早产危险因素的1∶1病例对照研究

doi:10.3969/j.issn.1004-583X.2021.06.012

摘要/Abstract

摘要：

目的探讨早产的主要危险因素,为降低早产发生率提供理论依据。方法系统抽样选取2018年1月1日至2018年12月31日青岛大学附属医院新生儿科NICU收治122例早产儿和122例足月儿及产妇进行问卷调查。分析早产危险因素。结果早产组的产妇在多胎妊娠、胎盘异常、宫颈机能不全、胎儿宫内窘迫、妊娠期高血压、试管婴儿、胎膜早破、阴道流血、居住在乡镇及农村的比例高于足月组(P均<0.05),是新生儿早产的独立危险因素。结论产妇存在多胎妊娠、胎盘异常、宫颈机能不全、胎儿宫内窘迫、妊娠期高血压、试管婴儿、胎膜早破、阴道流血、居住在乡镇及农村是新生儿早产的危险因素。

关键词: 早产, 危险因素, 病例对照研究

Abstract:

Objective To explore the main risk factors of premature delivery(PD) for the guidance for reducing preterm birth rate. Methods According to the ratio of 1∶1, 122 PD and mothers (PD group) and 122 full-term infants and mothers (full-term group) who came from Department of Neonatal Intensive Care Unit of the Affiliated Hospital of Qingdao University were enrolled by systematic sampling. The hospitalization time was from January 1, 2018 to December 31, 2018. A questionnaire survey in two groups was performing to analyze risk factors for PD. Results Independent risk factors for PD were multiple pregnancy, abnormal placenta, cervical insufficiency, fetal distress, gestational hypertension, test-tube baby, premature rupture of membranes, vaginal bleeding, living in township and rural, which were higher in PD group than full-term group (all P<0.05). Conclusion The risk factors of PD were multiple pregnancy, abnormal placenta, cervical insufficiency, fetal distress, gestational hypertension, test-tube baby, premature rupture of membranes, vaginal bleeding, living in township and rural.

Key words: premature birth, risk factor, case-control studies

中图分类号:

R714.21

安增岳, 张俏俏, 张沂洁, 李玉美, 姜红. 早产危险因素的1∶1病例对照研究[J]. 临床荟萃, 2021, 36(6): 540-544.

An Zengyue, Zhang Qiaoqiao, Zhang Yijie, Li Yumei, Jiang Hong. A Case-control study of risk factors for premature delivery[J]. Clinical Focus, 2021, 36(6): 540-544.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.06.012

