北京市四区／县18月龄儿童发育迟缓的流行病学研究

Epidemiological study on developmental delay of 18-month-old children from four districts/counties in Beijing

目的:探讨北京市四区/县18月龄儿童发育迟缓的患病率、影响因素及病因学的流行病学特点。方法:2011年5月至9月在北京市选取顺义、大兴、密云和延庆4个郊区/县,对所有四区/县的18月龄儿童进行发育迟缓的流行病学调查。采用儿童保健三级网管理与临床研究相结合的模式,先由一级保健网的社区医生对入选儿童进行儿童发育问卷调查以及丹佛发育筛查测验(Denver developmental screening test,DDST);再由二级保健网的区/县妇幼保健院医生采用Gesell对DDST筛查阳性儿童进行发育评估;诊断为发育迟缓的患儿,转诊至三级保健网医疗机构进行病因学诊断,并进行随访和后续评估。对诊断发育迟缓患儿,按照1∶4方式选择筛查结果为非发育迟缓的同性别和同居住社区的儿童,进行病例配比,采用SPSS 16.0进行数据描述及病例对照单因素分析。结果:北京市四区/县18月龄应筛查儿童4 037名,实际筛查3 182名,筛查率78.8%(3 182/4 037),诊断发育迟缓儿童22名,患病率6.91‰(22/3 182),其中15名为男性,7名为女性,男女比例为2.1∶1。顺义、大兴、密云与延庆四区/县发育迟缓患病率分别为3.45‰(4/1 160)、4.50‰(5/1 111)、15.87‰(7/441)和12.77‰(6/470)。单因素分析结果显示,低收入家庭、母亲文化程度低、小于胎龄儿、多胎儿、生后严重疾病史、先天畸形以及体格发育迟缓是影响发育迟缓的主要因素(P<0.05)。结论:北京市四区/县78.8%的18月龄儿童发育迟缓筛查结果显示,发育迟缓患病率为6.91‰,而且具有性别和地区差异性,其发生与社会文化因素、生物学等多因素有关。

Objective：To investigate epidemiological characteristics of prevalence, impact factors and etiology on developmental delay of 18-month-old children from four districts/counties in Beijing. Methods： An epidemiological study on developmental delay was designed to investigate all the 18-month-old children enrolled from Shunyi, Daxing, Miyun and Yanqing districts/counties in Beijing from May to September, 2011. Combining the tertiary network of child health with hospital clinical study was used. Child developmental questionnaires were completed by doctors in communities of the first network of child health. Gesell Developmental Schedules for children with Denver developmental screening test （DDST） screening positive results were assessed by doctors in districts/counties hospitals of the second network of child health. The children diagnosed as developmental delay were transferred to the tertiary hospitals of the third network of child health for further etiological diagnosis, follow-up and developmental evaluation. The case-control study compared between children with/without developmental delay were performed in accordance with the 1：4 ratios by gender and residence community matched. SPSS 16.0 was adopted for data analysis of the case-control study. Results： A total of 3 182 children were screened among the 4 037 children fitting the criteria, and the coverage rate was 78.8% （3 182/4 037）. Of the 3 182 screened children, 22 children were diagnosed as developmental delay. The prevalence rate was 6.91%o （22/ 3 182）. Out of the 22 children with developmental delay, 15 were boys and 7 were girls. The sex ratio was 2.1 ： 1. The prevalence rates of the children with developmental delay in Shunyi, Daxing, Miyun and Yanqing were 3.45‰ （4/1 160）, 4.50‰（5/1 111 ）, 15.87‰（7/441 ） and 12.77‰ （6/479）, re-spectively. The results from one-way ANOVA analysis showed the main risk factors in children with de- velopmental delay included low-income families, mothers＇ low educational level, small size for gestation-al age infant, multiple fetuses, serious diseases after birth, congenital malformations and physical retar-dation （P 〈0.05）. Conclusion： The screening coverage rate of this study is 78.8%. The prevalence rate of children with developmental delay is 6.91‰, which is significantly different in sex ratio and dis-tricts of the subjects. The etiology of developmental delay might be associated with social-economic and biological factors.