孕妇血清镉水平与小于胎龄儿和早产关联的出生队列研究
发布时间：2018-07-15 11:16
【摘要】：目的:本课题以大样本人群作为研究对象,采用出生队列研究方法分析孕妇血清镉水平与早产和小于胎龄儿的关联及其部分机制。方法:本课题的研究对象来自于中国安徽出生队列(C-ABCS)合肥亚队列,该队列共招募了4358例孕妇作为研究对象,按照本课题的设计要求和标准留取了3254例单胎母婴,采集所有的孕妇血清,并跟踪回访收取了孕妇的人口学特征和新生儿的部分资料。采用石墨炉原子吸收分光光度法(GFAAS)检测孕妇血清镉浓度,用Logistic回归分析计算孕妇血清镉水平与早产和小于胎龄儿关联的比值比(OR)以及95%可信区间(CI);在控制了孕妇年龄、孕前体质指数(BMI)、血清采集时间和家庭人均月收入等混杂因素后计算出调整OR。同时,本研究采用三分位数的方法将孕妇血清镉的浓度进行了分级,分别比较了孕妇在不同镉暴露程度下,其子代出现早产和小于胎龄儿的风险,也进一步分析了孕妇不同孕龄血清镉水平与早产和小于胎龄儿之间的关联。结果:本研究中,共测量了3254名孕妇的血清Cd的浓度,其平均血清Cd浓度为0.89μg/L,最小值为0.04μg/L,最大值为8.08μg/L,中位数为0.79μg/L。首先分析了孕妇血清镉水平与小于胎龄儿风险的关联,将孕妇低水平血清镉组浓度(L-Cd)定义为小于1.06μg/L,孕妇高水平血清镉组浓度(H-Cd)定义为大于等于1.06μg/L。结果显示,孕妇H-Cd组小于胎龄儿的发生率10.6%明显高于孕妇L-Cd组小于胎龄儿的发生率7.5%(OR:1.45;95%CI:1.11,1.90;P=0.007),调整OR为1.43(95%CI;1.09,1.88;P=0.009);在孕中期,孕妇H-Cd组小于胎龄儿的发生率11.2%明显高于孕妇L-Cd组小于胎龄儿的发生率7.3%(OR:1.59;95%CI:1.15,2.21;P=0.006),调整OR为1.57(95%CI:1.13,2.19;P=0.007)。紧接着,本研究分析了孕妇血清镉水平与早产的关联,将孕妇血清镉浓度分为高中低三个等级,其中孕妇高水平血清镉组浓度(H-Cd)界定为0.95μg/L,中水平血清镉组浓度(M-Cd)界定为0.65-0.94μg/L,孕妇低水平血清镉组浓度(L-Cd)界定为0.65μg/L。结果显示,孕妇L-Cd组、孕妇M-Cd组和孕妇H-Cd组的早产率分别为3.5%,3.8%和9.4%。孕妇H-Cd组胎儿早产的发生率明显高于孕妇L-Cd组胎儿早产的发生率(OR:2.86;95%CI:1.95,4.19;P0.001),调整的OR为3.02(95%CI:2.02,4.50;P0.001)。同时,本研究还分析了孕早、中期孕妇血清镉水平与早产的关联。在孕早期,孕妇L-Cd组,孕妇M-Cd组和孕妇H-Cd组的早产率分别为2.3%,4.0%和8.6%。其中孕妇H-Cd组胎儿早产的发生率明显高于孕妇L-Cd组胎儿早产的发生率(OR:4.46;95%CI:2.01,9.93;P0.001),调整的OR为4.51(95%CI:2.02,10.06;P0.001)。在孕中期,孕妇L-Cd组,孕妇M-Cd组和孕妇H-Cd组的早产率分别为4.2%,3.7%和9.8%,其中孕妇H-Cd组胎儿早产的发生率明显高于孕妇L-Cd组胎儿早产的发生率(OR:2.72;95%CI:1.71,4.31;P0.001),调整的OR为2.68(95%CI:1.68,4.27;P0.001)。最后,本研究还分析了孕妇血清镉水平与不同程度早产的关联。孕妇H-Cd组的胎儿中期早产率为2.2%显著高于孕妇L-Cd组胎儿中期早产率的0.8%(OR:2.94;95%CI:1.55,5.59;P0.001),调整的OR为2.95(95%CI:1.55,5.62;P0.001)。孕妇H-Cd组的胎儿晚期早产率为8.4%显著高于孕妇L-Cd组胎儿晚期早产率2.1%(OR:4.27;95%CI:2.95,6.19;P0.001),调整OR为4.25(95%CI:2.93,6.17;P0.001)。结论:孕期母体血清镉的水平与小于胎龄儿和早产发生风险呈正相关
[Abstract]:Objective: to analyze the relationship between maternal serum cadmium level and premature birth and less than gestational age by the method of birth cohort study in this subject. Methods: the object of this study was from the Anhui Hefei cohort (C-ABCS) in Hefei, China, which recruited 4358 pregnant women as a study. In accordance with the design requirements and standards of the subject, 3254 cases of single pregnant mother and baby were collected, all the pregnant women's serum were collected, and the demographic characteristics of pregnant women and some data of the newborn were collected after the follow-up visit. The serum cadmium concentration of pregnant women was detected by Graphite Furnace atomic absorption spectrophotometry (GFAAS), and the maternal serum was calculated by Logistic regression analysis. The ratio Ratio (OR) and 95% confidence interval (CI) were associated with preterm birth and less than gestational age. The concentration of serum cadmium in pregnant women was graded by three digits after controlling the age of pregnant women, the preconception body mass index (BMI), the time of serum collection and the monthly income of the family. The risk of preterm birth and less than gestational age of pregnant women at different levels of cadmium exposure was compared, and the correlation between serum cadmium level and preterm birth and less gestational age in pregnant women at different gestational ages was further analyzed. Results: in this study, the serum concentration of Cd in 3254 pregnant women was measured, and the average serum Cd concentration was 0.89 g/L, The minimum value of 0.04 mu g/L, the maximum value of 8.08 mu g/L, and the median of 0.79 mu g/L., first analyzed the correlation between the serum cadmium level of pregnant women and the risk of less than fetal age. The low level serum cadmium concentration (L-Cd) of pregnant women was defined as less than 1.06 Mu g/L, and the high level serum cadmium group concentration (H-Cd) of pregnant women was defined as the result of 1.06 mu g/L. and H-Cd group of pregnant women. The incidence of less than gestational age was 10.6% significantly higher than that of pregnant women in group L-Cd less than 7.5% (OR:1.45; 95%CI:1.11,1.90; P=0.007), and OR was 1.43 (95%CI; 1.09,1.88; P=0.009); in the middle of pregnancy, the incidence of group H-Cd less than fetal age 11.2% was significantly higher than that of pregnant women's L-Cd group less than 7.3% (OR:1.59; 95%CI:1.15,2.). 