儿童智力发育与母亲孕早期血清游离脂肪酸水平关联的巢式病例对照研究

发布时间：2018-01-17 19:10

本文关键词：儿童智力发育与母亲孕早期血清游离脂肪酸水平关联的巢式病例对照研究　出处：《安徽医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的建立母亲孕早期血清游离脂肪酸气相色谱－质谱联用分析方法，探讨儿童智力发育与母亲孕早期血清相应游离脂肪酸水平的关系。方法本研究采用基于队列人群的巢式病例对照研究方法。队列人群为2008年10月－2010年10月在安徽省马鞍山市4所医院的妇幼保健中心第一次产前医学检查并自愿签订知情同意书的孕妇。采用自编的《孕产妇基本信息收集表》收集孕妇的社会人口统计学资料、既往妊娠疾病史和孕前健康状况等信息。在建立孕产妇保健手册的同时，检验科医务人员采集孕妇外周静脉血5mL，离心后-80℃低温保存。在2011年4月－2011年10月期间研究人员运用《贝利婴幼儿发育量表（BISD-CR）（中国城市修订版）》对孕妇分娩的婴幼儿进行智力和运动水平进行评价，收集811名婴幼儿发育评价结果。根据MDI≤P_（x|1.64s）确定为边缘智力或智力障碍的43名儿童作为病例组。依据母亲年龄±2以内、家庭收入和母亲文化程度进行1:3配对，选取129名智力正常儿童作为对照组。2012年2月－2012年9月在安徽医科大学公共卫生学院理化中心实验室对172名儿童的母亲孕早期血清游离脂肪酸进行测定。本研究采用气相色谱－质谱（GC-MS）联用技术，建立血清游离脂肪酸的分析方法，分析出孕妇血清中主要游离脂肪酸的种类及其水平。采用配伍组设计协方差分析和条件logistic逐步回归分析（以SPSS11.0软件中Cox模型模块分析）等统计学方法分析儿童智力发育与母亲孕早期血清游离脂肪酸水平的关系。利用《孕产妇基本信息收集表》中孕妇孕早期食物调查结果分析富含多不饱和脂肪酸的鱼虾类水产品的摄入频率与孕妇孕早期血清中游离脂肪酸水平的关系。结果气相色谱－质谱联用分析方法测得孕妇孕早期血清中20种主要脂肪酸，脂肪酸类型包括饱和脂肪酸、单不饱和脂肪酸、双不饱和脂肪酸、多不饱和脂肪酸和反式脂肪酸。不同脂肪酸之间相关分析结果表明绝大多数脂肪酸之间存在相关关系，两者之间呈正相关关系（P＜0.05），运用系统聚类分析方法可以将所测得20种脂肪酸分为6类。运用配伍组设计协方差分析方法比较低发育商与智力正常组儿童的母亲孕早期血清中脂肪酸水平的差异，结果显示两组儿童的母亲孕早期血清中多不饱和脂肪酸总量（F=7.309，P=0.008）、ω-3多不饱和脂肪酸总量（F=7.971，P=0.006）、ω-6多不饱和脂肪酸总量（F=4.100，P=0.045）、DPA（F=6.115，P=0.015）、DHA（F=6.377，P=0.013）、EPA（F=11.803，P=0.001）、AA（F=4.747，P=0.031）、EPA+DHA（F=7.933，P=0.006）、DHA+AA（F=6.618，P=0.011）的差异具有统计学意义（P＜0.05）。运用条件logistic逐步回归模型（以SPSS11.0软件中Cox模型模块分析）在控制混杂因素后分析孕妇孕早期血清脂肪酸水平和儿童智力发育的关系，各类脂肪酸水平按照P50分为二分类后带入到Cox模型中，结果表明孕妇孕早期血清中高水平的EPA含量是儿童低发育商的保护性因素（β=-1.30，SE=0.43，Wald值=9.04，P=0.003，OR=0.27，95%CI：0.12～0.64）。将《孕产妇基本信息收集表》中孕妇孕早期摄入鱼虾等水产品类食物状况按照摄入频率分组，比较各组孕妇间血清中EPA的水平，趋势检验的结果呈现出随着孕妇孕早期鱼虾等水产品类食物的摄入频率降低，孕妇血清中EPA含量下降的趋势（F=3.41，P=0.019）。结论低发育商与智力正常组儿童的母亲孕早期血清中多不饱和脂肪酸含量差异具有统计学意义，母亲孕早期多不饱和脂肪酸摄入量不足会影响幼儿智力发育，，孕妇应该补充富含多不饱和脂肪酸的鱼虾类食物以促进儿童良好的智力发育。
[Abstract]:Objective to establish a GC-MS method for the determination of serum free fatty acids in the first trimester of pregnancy, and to explore the relationship between intelligence development and serum free fatty acids level in mothers.
Based on the method of case-control study nested case cohort based on maternal and child health care center from October 2008 to 2010 October in Anhui city of Ma'anshan Province in 4 hospitals in the cohort in the first antenatal examination and signed informed consent voluntarily by the self-designed maternal pregnant women. < basic information collection > social demographic data collected in pregnant women information, previous pregnancy history of disease and pre pregnancy health status. In the establishment of the maternal health manual inspection of medical personnel at the same time, acquisition of 5mL in peripheral blood of pregnant women, save the -80 low temperature after centrifugation. During the period of April 2011 October 2011, the researchers used the "Bailey scale of infant development (BISD-CR) (Chinese City Edition) > to evaluate the pregnant infant intelligence and sports level, collect 811 infants developmental evaluation results. According to the MDI P_ (x|1.64s) to determine 43 children edge intelligence or mental disorders as case group. According to the age of the mother is less than 2, 1:3 matched for family income and education level of mother, selected 129 mentally normal children as a control group.2012 in February 2012 on September at the Medical University Of Anhui School of Public Health Science Center Laboratory of 172 children with maternal serum free