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目的:了解和掌握本地区再生障碍性贫血(AA)发生的相关因素,尤其是多因素联合作用对其发生的影响,旨在为开展AA的Ⅰ级预防工作提供科学依据。方法:以我院近10年住院患者为研究对象,采用病例-对照研究方法。病例组(AA患者)220例,对照组986例,问卷调查内容包括个人一般情况、既往病史、家族史、发病前3个月内感染史等。对调查结果进行Logistic单因素和多因素回归分析;并对有意义的危险因素计算总分并采用ROC分析进行分类,观察各因素联合作用对AA发生的影响。结果:单因素和多因素分析均发现,住宅周围3km内有化工厂,居住新装修的住房,早产儿或低体重儿等是AA发病的独立危险因素(P<0.05);而主要饮用自来水是AA发病的保护因素(OR=0.127,P<0.05)。单因素分析发现除上述因素外,危险因素还包括自付医疗费用、吸烟、饮酒等,保护性因素包括新房装修后长时间通风,未发现AA发病与化肥接触、吸烟时间、饮酒时间存在明显相关性。多因素联合作用分析结果显示,每增加1个危险因素,AA的发生风险增加4.791(3.927~5.846)倍,ROC分析结果显示危险因素个数≥2个发生AA的风险是<2个的74.837(42.453~131.925)倍。结论:对高危人群进行危险因素的控制有助于有效预防和控制AA的发生发展。
OBJECTIVE: To understand and master the related factors of aplastic anemia (AA) in our region, especially the impact of multi-factor combination on its occurrence, and to provide a scientific basis for the prevention of AA. Methods: Inpatients in our hospital for nearly 10 years as the research object, using case-control study. 220 cases in the case group (AA patients) and 986 cases in the control group. The questionnaire survey included the general condition, past medical history, family history, history of infection within 3 months before onset. The results were analyzed by Logistic single factor and multivariate regression analysis. Total risk scores were calculated and classified by ROC analysis to observe the impact of various factors on AA. Results: Both univariate and multivariate analysis showed that there was a chemical factory within 3km around the residence, newly renovated housing, premature infant or low birth weight infant were independent risk factors for AA (P <0.05) AA protective factors (OR = 0.127, P <0.05). Univariate analysis found that in addition to the above factors, the risk factors included medical expenses, smoking, alcohol consumption, etc. Protective factors included long-time ventilation after renovation of new houses, no significant association between AA incidence and chemical fertilizer exposure, smoking time and drinking time Sex. Multivariate analysis showed that for each additional risk factor, the risk of AA increased by 4.791 (3.927-5.846) times. The ROC analysis showed that the number of risk factors was greater than or equal to 2. The risk of occurrence of AA was 74.837 (<2) 42.453 ~ 131.925) times. Conclusion: The control of risk factors in high-risk groups can effectively prevent and control the occurrence and development of AA.