中国6省及自治区小儿脑性瘫痪危险因素的研究  

Risk factors for childhood cerebral palsy in six provinces in China

作　　者：李松[1] 林庆[2] 刘建蒙[3] 郑俊池[3] 张淑霞 洪世欣[3] 姜梅芳[5] 王太梅[1] 朱岩[6] 赵凤临[1] 文荣康[7] 梁友玲[8] 施荣富[9] 赵平[3] 李竹[3] 

机构地区：[1]北京大学第三医院儿科,北京100083 [2]北京大学第一医院儿科 [3]北京大学生育健康研究所 [4]齐齐哈尔市第二医院 [5]苏州市妇幼保健院 [6]甘肃省卫生厅 [7]成都市儿童医院 [8]广西壮族自治区妇幼保健院 [9]河北省儿童医院

出　　处：《北京大学学报（医学版）》2002年第3期197-203,共7页Journal of Peking University:Health Sciences

基　　金：国家"九五"科技攻关项目 (96 90 4 0 6 0 3 )资助~~

摘　　要：目的 :探讨中国 1～ 6岁小儿脑瘫的危险因素 ,为病因和防治措施研究奠定基础。方法 :1997年 5月至1998年 12月在中国江苏等 6个省 (自治区 )对 1～ 6岁小儿脑性瘫痪进行了以人群为基础的 1∶2病例对照研究。结果 :共调查 1～ 6岁儿童 10 4 732 7名 ,发现 1～ 6岁儿童脑瘫病例共 2 0 0 9例 ;对 196 8例脑瘫及其对照者的危险因素研究结果表明 ,脑瘫的危险因素主要包括 2 8个 ,其中分娩前期 15个 ,分娩过程 5个 ,新生儿期 8个 ;新生儿期危险因素包括缺氧缺血性脑病 (OR =2 6 .4 ,95 %CI=4 .6 ,15 2 .2 )、高胆红素脑病 (OR =14 .2 ,95 %CI =5 .3,38.2 )、新生儿脑膜炎 (OR =2 6 7.6 ,95 %CI=2 1.2 ,3372 )和颅内出血 (OR =133.1,95 %CI =2 5 .4 ,6 97.7)等与脑瘫关联最强 ,分娩过程因素其次 ,分娩前因素最弱。分娩前因素包括父母是近亲 (OR =3.1,95 %CI=1.4 ,6 .8)、亲属中有智力低下者 (OR =5 .4 ,95 %CI =3.1,9.4 )、胎儿宫内发育迟缓 (OR =6 .6 ,95 %CI =2 .5 ,16 .7)、出生体重轻 (OR =5 .3,95 %CI =3.2 ,8.9)、出生孕周小 (OR =7.6 ,95 %CI =4 .2 ,13.7)、母孕期服用药品 (OR =7.9,95 %CI =2 .6 ,2 3.2 )等 ,虽然与脑瘫关联程度有限 ,但数目多 ,而且可能与新生儿期危险因素有因果关系。结论SUMMARY Objective: To evaluate risk factors for childhood cerebral palsy(CP) in China. Methods: We conducted a population based case control study among children in six provinces in China. They were 1-6 years old children with CP Two controls were selected for each child; controls were selected from children of same sex, same age, and living in the same township. Information on pregnancy, labor, delivery, and the neonatal period was obtained. Results: 1 047 327 children aged 1-6 years old were enrolled and 2 009 children of CP were found.Cases were much more likely than controls to experience hypoxic ischemic encephalopathy ( OR = 26.4, 95%CI = 4.6, 152.2 ), hyperbilirubinemia(OR=14.2,95%CI=5.3,38.2), intracranial hemorrhage(OR=133.1,95%CI= 25.4,697.7) , and neonatal meningitis (OR=267.6, 95%CI=21.2,3 372) in the neonatal period. Prenatal or intradelivery factors such as family history of mental retardation(OR=5.4, 95%CI=3.1, 9.4), poor maternal nutrition status(OR=1.9, 95%CI=1.6,2.4), maternal fever(OR=1.9, 95%CI=1.4,2.5) and drug exposure(OR=7.8, 95%CI=2.6,23.2), intrauterine growth retardation(OR=6.6, 95%CI=2.5,16.7), premature labor(OR=7.6, 95%CI=4.2,13.7), and low birth weight(OR=5.3, 95%CI=3.2,8.9); and demographic factors such as poor socioeconomic status(OR= 1.8, 95%CI=1.4,2.5) and exposure to cigarette smoke(OR=1.5, 95%CI=1.1,1.9) were with lower odds ratio. Conclusion: In this study, adverse events occurring during the neonatal period were more strongly associated with development of CP than were prenatal or demographic factors; however, the influence of prenatal or demographic factors on neonatal events needs further study.

关 键 词：小儿 脑性瘫痪 危险因素 研究 流行病学 病因学 

分 类 号：R742.3[医药卫生—神经病学与精神病学]