早孕期母体血清铜与自发性早产风险的关联：中国一项巢式病例对照研究。
Association of maternal serum copper during early pregnancy with the risk of spontaneous preterm birth: A nested case-control study in China.
机构信息
Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China.
Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, PR China.
出版信息
Environ Int. 2019 Jan;122:237-243. doi: 10.1016/j.envint.2018.11.009. Epub 2018 Nov 22.
BACKGROUND
The effect of maternal copper (Cu) level on the risk of spontaneous preterm birth (SPB) remains debate. Therefore, we conducted a prospective nested case-control study in Shanxi Province to investigate the relationship between maternal serum Cu concentration and SPB risk, as well as the potential mediation effect of lipid metabolism.
METHOD
From an overall cohort of 4229 women, 147 women affected by SPB at 20-36 gestational weeks (cases) and 381 women who delivered at ≥37 gestational weeks (controls) were included in our nested case-control study. Maternal blood samples were collected during 4-22 gestational weeks, and the concentrations of Cu, total cholesterol (TC), and triglycerides (TG) were measured. Information on maternal social demographic characteristics were collected using questionnaires. Unconditional logistic regression models were used to estimate the associations of Cu, TC or TG levels with SPB risk. Linear regressions were used to assess the relationships between concentrations of Cu and TC or TG.
RESULTS
Serum Cu concentrations in the case group (median: 184 μg/dL) were significantly higher than those in the control group (median: 166 μg/dL, p < 0.0001). Compared to the lowest serum Cu levels, the odds ratios associated with SPB increased to 2.02 (95% confidence interval [CI]: 1.07, 3.82), 3.10 (1.54, 6.22) and 4.18 (2.11, 8.27) in the second, third and fourth quartile respectively, after adjusting for sampling time, maternal age, pre-pregnancy BMI, education, occupation, parity, spontaneous abortion history, folic acid use, medication use, pre-pregnancy passive smoking status, child gender and fasting status. Plasma concentrations of TC and TG were positively associated with SPB risk in a dose-dependent manner. However, when stratified by sampling time, the above-mentioned relationships were significant in the first trimester but not in the second. In addition, plasma concentrations of TC and TG were positively correlated with serum Cu concentrations.
CONCLUSIONS
High maternal Cu level in the first trimester may increase the risk of SPB, by potentially increasing plasma concentrations of TC and TG.
背景
母体铜（Cu）水平对自发性早产（SPB）风险的影响仍存在争议。因此，我们在山西省进行了一项前瞻性巢式病例对照研究，以调查母体血清 Cu 浓度与 SPB 风险之间的关系，以及脂质代谢的潜在中介作用。
方法
在一个包含 4229 名女性的总体队列中，纳入了 147 名在 20-36 孕周（病例组）患有 SPB 的女性和 381 名在≥37 孕周分娩的女性（对照组）进行了巢式病例对照研究。在 4-22 孕周期间采集了母体血液样本，并测量了 Cu、总胆固醇（TC）和甘油三酯（TG）的浓度。使用问卷收集了有关母体社会人口统计学特征的信息。使用非条件逻辑回归模型估计了 Cu、TC 或 TG 水平与 SPB 风险之间的关联。线性回归用于评估 Cu 浓度与 TC 或 TG 之间的关系。
结果
病例组血清 Cu 浓度（中位数：184μg/dL）显著高于对照组（中位数：166μg/dL，p<0.0001）。与最低血清 Cu 水平相比，在调整采样时间、母亲年龄、孕前 BMI、教育、职业、产次、自然流产史、叶酸使用、药物使用、孕前被动吸烟状况、儿童性别和空腹状态后，血清 Cu 水平与 SPB 相关的比值比分别增加至 2.02（95%置信区间[CI]：1.07，3.82）、3.10（1.54，6.22）和 4.18（2.11，8.27）。在第二、第三和第四四分位数时。血浆 TC 和 TG 浓度与 SPB 风险呈剂量依赖性正相关。然而，按采样时间分层后，这些关系在第一孕期显著，但在第二孕期不显著。此外，血浆 TC 和 TG 浓度与血清 Cu 浓度呈正相关。
结论
第一孕期母体 Cu 水平升高可能会增加 SPB 的风险，可能是通过增加血浆 TC 和 TG 浓度。
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