胚胎停育影响因素的Meta分析

doi:10.11852/zgetbjzz2016-24-02-16

摘要/Abstract

摘要： 目的利用Meta分析方法探讨影响妇女胚胎停育的危险因素,为防治措施的制定提供理论依据。方法通过文献检索收集有关胚胎停育病例对照研究的文献,采用随机效应模型和固定效应模型通过Review Manager 5.2软件进行综合定量分析评价。结果纳入文献37篇,累计病例组7 223例,对照组6 689例;有统计学意义的因素及其合并OR(95%CI):沙眼衣原体8.46(5.84~12.25)、解脲支原体6.13(4.45~8.43)、沙眼衣原体与解脲支原体混合感染5.90(3.77~9.25)、电磁辐射4.83(3.63~6.44)、被动吸烟4.27(3.76~4.85)、家庭装修2.11(1.76~2.54)、妊娠焦虑1.42 (1.25~1.59);婚检0.60(0.51~0.71)、体育锻炼0.45(0.35~0.57)。结论沙眼衣原体、解脲支原体、沙眼衣原体与解脲支原体混合感染、电磁辐射、被动吸烟、家庭装修是胚胎停育的危险因素,婚检、体育锻炼则是胚胎停育的保护性因素。

关键词: 胚胎停育, 稽留流产, 影响因素, Meta分析

Abstract: Objective To investigate the risk factors related to the induction of embryo damage with meta-analysis and to provide theoretic evidence for the exploration and prevention. Methods References related to embryo damage were retrieved and collected with case-control study.Mantel-Haensel fixed effect model and Dersimonian-Laird random effect model were used to perform meta-analysis by Review Manager 5.2. Results Thirty-seven articles which included 7 223 cases in embryo damage group and 6 689 cases in control group were synthetically and quantitatively analyzed by Meta-analysis.The factors with odds ratios and 95% confidence intervals in descending order were Chlamydia trachomatis 8.46(5.84~12.25),Mycoplasma urealytium 6.13(4.45~8.43),Chlamydia trachomatis and mycoplasma urealytium 5.90(3.7 7~9.25),radiation 4.83(3.63~6.44),smoking passively 4.27(3.76~4.85),home decoration 2.11(1.76~2.54),pregnancy anxiety 1.42 (1.25~1.59);pre-marital check-up 0.60(0.51~0.71),physical exercise 0.45(0.35~0.57).All these factors were statistically significant. Conclusion Chlamydia trachomatis,Mycoplasma urealytium,radiation and smoking passively were considered to be risk factors of embryo damage,while pre-marital check-up and physical exercise might be associated with protective factors.

Key words: embryo damage, missed abortion, risk factors, Meta-analysis

中图分类号:

R179

郭立燕,翟敏,王莎莎,张妍. 胚胎停育影响因素的Meta分析[J]. 中国儿童保健杂志, 2016, 24(2): 166-179.

GUO Li-yan,ZHAI Min,WANG Sha-sha,ZHANG Yan. Meta-analysis of risk factors related to the induction of embryo damage[J]. journal1, 2016, 24(2): 166-179.

