不同孕期维生素D水平与早产关联的出生队列研究

发布时间：2018-03-19 23:22

  本文选题：早产　切入点：维生素D　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景及目的早产(preterm birth,PTB)的定义是妊娠满28周到不满37周分娩者。早产是导致新生儿死亡的最主要原因,也是出生后儿童生长发育障碍特别是神经发育障碍的危险因素。早产的危险因素及其具体的发生机制尚不完全清楚。目前认为早产是一种多因素综合征,常见的危险因素包括感染和炎症等。维生素D(VD)影响早产的发生可能是通过调节免疫和体内炎症因子水平途径。目前为止,关于孕期维生素D与早产关联的研究结论上不一致,且前瞻性队列研究较少。而关于同一孕妇孕期维生素D水平在不同妊娠时期的水平变化及与早产关联的研究更是少见报道。因此,本研究懫用前瞻性出生队列研究设计检测育龄妇女孕早、中、晚期维生素D水平,分析相关影响因素,探讨不同孕期维生素D缺乏对早产发生风险的影响以及可能的关键期问题,为降低早产发生率提供科学依据。方法本研究是以马鞍山优生优育队列为基础,开始于2013年5月,截止到2014年9月,收集有关孕母的社会人口学特征问卷(年龄、孕龄、教育程度、居住地、家庭收入等)、既往妊娠史(妊娠次数、不良妊娠史等),孕期补充含VD补充剂情况,妊娠合并症及胎儿出生结局资料等信息。本研究从该队列中随机选择801人收集并采用放射免疫分析法检测孕早、中、晚三期血清维生素D水平。以20ng/ml为分界点将25(OH)D水平分为缺乏和不缺乏组,采用χ2检验、方差分析(ANOVA)和多因素logistic回归分析不同孕期维生素D缺乏的影响因素;分别以20ng/ml和30ng/ml为分界点将维生素D水平分为缺乏组、不足组和充足组;以维生素D分组为不足组作为参照,单因素和多因素二分类logistic回归分析探讨不同孕期母体维生素D缺乏与总早产、自发性早产及医源性早产发病风险的关联。控制年龄、孕前BMI、血清收集季节和孕周等影响孕期维生素D水平的变量后,采用stata10.0分析维生素D与早产发生风险的非线性关联。所有检验均采用双侧检验,P0.05认为差异有统计学意义。结果本研究队列中,25(OH)D水平在不同时点存在变化:孕中期水平最高(平均为29.1±12.1ng/ml,缺乏率最低为25.5%),孕晚期水平其次(平均为20.1±9.7ng/ml,缺乏率为59.6%),孕早期水平最低(平均为19.2±8.4ng/ml,缺乏率最高为60.9%);孕早、中、晚期维生素D水平均存在季节差异:血清收集季节为夏秋季组的25(OH)D水平显著高于冬春季组(P0.001);本研究发现除了季节对孕期维生素D水平影响外,年龄≥30岁是孕中期维生素D缺乏的保护因素,孕前BMI≥24kg/m2会增加孕中期维生素D缺乏的风险;年龄≥30岁、初次妊娠是孕晚期维生素D缺乏的保护因素;血清收集季节在夏秋季、孕期补充含VD的孕妇孕早、中、晚期维生素D缺乏的风险均显著降低;与维生素D不足组相比,多因素分析结果显示孕早期和孕晚期维生素D缺乏和充足组早产的发生风险未见明显增加(孕早期OR值及95%CI分别为:0.89(0.40~1.98)、0.26(0.03~2.04);孕晚期分别为:0.82(0.23~2.98)、3.48(0.90~13.48));孕中期维生素D缺乏组总早产以及自发性早产和医源性早产的发生风险均显著增加(总早产:4.00(1.46~10.94);自发性早产:2.63(1.12~6.16);医源性早产:10.48(1.34~81.71)),且两者存在非线性关联(P=0.026):当维生素D水平小于20.2ng/ml时,早产风险显著增加;当孕中期维生素D水平在20~24ng/ml时,早产的发生风险最低;当超过24ng/ml时,早产风险趋于平缓。结论研究队列中妊娠期女性维生素D缺乏率较高,特别是孕早期和孕晚期;研究队列中,孕期和季节对25(OH)D水平有影响;年龄、孕前BMI、妊娠次数、血清收集季节、补充含VD补充剂等均对孕期维生素D有影响;研究队列中孕中期维生素D缺乏会增加总早产以及自发性早产和医源性早产的发生风险。
[Abstract]:Background and objective: premature delivery (preterm birth, PTB) is defined as 28 weeks less than 37 weeks of pregnancy with preterm delivery. Is the main cause of neonatal death, and after the birth of children's growth and development disorder especially risk factors for neurodevelopmental disorders. The risk factors of premature delivery and its specific pathogenesis is not entirely clear now think the preterm birth is a multifactorial syndrome, common risk factors include infection and inflammation. The vitamin D (VD) effect of preterm birth may be through the regulation of immune and inflammatory factor level way. So far, no consistent conclusions about vitamin D and preterm birth associated, and prospective cohort less research. Study on changes in different period of pregnancy pregnant women with the same level of vitamin D levels and associated with preterm birth is rarely reported. Therefore, forward-looking in this study Zhi The birth of women of childbearing age cohort study design, advanced detection of early pregnancy, vitamin D levels, analyze the related factors, to explore the different effects of vitamin D deficiency during pregnancy on risk of preterm birth and critical period may, in order to reduce the incidence of premature delivery and provide a scientific basis. This study is based on the Ma'anshan birth cohort based, began in the in May 2013, by the end of September 2014, the social demographic characteristics questionnaire about pregnant women (age, gestational age, educational level, residence, family income, previous pregnancy history) (pregnancy, adverse pregnancy history), supplemented with VD supplements during pregnancy, pregnancy complications and fetal birth outcome data and other information. The research collected randomly selected from the cohort of 801 people and analysis were measured by radioimmunoassay in the early, late in the three period, the level of serum vitamin D. With 20ng/ml as the boundary point 25 (OH) D levels were divided into 缂轰箯鍜屼笉缂轰箯缁，

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