中国30个县(市)1993～2000年神经管畸形在出生人群中的患病率及变动趋势分析(英文)

Prevalence of neural tube defects at birth in 30 counties and cities of China, 1993-2000

目的 :描述中国 30个县 (市 ) 1 993至 2 0 0 0年神经管畸形 (neuraltubedefects ,NTD)在出生人群中的患病率及变动趋势。方法 :资料来源于“中美预防出生缺陷和残疾合作项目”中出生缺陷监测的常规报告。研究对象为1 993～ 2 0 0 0年所有孕满 2 0周的总出生人群 (包括活产和死胎、死产 )。利用线性回归分析神经管畸形率按年变动的趋势。结果 :在 1 993～ 2 0 0 0年间 ,共监测到 1 1 891 2 6个活产儿和死胎、死产儿出生 ,其中有明确诊断的神经管畸形儿 1 2 6 4例 ;总出生人群中的神经管畸形率为 1 0 .6 3/ 1 0 0 0 0 ,1 993年的畸形率最高 ( 1 8.99/ 1 0 0 0 0 ) ,1 998年最低 ( 6 .0 5/ 1 0 0 0 0 ) ;无脑儿、脊柱裂和脑膨出在每 1 0 0 0 0个出生儿中的患病率分别为 4 .71、4 .39和 1 .53。在所有神经管畸形病例中 ,无脑儿和脊柱裂占的比例较高 ,分别为 4 4.3%和 4 1 .3% ,而脑膨出仅占 1 4 .4 %。在神经管畸形病例中有 6 9.3%为死胎、死产 ;而死胎、死产在无脑儿、脊柱裂和脑膨出中所占的比例分别为 95.4 %、4 3.7%和6 2 .6 %。线性回归分析结果显示 ,神经管畸形率从 1 993至 2 0 0 0年呈显著下降趋势 (F =1 1 .81 8,β =- 0 .81 4 ,P <0 .0 5) ;而对 3种畸形单独分析发现 ,无脑儿和脊柱裂率也呈显著?

SUMMARY Objective: To describe the prevalence rates of neural tube defects (NTD) and yearly trends (1993-2000) in China. Methods: All the data were obtained from the Birth Defects Surveillance System in thirty counties/cities of China. The calculation of NTD prevalence rates and time trend analyses were based on the data for live (L) and stillbirths (S) only, the denominator used was total births (L+S). Linear regression analysis of the prevalence rate over years has been used to measure time trends. Results: In the period of 1993-2000, there were 1 264 neural tube defects among 1 189 126 total births in 30 counties/cities in China. The overall neural tube defects rate was 10.63 per 10 000 births, and rates were higher (18.99 per 10 000 births) in the year 1993, lower (6.05 per 10 000 births) in 1998. The prevalence rates of anencephaly, spina bifida and encephalocele were 4.71 , 4.39 and 1.53 per 10 000 births respectively. Of all index NTD cases, anencephaly and spina bifida were most frequent, making up 44.3% and 41.3%, and encephalocele represented 14.4%. The stillbirth proportion was 69.3% over all index NTD cases, 95.4% in anencephaly cases, 43.7% in spina bifida, and 62.6% in encephalocele cases. Linear trend analysis indicated a significant decline for NTD rate ( F =11.818, β=-0.814, P =0.014). Analysis by specific defect showed significant declines for the rates of anencephaly ( P =0.004) and spina bifida ( P =0.026), but no significant annual variation of encephalocele ( P =0.227). Results of comparing with data reported from other surveillance systems (1994-1999) showed that the highest NTD rate (9.41 per 10 000 births) was seen in China, nearly 7 times the lowest rate (1.44 per 10 000 births) in England and Wales. Conclusion: The overall neural tube defects rate in 30 counties/cities of China presented a significant downward trend between 1993 and 2000, and China still had the higher neural tube defects prevalence.