中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (6): 438-441.

• 论著 • 上一篇    下一篇

胆道闭锁围生期危险因素的病例对照研究

宁禹,张明满,吴垒,顾曜隆,陈思,刘威   

  1. 重庆医科大学附属儿童医院肝胆外科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室重庆,400014
  • 收稿日期:2017-10-18 修回日期:2017-12-22 出版日期:2017-12-25 发布日期:2017-12-25
  • 通讯作者: 张明满,E-mail: zhangmingman-a@163.com

A case-control study on the perinatal risk factors of biliary atresia

NING Yu, ZHANG Ming-man, WU Lei, GU Yao-long, CHEN Si, LIU Wei   

  1. Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics.Chongqing 400014, China
  • Received:2017-10-18 Revised:2017-12-22 Online:2017-12-25 Published:2017-12-25
  • Contact: ZHANG Ming-man,E-mail: zhangmingman-a@163.com

摘要: 摘要 目的:探讨胆道闭锁的危险因素,为早期鉴别诊断及其病因和发病机制的研究提供可能的线索。方法:自行设计胆道闭锁危险因素调查问卷,包括患儿自身、母亲、父亲和环境共22项因素,对2016年7月21日至2017年6月21日在重庆医科大学附属儿童医院肝胆外科因不明原因黄疸住院的<7月龄患儿在入院时行问卷调查。在每个病例随访至少3个月后并从病志中截取所有调查对象的临床资料,确定胆道闭锁组和对照组,并按性别、年龄±10 d行两两匹配。先行单因素分析后,以结果中P<0.2的指标为自变量行多因素Logistic回归分析,考察问卷中的各项因素与胆道闭锁的相关性。结果:发放调查问卷146份,均回收,满足胆道闭锁组、对照组的纳入和排除标准者分别为96和42例,胆道闭锁组与对照组两两匹配后各42例进入本文分析。单因素分析显示,孕期四维彩超胆道异常、低出生体重、出生时不良事件、生后大便颜色变浅、母亲孕期补充微量元素、孕期补充叶酸、孕期存在并发症在两组间差异有统计学意义。多因素Logistic回归分析显示,母亲存在孕期并发症(OR=21.27,95%CI:3.50~129.21)、患儿生后大便颜色变浅(OR=6.70,95%CI:1.73~26.02)是胆道闭锁的独立危险因素;低出生体重是胆道闭锁发病的独立保护因素(OR=0.05,95%CI:0.00~0.67)。结论:母亲存在孕期并发症(妊娠期糖尿病、高血压、肝内胆汁淤积症)、生后大便颜色变浅可能是胆道闭锁的独立危险因素,对于胆道闭锁与其他黄疸性疾病的早期鉴别诊断有一定意义。

Abstract: AbstractObjective: To analyze and discuss the risk factors of biliary atresia, so as to provide the possible clues for the early differential diagnosis and the study of its etiology and pathogenesis.Methods: Questionnaire of biliary atresia risk factors was designed, including a total of 22 factors.Patients with unexplained jaundice admitted to Children's Hospital Of Chongqing Medical University from July 2016 to June 2017 were enrolled.The clinical data of all patients were collected in September 2017, the biliary atresia group and the control group were determined and matched by sex and age. Using a matched pair study, the relevant risk factors were analyzed in both one-way ANOVA analysis and multivariate Logistic regression analysis. Results: A total of 146 cases were surveyed by questionnaires, and the questionnaires were returned to meet the inclusion and exclusion criteria of biliary atresia group and control group. There were 96 biliary atresia cases and 42 control cases. 42 cases of biliary atresia were matched to control group ,84 cases entered the analysis in the end.In one-way ANOVA analysis, pregnant four-dimensional color Doppler ultrasound, birth weight, adverse events at birth, stool color becoming shallow, trace elements supplement during pregnancy, folic acid supplement during pregnancy, pregnancy complication were statistically significantly different. In multivariate Logistic regression analysis, pregnancy complications and stool color becoming shallow were independent risk factors of biliary atresia (OR=21.27,95%CI:3.50~129.21,P=0.03;OR=6.70,95%CI:1.73~26.02,P=0.01); low birth weight was the independent protective factor of biliary atresia (OR=0.05,95%CI:0.00~0.67,P=0.03). Conclusion: Pregnancy complications of mother (gestational diabetes mellitus, hypertension, intrahepatic cholestasis) and color stool becoming shallow are the risk factors of biliary atresia,they have certain guiding values for early differential diagnosis.of biliary atresia.