Esmaeili Arash, Hanaei Sara, Fadakar Kaveh, Dadkhah Sahar, Arjipour Mahdi, Habibi Zohreh, Nejat Farideh, El Khashab Mostafa
Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran.
Pediatr Neurosurg. 2013;49(4):202-7. doi: 10.1159/000362883. Epub 2014 Jun 11.
In general, it seems that both genetic and environmental factors play important roles in the induction of neural tube defects. Lipomyelomeningocele (LipoMMC) is a rather common type of closed neural tube defect, but only limited studies have investigated the potential risk factors of this anomaly. Therefore, the purpose of this case-control study was to investigate the risk factors involved in LipoMMC formation.
Various risk factors were evaluated in 35 children between 1 month and 10 years of age with LipoMMC in a hospital-based case-control study. The 2 control arms consisted of 35 children with myelomeningocele (MMC group) and 35 children with congenital anomalies other than central nervous system problems (control group). All groups were matched for age and visited the same hospital. A structured questionnaire was used for the collection of all data, including the mothers' weight and height during pregnancy, education, reproductive history, previous abortions, and socioeconomic status, as well as the parents' consanguinity and family history of the same anomalies.
Univariate analysis of the children with LipoMMC compared to the control group showed that the use of periconceptional folic acid supplementation was significantly lower in the MMC and LipoMMC groups compared to the control group. In addition, comparison of the MMC and control groups revealed statistically significant differences regarding the use of folic acid and maternal obesity. In multivariate analysis, use of folic acid in the periconceptional period and during the first trimester was an independent risk factor for LipoMMC and MMC. Furthermore, maternal obesity was a significantly positive risk factor for MMC.
The probable risk factors for LipoMMC were investigated in this case-control study. Consumption of folic acid in the periconceptional period and during the first trimester is an independent protective factor against LipoMMC. It seems that larger studies are needed to examine other possible risk factors.
一般来说，遗传因素和环境因素似乎在神经管缺陷的诱发中都起着重要作用。脂肪脊髓脊膜膨出（LipoMMC）是一种相当常见的闭合性神经管缺陷类型，但仅有有限的研究调查了这种异常的潜在危险因素。因此，本病例对照研究的目的是调查LipoMMC形成所涉及的危险因素。
在一项基于医院的病例对照研究中，对35名年龄在1个月至10岁之间患有LipoMMC的儿童的各种危险因素进行了评估。两个对照组分别由35名患有脊髓脊膜膨出的儿童（MMC组）和35名患有中枢神经系统问题以外先天性异常的儿童（对照组）组成。所有组均按年龄匹配，并就诊于同一家医院。使用结构化问卷收集所有数据，包括母亲孕期的体重和身高、教育程度、生育史、既往流产情况、社会经济状况，以及父母的近亲关系和相同异常的家族史。
与对照组相比，对患有LipoMMC的儿童进行单因素分析显示，MMC组和LipoMMC组围孕期补充叶酸的使用率显著低于对照组。此外，MMC组与对照组在叶酸使用和母亲肥胖方面存在统计学显著差异。在多因素分析中，围孕期和孕早期使用叶酸是LipoMMC和MMC的独立危险因素。此外，母亲肥胖是MMC的显著阳性危险因素。
本病例对照研究调查了LipoMMC可能的危险因素。围孕期和孕早期摄入叶酸是预防LipoMMC的独立保护因素。似乎需要进行更大规模的研究来检查其他可能的危险因素。