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I6/540

图/表 2

参考文献 23

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项目	早产组(n=122)	足月组(n=122)	统计值	P值
年龄(岁)	32.54±5.24	32.54±5.06	t=0.000	1.000
20~35岁[例(%)]	79(64.8)	77(63.1)	χ²=0.071	0.018
>35岁[例(%)]	43(35.2)	45(36.9)	χ²=0.018	0.894
孕次[例(%)]
1次 ≥2次	43(35.2) 79(64.8)	38(31.1) 84(68.9)	χ²=0.316	0.752
产次[例(%)]
1次 ≥2次	53(43.4) 69(56.6)	58(47.5) 64(52.5)	χ²=0.244	0.807
早产史[例(%)]	9(7.4)	1(0.8)		0.019^a
流产史[例(%)]	57(46.7)	56(45.9)	χ²=0.016	0.898
自然流产史	45(36.9)	46(37.7)	χ²=0.018	0.895
人工流产史	19(15.6)	19(15.6)	χ²=0.000	1.000
职业类型[例(%)]
工人或农民其他职业	67(54.9) 55(45.1)	51(41.8) 71(58.2)	χ²=4.201	0.040
居住地[例(%)]
乡镇及农村城市	58(47.5) 64(52.5)	39(32.0) 83(68.0)	χ²=6.177	0.013
文化水平[例(%)]
高中及以下大学及以上	54(44.3) 68(55.7)	43(35.2) 79(64.8)	χ²=2.071	0.150
试管婴儿[例(%)]	16(13.1)	4(3.3)		0.009^a
多胎妊娠[例(%)]	29(23.8)	2(1.6)		<0.001^a
妊娠期高血压[例(%)]	39(32.0)	13(10.7)	χ²=16.512	<0.001
妊娠期糖尿病[例(%)]	24(19.7)	25(20.5)	χ²=0.026	0.873
胎膜早破[例(%)]	32(26.2)	16(13.1)	χ²=6.639	0.010
胎盘异常[例(%)]	22(18.0)	3(2.5)		<0.001^a
阴道流血[例(%)]	43(35.2)	20(16.4)	χ²=11.319	0.001
羊水量异常[例(%)]	8(6.6)	10(8.2)	χ²=0.277	0.599
胎位异常[例(%)]	10(8.2)	6(4.9)	χ²=1.070	0.301
脐带绕颈[例(%)]	17(13.9)	14(11.5)	χ²=0.333	0.564
胎儿宫内窘迫[例(%)]	12(9.8)	3(2.5)	χ²=4.546	0.033
剖宫产史[例(%)]	37(30.3)	44(36.1)	χ²=0.906	0.415
生殖系统畸形[例(%)]	3(2.5)	1(0.8)		0.622^a
宫颈机能不全[例(%)]	15(12.3)	1(0.8)		<0.001^a
孕前孕早期补充叶酸[例(%)]	105(86.1)	93(76.2)	χ²=3.858	0.071
胆汁淤积[例(%)]	1(0.8)	0(0)		1.000^a
妊娠并其他内科疾病[例(%)]	44(36.1)	45(36.9)	χ²=0.033	0.894
意外伤害[例(%)]	2(1.6)	0(0)		0.498^a
孕前BMI[例(%)]
BMI<18.5 kg/m²	8(6.6)	9(7.4)
18.5≤BMI<24.0 kg/m²	68(55.7)	77(63.1)	χ²=1.998	0.584
24.0≤BMI<28 kg/m²	30(24.6)	25(20.5)
BMI≥28 kg/m²	16(13.1)	11(9.0)
妊娠间隔(月)	36.0(9.0,84.0)	30.0(12.0, 84.0)	U=0.129	0.897
孕期接触X线[例(%)]	0/115(0)	4/115(3.5)		0.122^a
孕期装修[例(%)]	17/115(14.8)	13/115(11.3)	χ²=0.613	0.434
孕期饲养宠物[例(%)]	5/115(4.3)	6/115(5.2)	χ²=0.095	0.757
睡眠时间(h)	8.0(8.0, 10.0)	8.0(8.0, 9.0)	U=1.963	0.050
使用电脑(h)	1.0(0.0,5.8)	2.0(0.0, 6.0)	U=1.803	0.071
被动吸烟[例(%)]	29/111(26.1)	30/120(25.2)	χ²=0.023	0.880
咖啡因摄入[例(%)]	3/115(2.6)	8/115(7.0)		0.215^a

