青海省不同海拔高度地区4～18岁人群先天性心脏病流行病学调查

A cross-sectional study of congenital heart disease among children aged from 4 to 18 years at different altitudes in Qinghai province, China

目的调查青海省6个州和海东地区3个县4～18岁少年儿童先天性心脏病（CHD）流行病学特征。方法共计对288066名少年儿童按初筛、复筛、彩色多普勒超声心动图确定三级筛选方法。分析不同海拔、不同民族CHD患病率及病种分布，探讨性别间及各年龄段间CHD变化及与海拔高度的关系。结果查出CHD1633例，总患病率为5．66‰。不同海拔（2000m^、3000m^-、4000m^-）患病率分别为4．89‰、5．71‰、8．74‰。不同海拔之间患病率差异有统计学意义（f=54．696，P〈0．001），趋势分析表明随着海拔高度的上升总患病率明显增加X^2=41．826，P〈0．001）。女性总患病率（6．95‰）明显高于男性（4．54‰），岔=73．79，P〈0．001。海拔2000m-地区男女性患病率差异无统计学意义（x2=0．807，P〉0．05）。随海拔升高女性CHD的患病率高于男性，3000m-（X^2=84．733，19〈0．001）、4000m～（X^2=16．313，P〈0．001）。海拔2000m～地区各年龄段间CHD患病率差异有统计学意义（X2=18．138，P〈0．001），但患病率不随年龄的增加而变化（x2=3．424，P〉0．05）。海拔3000m～、4000m～地区CHD患病率随年龄增长而增加，差异有统计学意义（x^2=19．230，P〈0．001；x^2=26．894，P〈0．001）。各民族间患病率的差异有统计学意义（x^2=24．456，P〈0．001），其中蒙古族7．55‰、藏族6．40‰、汉族5．32‰、土族5．23‰、回族4．89‰、撒拉族2．22‰。CHD构成比以房间隔缺损（ASD）为主（37．42％），其次为动脉导管未闭（PDA）（28．47％）和室间隔缺损（VSD）（26．01％）。但海拔不同其构成比又有不同，海拔2000m-、3000m-以ASD为首位，分别占37．80％、37．67％，4000m～PDA占首位（46．36％）。结论青海省4～7岁少年儿童CHD患病率、病种分布、性别间及各年龄段间变化与海拔高度有关。

Objective The epidemiological characteristics of congenital heart disease （CHD） in children aged from 4 to 18 years were investigated in Qinghai province. Methods Altogether 288 066 children inhabiting at 6 prefectures and 3 counties were examined by the following three steps： pre-screening, re-examination and diagnosis with color Doppler. And the entity distribution was analyzed while the differences were compared by age, gender, altitudes and nationalities respectively. Results Altogether 1633 cases of CHD were discovered. The total prevalence of CHD was 5.71‰. The prevalence of CHD was found to increase with the increase of altitude by 4.89% at the altitude of 2535 m, 5.71%0 at 3600 m, and 8.74%o at 4200 m respectively. There were significant differences among different altitude（x2= 54.696, P〈0.001）. x^2 trend analysis showed the increase with x^2=41.826 （P〈0.001）. The total incidence of CHD in females was 6.95‰ , which was significantly higher than that in males with 4.54‰ （ x^2 = 73.79, P〈0.001 ）. There were significant differences between males and females at the altitude of 3000 m（x^2 = 84.733, P〈0.001 ） and 4000 m （x^2= 16.313, P〈0.001 ） except at the altitude of 2000 m （x^2= 0.807, P〉0.05）. The prevalence of CHD in different age groups was statistically significant at the every altitude of 2000 m （x^2= 18.138, P〈0.001 ）, 3000 m（x2= 18.544, P〈0.001 ） and 4000 m（x2= 27.535 P〈0.001 ）. The prevalence of CHD was increasing with the increase of age groups at the altitude of 3000 m （ x2 = 19.230, P〈 0.001 ） and 4000 m（x2= 26.894, P〈0.001 ） except at the altitude of 2000 m.Within the prevalence of CHD of different nationalities, there was a significant difference with x2 = 24.456 （P〈0.001）. Within the constituent rate of CHD, the prevalence of atrial septal defect （ASD） was as high as 37.42%,followed by the prevalence of patent ductus arteriosus （PDA） as 28.47% and ventricular septal defect （VSD） as 26.01%. Regarding the four categories of CHD, the constituent rate varied at different altitudes. For example, the prevalence rate of ASD constituted 37% at the altitude of 2000 m and 3000 m, and that of PDA accounted for 46.36% at the altitude of 4200 m. Conclusion The epidemiological characteristics of CHD in Qinghai children were possibly associated with altitude levels.