孕期和围产期危险因素对儿童发育性运动协调障碍影响的研究  

Prenatal and perinatal risk factors for developmental coordination disorder in children

作　　者：花静[1] 孟炜[2] 吴擢春[2] 张郦君[3] 古桂雄[3] 朱丽萍[1] 

机构地区：[1]同济大学附属第一妇婴保健院,上海200032 [2]复旦大学公共卫生学院 [3]苏州大学儿科医学研究所

出　　处：《中华流行病学杂志》2014年第3期250-254,共5页Chinese Journal of Epidemiology

基　　金：上海市科学技术委员会重点项目（12DZl202600）;上海市浦东新区卫生和计划生育委员会联合攻关项目（PW2013D-9）;欧盟第6框架基金（015396）

摘　　要：目的探讨发育性运动协调障碍（DCD）的孕产期和围产期危险因素，为其病因学研究以及早期预防提供依据。方法在苏州市区随机整群抽取15个幼儿园160个班级共4001名儿童，采用儿童运动成套评估工具（M-ABC）对DCD筛查和确诊，采用多水平logistic回归模型和结构方程模型分析DCD危险因素。结果多水平logistic回归模型分析显示，在控制班级群内聚集性以及儿童性别、年龄、Kaup指数情况下，急性胎儿宫内窘迫史、早产史、新生儿期病理性黄疸史纳入模型，差异有统计学意义（OR值分别为7．030、3．374、1．993，P值均〈0．001），可能与DCD存在关联。结构方程模型分析显示，轻微脑发育障碍与运动协调能力的相关系数为-0．18，差异有统计学意义（P〈0．05），提示轻微脑发育障碍对运动协调能力的发育具有不良影响。结论孕期和围产期危险因素对儿童DCD存在影响。Objective To explore the prenatal and perinatal risk factors for developmental coordination disorder （DCD） in children so as to provide a basis for etiological studies and early diagnosis on DCD. Methods Stratified clustered sampling was used to select 160 classes from randomly selected 15 public nursery schools which were distributed throughout the five main districts in Suzhou city. A total of 4 001 children were included in the study. Multilevel logistic regression and structural equation model （SEM） were used to analyze the risk factors of DCD. Results Results from the multilevel logistic regression model showed that when factors as： class internal clustering, children＇ s gender, age and Kaup value etc., were under control, factors as acute fetal distress, premature and newborn pathological jaundice would be included in the model （OR values were 7.030, 3.374, 1.993, with all their Ps〈0.001 ）, and showing these variables were related to DCD. Results of SEM showed that the related coefficient between ＇Minimal Brain Dysfunction＇ and ＇Motor coordination skill＇ was -0.18 with statistical significance （P〈0.05）. It also indicated that the minimal brain dysfunction would negatively impact on the children＇ s motor skill. Conclusion There were risk factors of DCD noticed during the prenatal and peri-natal periods. Practitioners working at the maternity and child health care areas should improve the skills in assessing and monitoring the prenatal and peri-natal risk factors related to DCD, and to better carry out early screening, diagnosis, treatment and prevention of DCD.

关 键 词：发育性运动协调障碍 孕产期和新生儿期 危险因素 

分 类 号：R748[医药卫生—神经病学与精神病学]