21; P=0.006), OR was adjusted to 1.57 (95%CI:1.13,2.19; P=0.007). In this study, the relationship between serum cadmium level and preterm birth of pregnant women was analyzed. The serum cadmium concentration in pregnant women was divided into three grades in high school, and the high level of maternal serum cadmium concentration (H-Cd) in pregnant women was defined as 0.95 mu g/L, and the level of serum cadmium group concentration (M-Cd) was defined as 0.65-0.94 u g/L, and pregnancy was defined as 0.65-0.94 u g/L. The low level of serum cadmium concentration (L-Cd) defined as 0.65 mu g/L. showed that the preterm birth rate of pregnant women L-Cd group, pregnant woman M-Cd group and pregnant H-Cd group was 3.5%, and the incidence rate of fetal premature delivery in H-Cd group of pregnant women was significantly higher than that of pregnant women L-Cd group (OR:2.86; 95%CI:1.95,4.19; P0.001), and the adjusted OR was 3.02. .50; P0.001). At the same time, this study also analyzed the relationship between early pregnancy and maternal serum cadmium levels and preterm birth. In the early pregnancy, the pregnant women L-Cd, the pregnant M-Cd group and the H-Cd group were 2.3%, 4% and 8.6%. respectively. The incidence of premature birth in H-Cd group was significantly higher than that of the pregnant L-Cd group (OR:4.46; 95%CI:2.01,). 9.93; P0.001), the adjusted OR was 4.51 (95%CI:2.02,10.06; P0.001). The premature birth rate of pregnant women in group L-Cd, pregnant woman M-Cd group and pregnant woman H-Cd group was 4.2%, 3.7% and 9.8% respectively. The incidence of premature birth in pregnant H-Cd group was significantly higher than that of pregnant women in group L-Cd (OR:2.72; 95%CI:1.71,4.31; P0.001) and 2.68 I:1.68,4.27; P0.001). Finally, the study also analyzed the association of serum cadmium levels in pregnant women with different degrees of preterm birth. The mid-term premature birth rate of fetal H-Cd was 2.2% significantly higher than that of pregnant women in group L-Cd, 0.8% (OR:2.94; 95%CI:1.55,5.59; P0.001), and the adjusted OR was 2.95 (95%CI:1.55,5.62; P0.001). The preterm birth rate was 8.4% significantly higher than that of pregnant women in group L-Cd (OR:4.27; 95%CI:2.95,6.19; P0.001), and OR was 4.25 (95%CI:2.93,6.17; P0.001). Conclusion: the level of maternal serum cadmium in pregnant women is positively correlated with the risk of less than gestational age and the risk of premature birth.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.21
[Abstract]:Objective: to analyze the relationship between maternal serum cadmium level and premature birth and less than gestational age by the method of birth cohort study in this subject. Methods: the object of this study was from the Anhui Hefei cohort (C-ABCS) in Hefei, China, which recruited 4358 pregnant women as a study. In accordance with the design requirements and standards of the subject, 3254 cases of single pregnant mother and baby were collected, all the pregnant women's serum were collected, and the demographic characteristics of pregnant women and some data of the newborn were collected after the follow-up visit. The serum cadmium concentration of pregnant women was detected by Graphite Furnace atomic absorption spectrophotometry (GFAAS), and the maternal serum was calculated by Logistic regression analysis. The ratio Ratio (OR) and 95% confidence interval (CI) were associated with preterm birth and less than gestational age. The concentration of serum cadmium in pregnant women was graded by three digits after controlling the age of pregnant women, the preconception body mass