fatty acids were determined. This study using gas chromatography-mass spectrometry (GC-MS) technique, establish the analysis method of free fatty acid in serum of pregnant women serum free fatty acid species and water level. The block design covariance analysis and logistic regression analysis (Cox model based on SPSS11.0 software module analysis) were used to analyze relationship between children's intelligence development and maternal serum levels of free fatty acids. The maternal < basic information collection table The relationship between the intake frequency of polyunsaturated fatty acids and the level of free fatty acids in the serum of pregnant women was analyzed.
The results of gas chromatography-mass spectrometry analysis method for measuring 20 major fatty acid in the serum of pregnant women in early pregnancy, fatty acid types including saturated fatty acids, monounsaturated fatty acids, - unsaturated fatty acids, polyunsaturated fatty acids and trans fatty acids between different fatty acids. Correlation analysis results show that there is the relationship between the vast majority of fatty acids, they showed positive correlation (P < 0.05), using the cluster analysis method can be measured for 20 kinds of fatty acids are divided into 6 categories. The difference using block design covariance analysis method is relatively low and normal intelligence quotient group of mothers of children with early pregnancy serum fatty acid the results showed that the early pregnancy serum of the two groups in total polyunsaturated fatty acids (F=7.309, P=0.008), -3 polyunsaturated fatty acids (F=7.971, P=0.006), -6 polyunsaturated fatty acids (F=4.100, P=0.04 total amount 5), DPA (F=6.115, P=0.015), DHA (F=6.377, P=0.013), EPA (F=11.803, P=0.001), AA (F=4.747, P=0.031), EPA+DHA (F=7.933, P=0.006), DHA+AA (F=6.618, P=0.011) with statistically significant difference (P < 0.05). Using logistic regression model (in SPSS11.0 software Cox model analysis) analysis of the relationship between serum fatty acid levels and the intelligence development of the children of pregnant women in the control of confounding factors, all kinds of fatty acids to P50 divided into two classification into Cox model. The results show that pregnant women in early pregnancy serum level of the content of EPA is a protective factor for children development taking the (beta =-1.30, SE=0.43, Wald value of =9.04, P=0.003, OR=0.27,95%CI:0.12 ~ 0.64). The basic information collection table > < maternal in pregnant women in early pregnancy, intake of fish and other aquatic products in accordance with the status of food intake frequency were compared between the groups, the level of serum EPA in pregnant women, The results of trend test showed that with the early pregnancy, the intake frequency of fish and shrimp and other aquatic products decreased, and the EPA content of pregnant women decreased (F=3.41, P=0.019).
Statistically significant early pregnancy serum conclusion low developmental quotient and intelligence of children in normal group the content of polyunsaturated fatty acids in different maternal polyunsaturated fatty acid intake will affect the mental development of children, pregnant women should be rich in polyunsaturated fatty acids, fish food to promote children's good mental development.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R179

【共引文献】