,卵圆孔过大13例,单纯继发孔型大房缺3例,主动脉狭窄7例,肺动脉狭窄、闭锁8例,心脏横纹肌瘤5例,冠状动脉漏1例;合并心外畸形84例,其中唇腭裂15例,脊柱裂6例,双侧脑室扩张、脑积水7例,颈淋巴管水囊瘤18例,无脑儿11例,前全脑14例,腹壁缺损2例,膈疝5例,多指多趾4例,并指2例。结论胎儿超声心动图是检查胎儿心脏畸形的有价值的无刨性诊断技术,可以早期发现严重先心病,通过对胎儿时期心脏及心外畸形的全面了解,对临床正确处理提供依据。