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目的探讨多种微量元素与神经管畸形的关系,及其他危险因素。方法采用1:1配比的病例对照研究方法,在“中美出生缺陷监测系统”中,募集新近发生的88对神经管畸形病例和对照, 问卷调查出生缺陷其他已知危险因素的暴露情况;采用微波消化、原子吸收、ICP质谱分析等方法,测定了病例和对照孕妇怀孕早期阶段,毛发中必需微量元素(铬、锰、铜、锌、钴、钼)、毒性元素(铅、砷、镉、汞)以及部分稀土元素(钇、镧、镨、钕)的含量;用Cox比例风险模型进行了流行病学多因素分析。结果孕期发热是神经管畸形的危险因素(OR=6.525,P=0.034),而孕妇早期发锌含量(OR= 0.541 μg/100 g,P=0.02)和产前检查次数(OR=0.634,P<0.001)作为保护性因素保留在多因素模型中。结论孕早期锌缺乏可能是神经管畸形的原因之一,避免孕早期发热性感染,以及定期产前检查,可降低神经管畸形的发生率。
Objective To explore the relationship between multiple trace elements and neural tube defects and other risk factors. Methods A case-control study with a 1: 1 ratio was used to collect 88 recent cases of neural tube defects and controls in the “Birth Defects Monitoring System of China and the United States” and to investigate the exposure of other known risk factors of birth defects. The contents of trace elements (chromium, manganese, copper, zinc, cobalt and molybdenum), toxic elements (lead, arsenic and cadmium) in the pregnant and early pregnant women were measured by microwave digestion, atomic absorption spectrometry and ICP- , Mercury), and some rare earth elements (yttrium, lanthanum, praseodymium and neodymium). Cox proportional hazards model was used to conduct epidemiological multivariate analysis. Results Pregnancy fever was a risk factor of neural tube defects (OR = 6.525, P = 0.034), but the zinc content in early pregnant women (OR = 0.541 μg / 100 g, P = 0.02) and prenatal diagnosis (OR = 0.634, P <0.001) was retained as a protective factor in the multivariate model. Conclusions Zinc deficiency in early pregnancy may be one of the causes of neural tube deformity. Avoiding febrile febrile infection in early pregnancy and regular antenatal examination may reduce the incidence of neural tube defects.