父源性影响因素及交互作用与子代先天性心脏病关系的初步研究

目的探讨父源性影响因素及其与家族史交互作用对子代先天性心脏病(简称先心病)风险的关系。方法采用以医院为基础的病例对照研究设计,按照标准选择144例先心病患儿为病例组,168例无先心病或其他畸形的就诊患儿为对照组,对其父母进行结构式问卷调查,采用单因素和多因素非条件logistic回归模型,进行影响因素关联强度及交互作用分析。结果病例组和对照组一般情况指标差异无统计学意义。阳性家族史是先心病的危险因素,OR=3.459(95%CI:1.819～6.579)。调整混杂因素后,筛选出3个父源性暴露因素与子代先心病有关联,分别是有害化学物接触、饮酒指数阳性、负性事件阳性,关联强度分别为OR=5.551(95%CI:2.023～15.232)、OR=3.522(95%CI:2.015～6.157)、OR=3.380(95%CI:1.838～6.219);先心病家族史与父亲有害化学物接触以及饮酒指数之间具有正相加交互作用,调整混杂因素前后,家族史与化学物接触的RERI为8.465、8.991,AP(AB)为34.56%、35.67%,AP*(AB)为36.29%、37.48%;与饮酒指数之间的RERI为7.113、7.832,AP(AB)为30.18%、32.07%,AP*(AB)为33.17%、33.89%。结论父源性危险因素可增加子代先心病发生的风险并与家族史具有协同作用。

A preliminary study on paternal risk factors for congenital heart disease

Objective To study the correlationship between congenital heart disease（CHD） and paternal risk factors as well as family CHD history,and also their interaction on the occurance of the disease.Methods A case-control study was conducted in which 144 cases and 168 controls were enrolled according to the criterions,and their parents were required to complete a questionnaire including basic demographic information,family history,occupational history,chemical exposure,life style（smoking,drinking） and Life Events Checklist.The Logistic regression analysis was used to analyze the correlationship and interaction of the factors.Results The analysis revealved that CHD was highly associated with family history with the OR of 3.459,95%CI：1.819-6.579.After adjusting the confounding factors,three major paternal risk factors were identified to be correlated to the occurrence of CHD,including chemical exposure history（OR=5.551,95%CI：2.023-15.232）,positive drinking index（OR=3.522,95%CI：2.015-6.157） and negative life events（OR=3.380,95%CI：1.838-6.219）.Meanwhile,the interaction analysis suggested that family history of CHD interacted with chemical exposure or positive drinking index which synergistically increased the risk of having CHD of offsprings.After adjusting the confounding factors,the RERI of family history and chemical contact history was 8.465 and 8.991 with AP（AB） of 34.56% and 35.67% and AP＊（AB） of 36.29% and 37.48.Also the RERI of family history and positive drinking index was found to be 7.113 and 7.832 with AP（AB） of 30.18% and 32.07% and AP＊（AB） of 33.17% and 33.89%.Conclusions Multiplepaternal influencing factors play a certain role in the occurrence of congenital heart disease,also these factors interact with positive family history of CHD and synergistically raises the risk of CHD.