宁波市江北区2012-2018年自然出生队列<1岁先天性心脏病累计检出与变化趋势及生后3年内转归情况分析  

Annual and cumulative detection rate and three-year outcome of congenital heart disease diagnosed within one year after birth among children born during 2012-2018 in Ningbo city

作　　者：赵一鸣 吕兰秋[2] 史慧静[3] 严蕙蕙[4] ZHAO Yiming;LÜLanqiu;SHI Huijing;YAN Huihui(Department of Child Healthcare,Jiangbei District Maternal and Child Health and Family Planning Service Center,Ningbo 315020,China;Department of Child Healthcare,Ningbo Municipal Women and Children's Hospital,Ningbo 315010,China;Department of Child and Adolescent Health,School of Public Health,Fudan University,Shanghai 200032,China;Department of Gastroenterology,The Second Affiliated Hospital,Medical College,Zhejiang University,Hangzhou 310009,China)

机构地区：[1]宁波市江北区妇幼保健计划生育服务中心儿童保健科,宁波315020 [2]宁波市妇女儿童医院儿童保健科,宁波314000 [3]复旦大学公共卫生学院儿少卫生系,上海200032 [4]浙江大学医学院附属第二医院消化内科,杭州310000

出　　处：《中国公共卫生》2023年第10期1282-1288,共7页Chinese Journal of Public Health

基　　金：2018年浙江省医药卫生科技计划(2018KY719)。

摘　　要：目的分析自然出生队列中婴幼儿在生后1年内先天性心脏病(以下简称先心病)的累计检出、年度变化趋势和生后3年内的结局转归情况,探索合适的监测时间和影响结局的因素。方法从浙江省宁波市自然出生队列中获取2012-2018年在宁波江北出生并完成生后3年随访的28208例活产儿,收集生后1年内报告的全部先心病个案,描述性分析婴儿期内先心病的累计检出率;以年度变化百分比为主要指标,采用Join Point回归描述先心病检出的变化趋势和类型分布。随访调查1304例先心病在出生后3年内发生死亡、自然愈合、手术等转归情况;使用多因素logistics回归模型分析转归结局中先心病不能自然愈合的影响因素和Kaplan-Meier生存分析计算自愈时间。结果宁波市2012-2018年自然出生队列监测28208例活产儿,婴儿期内共发现1304例先心病,每100名活产儿生后1年内的先心病累计检出率为4.62%。2012-2018年度累计检出率分别为1.87%、2.58%、3.13%、4.25%、6.20%、6.37%、8.26%,并呈逐年上升趋势,2016年为变化转折点。从先心病分类来看,构成比列前3位的分别是房间隔缺损431例(33.05%)、动脉导管未闭合并卵圆孔未闭232例(17.79%)和房间隔缺损合并卵圆孔未闭196例(15.03%)。出生后3、6、12个月内的先心病累计检出率分别为4.29%、4.51%和4.62%,约97.62%的先心病在出生后6个月内被发现。全部1304例先心病病例在出生后3年时间内,发生自然愈合934例(71.63%),M(P25,P75)自愈时间为8.6个月(7.8,9.4个);接从受先心病手术60例(4.60%);因先心病死亡22例(1.69%);未愈149例(11.43%);另外失访或拒绝随访139例(10.66%)。母亲年龄的增加会降低未愈风险(OR=0.9342,95%CI=0.893~0.974);相对本省户籍,外省户籍增加儿童未愈风险(OR=1.893,95%CI=1.459~2.456)。先心病类型会显著影响自愈时长,复合型先心病自愈时长显著长于单纯型先心病,女婴愈合时间长于男婴,�Objective To analyze annual and cumulative detection rate and three-year outcome of congenital heart disease(CHD)diagnosed within one year after birth among children born during 2012-2018 in Ningbo city for developing appropriate measures on diagnosis and treatment of the disease.Methods The data on 28208 live births during 2012-2018 in a district of Ningbo city,Zhejiang province were extracted from a natural birth cohort study conducted in the city.Totally 1304 cases of CHD diagnosed within one year after birth among the live births were identified and followed up for 3 years after birth to collect the information on their outcomes of CHD.The annual and cumulative detection rate of CHD in the live births were analyzed and the change trend in annual detection rate of CHD were described with annual percentage change using join point regression.Kaplan-Meier survival analysis was used to calculate the duration of spontaneous-healing of CHD and multivariate logistic regression model was adopted to explore factors associated with CHD spontaneous healing of the cases.Results For all the live births,the cumulative detection rate of CHD diagnosed within one year after birth was 4.62 per 100 live births and the annual detection rate for years from 2012 to 2018 were 1.87,2.58,3.13,4.25,6.20,6.37,and 8.26 per 100 live births,respectively,indicating an increasing trend.The number(proportion)of top three types of CHD detected were 431(33.05%)for atrial septal defect,232(17.79%)for patent ductus arteriosus and patent foramen ovale,and 196(15.03%)for atrial septal defect and patent foramen ovale.The cumulative detection rate of CHD diagnosed within 3,6,and 12 months after birth were 4.29,4.51and 4.62 per 100 live births.Of all the CHD cases,97.62%were detected within 6 months after birth.The three-year after birth follow-ups revealed that among all the CHD cases,934(71.63%)had spontaneous-healing at a median time of 8.6months(25th percentile:7.8 months,75th percentile 9.4 months);60(4.60%)underwent surgeries for CHD;22(1.69%)di

关 键 词：先心病 累计检出率 变化趋势 自然愈合 

分 类 号：R725.4[医药卫生—儿科]