青海省不同海拔高度地区4～18岁藏族少年儿童先天性心脏病流行病学调查

Study on the epidemiology of congenital heart disease in Tibetan ethnic children aged from 4 to 18 living at different altitudes in Qinghai province

目的调查青海省不同海拔高度4～18岁藏族少年儿童先天性心脏病（CHD）流行病学特征。方法对海拔2535m、3600m和4200m的32578名藏族少年儿童按初筛、复筛、彩色多普勒超声心动图确定三个阶段进行调查；分析CHD不同海拔高度的患病率、病种分布、性别及各年龄组间变化。结果3个地区（海东、黄南、果洛）查出CHD235例，患病率为7．21‰。随着海拔的升高CHD患病率有所增加，分别为5．45‰、6．80‰和9．79‰。但海拔2535m与3600m之间CHD患病率差异无统计学意义（χ^2=1．594，P〉0．05）；海拔2535m与4200m、3600m与4200m之间CHD患病率的差异有统计学意义（χ^2=7．002，P〈0．01；χ^2=5．540，P〈0．05）。在海拔2535m地区各年龄组间CHD患病率差异无统计学意义，海拔3600m、4200m地区随着年龄增加CHD检出率也增加。各年龄组间比较，16～18岁组患病率最高，与4～7岁和8～12岁年龄组比较，差异有统计学意义（χ^2=10．79，P〈0．005；χ^2=5．60，P〈0．05）。CHD的病种构成以房间隔缺损（ASD）为主（39．1％），室间隔缺损（VSD）其次（32．8％），动脉导管未闭（PDA）列第三（24．7％）。但不同地区其构成比不同，海拔2535m以VSD为首位，3600m以ASD患病率最高42．8％，4200m地区PDA占50．8％。结论藏族少年儿童CHD患病率、病种分布、性别及各年龄组间变化与海拔高度有关。

Objective The epidemiological characteristics of congenital heart disease （CHD） among Tibetan children whose age ranged from 4 to 18 at different altitude were investigated in Qinghai province. Methods 32 578 Tibetan children living at 2535 m, 3600 m and 4200 m were surveyed with the following 3 steps; prescreened, counterchecked and diagnosed with color Doppler. The entity distribution was then analysed and the age and gender were compared respectively. Results 235 CHD cases were identified. The total morbidity was 7.21‰. CHD morbidity was rising with the increase of altitude with 5.45‰ at 2535 m, 6.80‰ at 3600 m and 9.79‰ at 4200 m respectively. There were significant static differences between 4200 m and the others with χ^2=7.002 （P〈0.01） to 2535 m and χ^2=5.540（P〈0.05） to 3600 m. However, there was no statistical difference between 2535 m altitude and 3600 m altitude. The morbidity in different age had no statistical difference at 2535 m altitude but statistically increased with the increase of age at 3600 m and 4200 m. The total ratio of 16-18 age was significantly higher than other age periods with χ^2 = 10.79（P〈0.005） to 4-7 age period and with χ^2 = 5.60（P〈0.05） to 8-12 age period. The atrial septal defect （ASD） morbidity rates in three places was 39.1% followed by ventricular septal defect （VSD） with 32.8% and patent ductus arteriosus （PDA） with 24.7%. However, the constitute of CHD was different in different altitudes that VSD with 43.5% at 2535 m, ASD with 42.8% at 3600 m and PDA with 50.8% at 4200 m which was the highest morbidity. Conclusion Morbidity, constitutes and difference in gender and age were related to altitude.