index (BMI), the time of serum collection and the monthly income of the family. The risk of preterm birth and less than gestational age of pregnant women at different levels of cadmium exposure was compared, and the correlation between serum cadmium level and preterm birth and less gestational age in pregnant women at different gestational ages was further analyzed. Results: in this study, the serum concentration of Cd in 3254 pregnant women was measured, and the average serum Cd concentration was 0.89 g/L, The minimum value of 0.04 mu g/L, the maximum value of 8.08 mu g/L, and the median of 0.79 mu g/L., first analyzed the correlation between the serum cadmium level of pregnant women and the risk of less than fetal age. The low level serum cadmium concentration (L-Cd) of pregnant women was defined as less than 1.06 Mu g/L, and the high level serum cadmium group concentration (H-Cd) of pregnant women was defined as the result of 1.06 mu g/L. and H-Cd group of pregnant women. The incidence of less than gestational age was 10.6% significantly higher than that of pregnant women in group L-Cd less than 7.5% (OR:1.45; 95%CI:1.11,1.90; P=0.007), and OR was 1.43 (95%CI; 1.09,1.88; P=0.009); in the middle of pregnancy, the incidence of group H-Cd less than fetal age 11.2% was significantly higher than that of pregnant women's L-Cd group less than 7.3% (OR:1.59; 95%CI:1.15,2.). 21; P=0.006), OR was adjusted to 1.57 (95%CI:1.13,2.19; P=0.007). In this study, the relationship between serum cadmium level and preterm birth of pregnant women was analyzed. The serum cadmium concentration in pregnant women was divided into three grades in high school, and the high level of maternal serum cadmium concentration (H-Cd) in pregnant women was defined as 0.95 mu g/L, and the level of serum cadmium group concentration (M-Cd) was defined as 0.65-0.94 u g/L, and pregnancy was defined as 0.65-0.94 u g/L. The low level of serum cadmium concentration (L-Cd) defined as 0.65 mu g/L. showed that the preterm birth rate of pregnant women L-Cd group, pregnant woman M-Cd group and pregnant H-Cd group was 3.5%, and the incidence rate of fetal premature delivery in H-Cd group of pregnant women was significantly higher than that of pregnant women L-Cd group (OR:2.86; 95%CI:1.95,4.19; P0.001), and the adjusted OR was 3.02. .50; P0.001). At the same time, this study also analyzed the relationship between early pregnancy and maternal serum cadmium levels and preterm birth. In the early pregnancy, the pregnant women L-Cd, the pregnant M-Cd group and the H-Cd group were 2.3%, 4% and 8.6%. respectively. The incidence of premature birth in H-Cd group was significantly higher than that of the pregnant L-Cd group (OR:4.46; 95%CI:2.01,). 9.93; P0.001), the adjusted OR was 4.51 (95%CI:2.02,10.06; P0.001). The premature birth rate of pregnant women in group L-Cd, pregnant woman M-Cd group and pregnant woman H-Cd group was 4.2%, 3.7% and 9.8% respectively. The incidence of premature birth in pregnant H-Cd group was significantly higher than that of pregnant women in group L-Cd (OR:2.72; 95%CI:1.71,4.31; P0.001) and 2.68 I:1.68,4.27; P0.001). Finally, the study also analyzed the association of serum cadmium levels in pregnant women with different degrees of preterm birth. The mid-term premature birth rate of fetal H-Cd was 2.2% significantly higher than that of pregnant women in group L-Cd, 0.8% (OR:2.94; 95%CI:1.55,5.59; P0.001), and the adjusted OR was 2.95 (95%CI:1.55,5.62; P0.001). The preterm birth rate was 8.4% significantly higher than that of pregnant women in group L-Cd (OR:4.27; 95%CI:2.95,6.19; P0.001), and OR was 4.25 (95%CI:2.93,6.17; P0.001). Conclusion: the level of maternal serum cadmium in pregnant women is positively correlated with the risk of less than gestational age and the risk of premature birth.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.21
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