摘要目的 综合评价患儿出生顺序、孕妇流产史及分娩方式与儿童急性白血病发病风险之间的关系.方法 在PubMed、Google学术搜索、中国知网(CNKI)、万方数据库中以“childhoodleukemia"、“acute lymphoblastic leukemia"、“acute myeloid leukemia"、“birth order"、“abortion”、“miscarriage”、“caesarean”、“birth characteristics”、“prenatal risk factor”或其对应的中文词目为检索词,收集2013年3月前有关患儿出生顺序、孕妇流产史及分娩方式与儿童急性白血病发病风险之间关系的队列研究和病例对照研究,采用Stata软件进行Meta分析.结果 共纳入相关文献23篇.孕妇流产史与急性白血病发病风险相关(自然流产:OR=1.21,95％ CI:1.05 ～ 1.41;人工流产:OR=1.23,95％ CI:1.07～1.43),而患儿出生顺序、孕妇分娩方式与急性白血病发病风险无关(患儿出生顺序依次为2、3、≥4:OR=0.97,95％ CI:0.89 ～ 1.05、OR=1.00,95％ CI:0.91 ～ 1.11、OR=1.02,95％ CI:0.87 ～ 1.20;孕妇分娩方式:OR=1.05,95％CI:0.96 ～ 1.15).亚组分析进一步揭示,孕妇自然流产史和人丁流产史分别与儿童急性髓性白血病(OR=1.71,95％ CI:1.09 ～2.70)、急性淋巴细胞白血病的发病风险存在显著关联(OR=1.23,95％CI:1.05 ～ 1.42).结论 孕妇流产史可能是儿童急性白血病的危险因素,但仍需进一步验证.

abstractsObjective To evaluate the associations between birth order,maternal abortion and mode of delivery and childhood acute leukemia risk.Method Multiple electronic databases were searched to identify relevant studies up to March 2013 using the search terms " childhood leukemia"," acute lymphoblastic leukemia"," acute myeloid leukemia"," birth order"," abortion "," miscarriage ","cesarean","birth characteristics" and "prenatal risk factor".Data from cohort and case-control studies were analyzed using the Stata software.Result Twenty-three studies were included in this meta-analysis according to the selection criteria.No significant associations were identified for birth order and mode of delivery (birth order =2:OR =0.97,95％ CI:0.89-1.05 ; birth order =3:OR =1.00,95％ CI:0.91-1.11 ; birth order ≥4:OR =1.02,95％ CI:0.87-1.20; mode of delivery:OR =1.05,95％ CI:0.96-1.15).However,there was a significant association between maternal abortion and childhood acute leukemia risk (spontaneous abortion:OR =1.21,95％ CI:1.05-1.41 ; induced abortion:OR =1.23,95％ CI:1.07-1.43).Furthermore,the stratified analysis by disease subtypes showed that spontaneous and induced abortions were significantly associated with the risks of childhood acute myeloid leukemia (OR =1.71,95％ CI:1.09-2.70) and acute lymphoblastic leukemia (OR =1.23,95％ CI:1.05-1.42),respectively.Conclusion This meta-analysis revealed that maternal abortion might contribute to the childhood acute leukemia risk.