中国2003年出生缺陷高发区和低发区重大体表畸形患病率监测

Prevalence of major external birth defects in high and low risk areas in China,2003

目的了解中国出生缺陷高发区目前常见体表出生缺陷的患病水平以及主要畸形种类。方法选择出生缺陷高发的山西省5个县市和出生缺陷低发的江苏省无锡地区作为研究现场,对研究地区2003年所有孕满20周以上的出生进行以人群为基础的出生缺陷监测,分析和比较高低发地区24种体表重大出生缺陷的患病情况。结果山西省4个县体表重大缺陷患病率为232.4/万,神经管畸形患病率138.7/万,显著高于太原市区相应的患病率(75.3/万和28.2/万)。无锡市区和锡山区(原无锡县)之间各种出生缺陷患病率差异无统计学意义。太原市区神经管畸形(NTDs)出生患病率是无锡市区(4.6/万)的6.1倍;山西省4个县无脑儿、脊柱裂、脑膨出、脑积水、腭裂和多指畸形的出生患病率显著高于无锡市区,NTDs的出生患病率是无锡市区的30.2倍。高发地区NTDs患病率与既往监测资料相比未见明显下降趋势。如果从孕满28周开始监测,则高发地区出生患病率较孕满20周监测率下降31.8%。结论NTDs仍然是山西省最常见的出生缺陷。山西省部分地区NTDs的患病率仍然是国内乃至世界最高的患病水平。NTDs出生患病率在部分出生缺陷高发地区未见明显的下降趋势。监测方法和产前诊断对于体表重大出生缺陷患病率具有较大影响。

Objective To study the prevalence rates of birth defects in high and low risk areas in China. Methods A population-based surveillance system on birth defects was used to obtain the prevalence rates of 24 kinds of major external birth defects from ≥20 weeks of gestation to 7 days of life in selected areas in Shanxi and Jiangsu provinces. Results The birth prevalence of birth defects ( 232.4 per 10 000 births) and neural tube defects (NTDs) ( 138.7 per 10 000 births) in four counties of Shanxi province were significantly higher than that in Taiyuan city ( 75.3 and 28.2 per 10 000 births,respectively).There was no significant difference for all selected birth defects between Wuxi city and Xishan counties in low risk areas. There was a 6.1- fold of higher prevalence for NTDs in Taiyuan city compared with that in Wuxi areas ( 4.6 per 10 000 births).In four counties of Shanxi province,the prevalence rates of anencephaly,spina bifida,hydrocephaly,cleft palate alone and polydactyly were significantly higher than in Wuxi areas.The NTDs prevalence rate in four counties of Shanxi was 30.2 times higher than in Wuxi areas.When compared with previous surveillance data,the NTDs prevalence rate did not present obvious declining trend in high risk areas. The birth prevalence rate had a 31.8 % decrease when births were calculated after 28 gestational weeks and compared with those from 20 gestational weeks. Conclusion NTDs remained to be the most common birth defect seen in Shanxi province.The birth prevalence rate of NTDs in some areas of Shanxi province was among the highest that ever reported in the world in comparison with data from other countries and regions.The current prevalence rate in high risk areas in Shanxi province did not clearly show a declining trend.Programs on surveillance and prenatal diagnosis were proved to have made big impact on the rates of major external birth defects.