参考文献

[1] Coulam CB.Epidemiology of recurrent spontaneous abortion[J].Am J Rep Rod Immuno,1991,26(1):23-27.
[2] Wells GA,Shea B,O'Connell D,et al.The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses[EB/OL].[2015-11-13].http://www.ohri.ca/ programs/.
[3] 张华坤,罗福薇,耿茜,等.252例稽留流产者绒毛细胞遗传学分析及环境因素初探[J].中华医学遗传学杂志,2011,28(5):575-578.
[4] 王瑞华,林江,马继玲,等.东平县育龄妇女胚胎停育的危险因素的病例-对照研究[J].中外妇儿健康,2011,19(7):41-42.
[5] 曹立,祝茹,汪艳,等.127例稽留流产与解脲支原体和衣原体感染的相关性研究[J].皖南医学院学报,2012,31(4):320-321.
[6] 曾秋芳,孙祥熙.稽留流产与子宫颈解脲支原体、人型衣原体和沙眼衣原体感染的关系[J].现代医院,2011,11(11):40-41.
[7] 啜丽清,刘俊芬,张林爱.孕妇沙眼衣原体和解脲支原体感染与稽留流产的关系[J].中国妇幼保健,2005,20(14):1721-1722.
[8] 樊揪顺,王云.稽留流产与解脲支原体感染的关系[J].中国实用医刊,2010,37 (16):34-35.
[9] 郝素梅,啜丽清,张林爱.稽留流产患者沙眼衣原体和解脲支原体宫内感染的检测研究[J].临床医药实践杂志,2005,14(9):656-657.
[10] 何远红.稽留流产与解脲支原体、沙眼衣原体感染的关系探讨[J].中国医疗前沿,2007,24(2):122-123.
[11] 吴晓玲.稽留流产患者解脲支原体感染分析[J].中国误诊学杂志,2007,30(7):7260-7261.
[12] 黄宏毅.对稽留流产的病因分析探讨[J].中外医疗,2011,28(1):91-92.
[13] 黄江宁,刘和录,赵期菊,等.沙眼衣原体和解脲支原体感染与稽留流产的关系[J].中国优生与遗传杂志,2008,16(1):75-76.
[14] 黄凌云,杨月芬.解脲脲原体感染与稽留流产的关系[J].交通医学,2009,23(6):696-697.
[15] 黄敏.解脲支原体感染与稽留流产的关系[J].温州医学院学报,2004,34(4):306-307.
[16] 赖铁英,王芳梅.解脲支原体感染与稽留流产关系的探讨[J].全科医学临床与教育,2009,7(4):423-424.
[17] 刘平珍.稽留流产的病因探讨[J].中国医药指南,2011,9(13):41-42.
[18] 杨柳,吴玉英.稽留流产与沙眼衣原体和解脲支原体感染的关系及临床意义[J].广西医学,2007,29(12):1882-1883.
[19] 赵芳芳,蒋晓莉,覃桂荣.稽留流产患者感染因素的分析[J].广西医学,2009,31(2):245-246.
[20] 赵会.生殖道解脲支原体感染与稽留流产的关系[J].临床合理用药,2012,5(2A):116-117.
[21] 朱雷.生殖道沙眼衣原体和解脲支原体感染与稽留流产的关系及临床意义[J].中国医学创新,2013,10(7):116-117.
[22] 王瓅,李常清,杨承东,等.稽留流产192例的相关因素分析[J].现代中西医结合杂志,2010,19(20):2528-2530.
[23] 张雪艳,顾依群,王金玲,等.北京市某区胚胎停育环境危险因素初步研究[J].环境与职业医学,2008,25(4):346-350.
[24] 张慧君.稽留流产危险因素流行病学分析[J].中国病案,2012,13(8):71-72.
[25] 安茂伟,徐有涛,卢少明,等.日照地区自然流产与环境因素的相关性研究[J].中国优生与遗传杂志,2007,15(10):61-63.
[26] 陈俊,陈亚琼,侯海燕,等.妊娠早期环境有害因素的暴露与胚胎停育[J].国际妇产科学杂志,2012,39(3):302-305.
[27] 顾依群,凌颖蕾,王金玲,等.胚胎停育某些环境危险因素的病例-对照研究[J].环境与健康杂志,2010,27(6):499-501.
[28] 韩京秀,曹兆进,刘欣燕,等.怀孕早期电磁辐射暴露对胚胎停育影响研究[J].卫生研究,2010,39(3):349-352.
[29] 刘维娜,张文静,李军.胚胎停止发育的环境、心理影响因素的病例对照研究[J].中国儿童保健杂志,2010,18(11):852-854.
[30] 刘欣燕,边旭明,韩京秀,等.早期自然流产孕妇生活环境中的有危险因素[J].中国医学科学院学报,2007,29(5):661-664.
[31] 田聪贵.300例稽留流产危险因素流行病学分析[J].中国现代药物应用,2013,7(2):39-40.
[32] 王萍,李芳,甘露.稽留流产相关因素分析[J].中国妇幼健康研究,2010,21(5):631-633.
[33] 杨淑兰,姜开福,高辉花,等.沂蒙山区孕妇自然流产原因分析[J].中国妇幼保健,2011,26(10):1514-1517.
[34] 曹枫林,张友忠,高庆岭,等.反复性自然流产病人应对方式与心理健康状况的相关分析[J].护理学杂志,2004,19(1):12-14.
[35] 刘维娜,张文静,李军,等.胚胎停止发育的环境影响因素分析[J].中国儿童保健杂志,2010,18(8):654-656.
[36] 谭燕,徐烨,莫鹏.孕妇心理因素与稽留流产的关系探索[J].岭南急诊医学杂志,2011,16(4):295-296,301.
[37] 凌颖蕾,顾依群,王爱春,等.职业紧张对胚胎停育影响的病例-对照研究[J].中国职业医学,2010,37(1):18-20.
[38] Rodrigues T,Barros H.Maternal unemployment:an indicator of spontaneous preterm delivery risk[J].Eur J Epidemiol,2008,23(10):689-693.
[39] PinNg T,Foo SC,Yoong T.Risk of spontaneous abortion in worker sex posed to toluene[J].British Journal of Industrial Medicine,1992,49(11):804-808.
[40] 詹思延.流行病学[M].7 版.北京:人民卫生出版社,2012:359-374.
[41] 乐杰.妇产科学[M].7 版.北京:人民卫生出版社,2008:287-306.
[42] Spica V,Mucci N,Ursini CL,et al.Etsloncogene induction by ELF-modulated 50 MHZ radiofrequency electromagnetic field[J].Bioelectromagnetics,2000,21(1):8-18.
[43] Wolch S.Dynamics of morphological and cytochemical changes in the placenta following cadmium chloride intoxication[J].Ginkol Pol,1992,63(6):265-274.
[44] 李雪梅,李振义,王晓红.关于苯作业对女工健康影响的调查[J].黑龙江医学,2001,25(6):463-464.
[45] Katz VL.Work and work-related stress in pregnancy[J].Clin Obstet Gynecol,2012,55 (3):765-773.