应用超声心动图分析西藏地区藏族新生儿先天性心脏病发病情况

Screening for congenital heart disease in Tibetan newborns using echocardiography in Tibet region

目的采用超声心动图方法筛查西藏地区藏族新生儿先天性心脏病(CHD),以评估其发病情况及畸形类型。方法对2016年11月至2017年5月在拉萨市人民医院出生的所有藏族活产新生儿于出生后1～5 d行常规彩色多普勒超声心动图检查,记录新生儿的一般资料(性别、年龄、孕周、民族、出生体质量、居住海拔及母亲年龄),对CHD的检出率及畸形类型进行分析。结果纳入研究的藏族活产新生儿共488例[足月儿445例,男性301例,居住海拔2 300～4 801 m、平均(3 870±365) m],经超声心动图诊断CHD 314例,总检出率为63. 2%。单纯型动脉导管未闭占89. 8%(282例),动脉导管未闭并房间隔缺损或室间隔缺损占8. 0%(25例),单纯型房间隔缺损占1. 6%(5例),单纯型室间隔缺损占0. 6%(2例),未发现其他类型简单CHD或复杂CHD。Logistic回归分析显示CHD检出率和畸形类型与性别、孕周、出生体质量、居住海拔及母亲年龄等因素均无明显相关性(均P> 0. 1)。结论西藏地区藏族新生儿CHD检出率为平原地区的13倍,为青海的2. 3倍。畸形类型以动脉导管未闭为主,还有少数房间隔缺损和室间隔缺损。建议在西藏地区常规实施新生儿超声心动图筛查,为临床尽早干预提供依据。

Objective To analyze the prevalence of congenital heart disease(CHD) in Tibetan newborns using echocardiography and evaluate the incidence and types of CHD in Tibetan region. Methods Color Doppler echocardiography was performed in Tibetan newborns(0-5 d) in Lhasa People′s Hospital between November 2016 and May 2017. Clinical data including gender, age, gestational age, ethnic, birth weight, living altitude and maternal age were recorded;the incidence and type of CHD were analyzed. Results A total of 488 Tibetan newborns were enrolled in the study, including 445 term infants, 301 boys;living altitude ranged from 2 300 to 4 801 meters and the median altitude was (3 870±365)meters;314 cases of CHD(64.3%) were confirmed by echocardiography. Common types of CHD were single patent ductus arteriosus[89.8%(282 cases)], patent ductus arteriosus with atrial septal defect or ventricular septal defect[8.0%(25 cases)], single secundum atrial septal defect[1.6%(5 cases)] and single ventricular septal defect[0.6%(2 cases)]. Logistic regression analysis showed that the incidence and types of CHD were not related with sex, gestational age, birth weight, living altitude and maternal age(all P>0.1). Conclusions Incidence of neonatal CHD in Tibet is 13 times that in plain area and 2.3 times that in Qinghai. Main malformation is patent ductus arteriosus and other common types are atrial septal defects and ventricular septal defects. Echocardiography should be routinely applied in newborns in Tibet for early clinical intervention.