中国神经管畸形高低发地区季节及性别分布特征

裴丽君; 李竹; 李松; 洪世欣; 叶荣伟; 陈新; 郑俊池; 王太梅; 赵秀琴; 肖岚; 王丽娜; 张伯兰; 刘志欣; 周永兰; 姜梅芳; 孙霞美; 陈海兰; 李敏; 杨晓玲; 沈泉珍; 邵佩云; 谢连云

文章摘要

裴丽君,李竹,李松,洪世欣,叶荣伟,陈新,郑俊池,王太梅,赵秀琴,肖岚,王丽娜,张伯兰,刘志欣,周永兰,姜梅芳,孙霞美,陈海兰,李敏,杨晓玲,沈泉珍,邵佩云,谢连云.中国神经管畸形高低发地区季节及性别分布特征[J].中华流行病学杂志,2003,24(6):465-470

中国神经管畸形高低发地区季节及性别分布特征

The epidemiology of neural tube defects in high-prevalence and low-prevalence areas of China

收稿日期:2003-01-07 出版日期:2014-09-18

DOI：

中文关键词: 神经管畸形病因异质性流行病学

英文关键词: Neural tube defects Heterogeneity Epidemiology

基金项目:美国CDC1993年404号项目经费资助(UII/CCU0065);国家“八五”(85-918-06-12);“九五”重点攻关基金资助项目(96-904-06-01)

作者	单位
裴丽君	北京大学生育健康研究所, 100083
李竹	北京大学生育健康研究所, 100083
李松	北京大学第三医院儿科
洪世欣	北京大学生育健康研究所, 100083
叶荣伟	北京大学生育健康研究所, 100083
陈新	北京大学生育健康研究所, 100083
郑俊池	北京大学生育健康研究所, 100083
王太梅	北京大学第三医院儿科
赵秀琴	北京大学生育健康研究所, 100083
肖岚	北京大学生育健康研究所, 100083
王丽娜	北京大学生育健康研究所, 100083
张伯兰	河北省香河妇幼保健院
刘志欣	河北省满城妇幼保健院
周永兰	苏州市卫生局
姜梅芳	苏州市妇幼保健院
孙霞美	浙江省海宁市妇幼保健院
陈海兰	舟山市妇幼保健院
李敏	舟山市妇幼保健院
杨晓玲	江苏省吴中妇幼保健院
沈泉珍	江苏省锡山市妇幼保健院
邵佩云	江苏省昆山市妇幼保健院
谢连云	石家庄市妇幼保健院

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中文摘要:

目的分析中国高低发区神经管畸形(NTDs)的流行病学分布特点。方法利用1992～1994年期间“中美预防神经管畸形合作项目”监测资料,按照国际上采用的脊柱裂高低位不同损害水平分类方法,将NTDs分为四类,即无脑畸形、脑膨出、高位和低位脊柱裂(SB),同时再将每一类按照是否合并其他畸形分为单纯与合并型,比较中国南北方、城乡、季节、性别NTDs发生率。分析中对城乡、季节、NTDs种类、性别分别进行调整,计算调整率。结果326874名新生儿(包括孕20周及以上的活产、死胎和死产)中,NTDs784例,北方NTDs发生率为5.57‰,南方为0.88‰。各类NTDs发生率存在南北方差别(P<0.01)。调整其他影响因素后,北方总NTDs发生率大约是南方的3～7倍;NTDs发生率存在城乡差别(P<0.01),调整后北方农村NTDs发生率大约是城市的3～4倍,调整后南方农村NTDs发生率大约是城市的1.6～1.9倍;北方高位SB发生率在9～11月有季节性升高现象,南方无脑畸形率9～11月低于其他季节,其他类型NTDs在南北方无明显季节变化。结论中国北方是世界上NTDs高发地区。NTDs发生率存在南北方、城乡差别,北方高位SB发生率有季节升高现象。不同类型NTDs之间在流行病学特征和表型上存在病因异质性。

英文摘要:

Objective To describe the epidemiology of neural tube defects (NTDs) in high-and low-prevalence areas of China.Methods Birth defects surveillance data, collected from 1992 through 1994 was analyzed. These data were collected as part of the Sino-American cooperative project on NTDs prevention. We classified NTDs as anencephaly,encephalocele, high-level and low-level spina bifida (SB) according to location of the lesion (high vs low) and whether the defect was isolated or occurred in association with other birth defects. Rates were compared in the high-prevalence (North) region and the low-prevalence (South) region, after adjusted for classification, urban and rural,season and sex,and calculated the adjusted rate of NTDs.Results Among seven hundred and eighty-four NTDs cases in 326 874 recorded births (include in livebirth,stillbirth and fetal death with a gestational age of at least 20 weeks), the overall NTDs prevalence in the North was 5.57/ 1 000 births, and in the South was 0.88/ 1 000. There were also significant differences in the prevalence of anencephaly, encephalocele, high-level and low-level SB between North (0.97, 0.49, 2.75 and 1.11/ 1 000 birth) and South (0.36, 0.15, 0.21 and 0.14/ 1 000 birth)(P 0.01), with adjusted prevalences in the North 3-7 times higher than those in the South. There were significant difference between urban (2.04) and rural areas (6.57/ 1 000 birth) in the North (P 0.01), urban (0.52) and rural areas (0.95/ 1 000 birth) in the South (P 0.05). Adjusted prevalence rates in the rural were 3- 4 times higher than those of urban in the North and 1.6- 1.9 times higher than in theSouth;Theseasonalrateofhigh levelSBincreasedbetweenSeptemberandNovemberintheNorth (3.44 / 10 0 0birth),whiletheseasonalrateofanencephalydecreasedbetweenSeptemberandNovember (0.18/ 10 0 0birth)intheSouth.HowevertherewerenoseasonalchangesinotherclassifiedNTDsbothinthe SouthandNorth.Conclusions ThebirthprevalenceofNTDsintheNorthofChinawasthehighestinthe world.ThereweresignificantdifferencesbetweentheNorthandtheSouth,urbanandrural.Therewas seasonalchangeinhigh levelSBintheNorth,whichwasinaccordancetothephenotypeofNTDs.Itwas suggestedthattheremightexistetiologicalheterogeneityamonganecephalus,low andhigh levelSB.

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