中国南方四县市先天性心脏病的危险因素分析

Risk factors of congenital heart diseases in south China

目的本研究旨在探讨先天性心脏病（简称先心病）的危险因素，为先心病的预防及胎儿期筛查提供研究基础。方法所有募集对象无论是否有指征，均由当地经培训的超声检查人员在妊娠20～26周分别进行1次胎儿B超和1次胎儿超声心动图检查，在新生儿期进行1次超声心动图检查，并建立围生保健册。检出先心病患儿的75例孕产妇为病例组，未检出先心病患儿的孕产妇3907例为正常对照组，比较两组围生期危险因素的暴露情况。结果先心病总的患病率为18．7‰，胎儿期先心病检出率为2．5‰；两组先心病家族史，高危年龄，发热，糖尿病史等因素比较，差异无统计学意义。结论以高危年龄，孕早期发热，先心病家族史，糖尿病史等因素作为高危因素进行胎儿期先心病筛查，不能提高人群检出率。

Objective The objective of the study was to explore the risk factors of congenital heart diseases （CHD） in a screening project. Methods Pregnant women were recruited between April 2004 and December 2005 in Jiaxing City, Suzhou City, Changshu County, and Haining County. All participants had three fetal sonographic examinations performed by specially trained physicians regardless of medical indications ： a fetal sonographic screen and fetal echocardiography between 20 and 26 weeks of gestation, and neonatal echocardiography. Seventy-five women with CHD fetuses were considered as the case group and other women with normal fetuses as the control group. Characteristics and potential risk factors at the register of perinatal health care in the two groups were compared. Results The overall prevalence for all congenital heart defects was 18.7 per 1000 births, and the rate of fetal heart defects was 2.5 per 1000 births. We did not find any significant differences between the two groups in term of maternal age, history of congenital heart disease, diabetes mellitus, and fever in first trimester of pregnancy. Conclusion We did not identify any risk factors for fetal heart defects. Screening based on risk factors such as advanced maternal age, fever in first trimester, history of congenital heart diseases, and history of diabetes may not increase the detection rate of fetal heart defects.