项目	早产组(n=122)	足月组(n=122)	统计值	P值
年龄(岁)	32.54±5.24	32.54±5.06	t=0.000	1.000
20~35岁[例(%)]	79(64.8)	77(63.1)	χ²=0.071	0.018
>35岁[例(%)]	43(35.2)	45(36.9)	χ²=0.018	0.894
孕次[例(%)]
1次 ≥2次	43(35.2) 79(64.8)	38(31.1) 84(68.9)	χ²=0.316	0.752
产次[例(%)]
1次 ≥2次	53(43.4) 69(56.6)	58(47.5) 64(52.5)	χ²=0.244	0.807
早产史[例(%)]	9(7.4)	1(0.8)		0.019^a
流产史[例(%)]	57(46.7)	56(45.9)	χ²=0.016	0.898
自然流产史	45(36.9)	46(37.7)	χ²=0.018	0.895
人工流产史	19(15.6)	19(15.6)	χ²=0.000	1.000
职业类型[例(%)]
工人或农民其他职业	67(54.9) 55(45.1)	51(41.8) 71(58.2)	χ²=4.201	0.040
居住地[例(%)]
乡镇及农村城市	58(47.5) 64(52.5)	39(32.0) 83(68.0)	χ²=6.177	0.013
文化水平[例(%)]
高中及以下大学及以上	54(44.3) 68(55.7)	43(35.2) 79(64.8)	χ²=2.071	0.150
试管婴儿[例(%)]	16(13.1)	4(3.3)		0.009^a
多胎妊娠[例(%)]	29(23.8)	2(1.6)		<0.001^a
妊娠期高血压[例(%)]	39(32.0)	13(10.7)	χ²=16.512	<0.001
妊娠期糖尿病[例(%)]	24(19.7)	25(20.5)	χ²=0.026	0.873
胎膜早破[例(%)]	32(26.2)	16(13.1)	χ²=6.639	0.010
胎盘异常[例(%)]	22(18.0)	3(2.5)		<0.001^a
阴道流血[例(%)]	43(35.2)	20(16.4)	χ²=11.319	0.001
羊水量异常[例(%)]	8(6.6)	10(8.2)	χ²=0.277	0.599
胎位异常[例(%)]	10(8.2)	6(4.9)	χ²=1.070	0.301
脐带绕颈[例(%)]	17(13.9)	14(11.5)	χ²=0.333	0.564
胎儿宫内窘迫[例(%)]	12(9.8)	3(2.5)	χ²=4.546	0.033
剖宫产史[例(%)]	37(30.3)	44(36.1)	χ²=0.906	0.415
生殖系统畸形[例(%)]	3(2.5)	1(0.8)		0.622^a
宫颈机能不全[例(%)]	15(12.3)	1(0.8)		<0.001^a
孕前孕早期补充叶酸[例(%)]	105(86.1)	93(76.2)	χ²=3.858	0.071
胆汁淤积[例(%)]	1(0.8)	0(0)		1.000^a
妊娠并其他内科疾病[例(%)]	44(36.1)	45(36.9)	χ²=0.033	0.894
意外伤害[例(%)]	2(1.6)	0(0)		0.498^a
孕前BMI[例(%)]
BMI<18.5 kg/m²	8(6.6)	9(7.4)
18.5≤BMI<24.0 kg/m²	68(55.7)	77(63.1)	χ²=1.998	0.584
24.0≤BMI<28 kg/m²	30(24.6)	25(20.5)
BMI≥28 kg/m²	16(13.1)	11(9.0)
妊娠间隔(月)	36.0(9.0,84.0)	30.0(12.0, 84.0)	U=0.129	0.897
孕期接触X线[例(%)]	0/115(0)	4/115(3.5)		0.122^a
孕期装修[例(%)]	17/115(14.8)	13/115(11.3)	χ²=0.613	0.434
孕期饲养宠物[例(%)]	5/115(4.3)	6/115(5.2)	χ²=0.095	0.757
睡眠时间(h)	8.0(8.0, 10.0)	8.0(8.0, 9.0)	U=1.963	0.050
使用电脑(h)	1.0(0.0,5.8)	2.0(0.0, 6.0)	U=1.803	0.071
被动吸烟[例(%)]	29/111(26.1)	30/120(25.2)	χ²=0.023	0.880
咖啡因摄入[例(%)]	3/115(2.6)	8/115(7.0)		0.215^a

影响因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
影响因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
多胎妊娠	3.368	0.827	16.603	<0.001	29.014	5.742	146.606
胎盘异常	2.801	0.737	14.452	<0.001	16.466	3.885	69.796
妊娠期高血压	2.064	0.458	20.283	<0.001	7.876	3.208	19.336
胎膜早破	1.472	0.458	10.340	0.001	4.358	1.777	10.690
阴道流血	1.193	0.462	6.670	0.010	3.296	1.333	8.150
胎儿宫内窘迫	2.103	0.828	6.451	0.011	8.189	1.616	41.491
早产史	2.395	1.306	3.364	0.067	10.970	0.848	141.847
试管婴儿	1.763	0.758	5.417	0.020	5.832	1.321	25.748
宫颈机能不全	2.635	1.119	5.543	0.019	13.944	1.555	125.044
体力劳动	0.704	0.379	3.445	0.063	2.022	0.961	4.254
居住地乡镇及农村	0.933	0.376	6.155	0.013	2.541	1.216	5.310

影响因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
影响因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
多胎妊娠	3.368	0.827	16.603	<0.001	29.014	5.742	146.606
胎盘异常	2.801	0.737	14.452	<0.001	16.466	3.885	69.796
妊娠期高血压	2.064	0.458	20.283	<0.001	7.876	3.208	19.336
胎膜早破	1.472	0.458	10.340	0.001	4.358	1.777	10.690
阴道流血	1.193	0.462	6.670	0.010	3.296	1.333	8.150
胎儿宫内窘迫	2.103	0.828	6.451	0.011	8.189	1.616	41.491
早产史	2.395	1.306	3.364	0.067	10.970	0.848	141.847
试管婴儿	1.763	0.758	5.417	0.020	5.832	1.321	25.748
宫颈机能不全	2.635	1.119	5.543	0.019	13.944	1.555	125.044
体力劳动	0.704	0.379	3.445	0.063	2.022	0.961	4.254
居住地乡镇及农村	0.933	0.376	6.155	0.013	2.541	1.216	5.310