文章信息
- 张淼, 郑英杰.
- Zhang Miao, Zheng Yingjie.
- 中国母婴队列研究特点
- Characteristics related to maternal and child cohort studies in China: A review
- 中华流行病学杂志, 2019, 40(1): 112-118
- Chinese Journal of Epidemiology, 2019, 40(1): 112-118
- http://dx.doi.org/10.3760/cma.j.issn.0254-6450.2019.01.022
-
文章历史
收稿日期: 2018-09-07
2. 复旦大学公共卫生学院国家卫生健康委员会卫生技术评估重点实验室, 上海 200032;
3. 复旦大学公共卫生学院公共卫生安全教育部重点实验室, 上海 200032
2. Key Laboratory of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai 200032, China;
3. Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
母婴健康为全球所关注,是衡量人群健康状况和社会综合发展水平的指标体系中重要组成部分之一。1995年,英国流行病学家Barker提出“成年人疾病的胎儿起源假说”(Fetal Origins of Adult Disease,FOAD),并进一步扩大发展成“健康和疾病的发育起源理论”(Developmental Origins of Health and Disease,DOHaD)[1]。DOHaD促使人们更加关注母婴健康,亦成为了许多相关成年人研究依托的理论,促进了健康研究的整体发展。
母婴队列研究在母婴相关研究中有着不可替代的地位,主要研究生命早期(围孕期)暴露因素对妊娠结局及/或对子代短期或长期(至成年人)的影响。国外母婴队列研究起步较早:英国自20世纪50年代以来已先后建立了多个出生队列,如1958年出生队列(1.7万人)、1970年出生队列(1.7万人)、1989-1990年出生队列(1.6万人)、Millennium Cohort(2000-2001年出生者队列,1.9万人);规模更大的母婴队列,如丹麦的Danish National Birth Cohort(10.1万名孕妇及其生产的9.7万名婴儿)和挪威的Norwegian Mother and Child Cohort(7.2万名孕妇及其丈夫和婴儿,共27.0万人)[2]。与国外相比,中国母婴队列研究起步虽然较晚,但队列规模通常较大;在近二十余年间得以快速发展,以医院为基础的小型母婴队列研究逐渐增多,同时,各地也相继建设起大型母婴自然人群队列。
本文对近25年来覆盖范围较广、影响力较大的中国母婴队列的基本情况做简要综述(表 1)。
根据以上队列的基本情况可以发现,中国母婴队列的建设存在以下特点:
1.多依托于医院。本文队列都是依托医院而建立的,此外还有许多临床多中心队列的形式,如由复旦大学附属儿科医院等11家医院建立的“早产儿视网膜病危险因素的前瞻性多中心队列”[46]、由中国台湾大学职业医学与工业卫生研究所联合台湾地区9所医院建立的“台湾母婴队列”[47]。因此,研究设计时需重视可能存在的入院率偏倚等问题,如因医院的专科性和治疗水平等的差异而导致的偏倚。
2.研究范围广泛,多涵盖基因、社会、心理、生物、环境因素等诸多方面。虽许多队列有主要研究方向,但通常涉及各种其他暴露因素,及各种相关结局。因研究的便利性,总体上多注重通过孕期随访收集暴露资料和妊娠结局资料,缺少远端暴露资料,且少有队列收集父亲资料。
3.大多数队列在孕期研究基础上,继续对产后儿童进行随访,随访时长一般至学龄前,亦有部分队列随访至成年。少数单向回顾性研究仅关注妊娠结局的孕期影响因素,而无产后随访。
4.目前国内大型母婴队列更关注一般孕妇人群的围孕期环境暴露因素对妊娠结局和子代健康的影响。因结局发生的时序相对明确,应重视对妊娠期特发性疾病(妊娠期糖尿病、妊娠期高血压疾病等)的研究。
5.成功的大型母婴队列,多依托于成熟的信息收集系统,如医院电子病历系统、孕妇监测系统。完善现有系统功能及保证信息对科研人员的可获得性,将极大地促进母婴相关科学研究的发展。
6.研究结果以关联为主。大型队列研究通常可收集到丰富的资料,涉及多种暴露因素,在研究设计时使用因果模型进行变量的分析、调整,可有针对性地指导资料的收集和数据处理,并在一定程度上可有效控制混杂[48-49]。如何利用因果关系研究的新思维和新工具成果[50],从关联中识别出因果关联,是值得进一步关注和发展的方向。
7.目前国内各地区相继开展地域性母婴队列的建设,多中心、多地区合作,数据共享是国内母婴队列的发展趋势之一。近年来,中国建立起了多个医疗卫生领域的数据共享平台,如中国队列共享平台、中国健康医疗数据共享平台,中国肾脏疾病数据网络等,将进一步促进这一趋势的发展。
8.新兴技术为母婴队列研究领域的扩大提供了契机。诸如近年发展的代谢组学、宏基因组学、免疫组学及蛋白质组学等技术的发展为母婴健康的分子生物学相关研究带来了便利;大数据、生物信息学等技术也是母婴队列研究今后发展不可忽视的工具。
除以上表格所列的队列外,近两年内启动的一些大型母婴队列项目包括“国家出生队列”,该队列依托国家重点研发计划“中国人群辅助生殖人口及子代队列建立与应用基础研究”,关注生殖健康、不良生殖结局和胚胎源性疾病,由南京医科大学生殖医学国家重点实验室牵头,来自北京大学、上海交通大学、山东大学、华中科技大学、中山大学等全国16家单位共同参与实施;由复旦大学公共卫生学院建立的“上海市亲子队列”;由深圳出生队列研究中心建立的“深圳出生队列”等。
母婴健康是社会发展不可忽视的问题。母婴人群具有特殊性,孕妇在围孕期需定期孕检,婴幼儿也有定期体检的需求,因此通常可收集到较为准确全面的资料,孕妇特发性疾病及婴儿不良结局的时序明确以及队列研究周期短(若仅关注妊娠结局,对象观察时长一般最长约10个月),因此,以母婴为队列进行围孕期相关病因学研究是绝佳选择。近数十年来,中国母婴队列研究在研究者、政府及各相关机构的关注和支持下,得到迅速发展,成果丰富,为改善儿童和妇女健康状况提供了科学依据。在当前形势下,中国母婴队列研究应利用现有医疗资源、社会及政府的支持及新兴技术,持续关注母婴健康问题。
利益冲突 所有作者均声明不存在利益冲突
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