中国十二省市小儿脑性瘫痪流行病学特征

Epidemiological characteristics of cerebral palsy in twelve province in China

目的了解中国1～6岁小儿脑性瘫痪（脑瘫）流行病学特征，包括发病率、患病率、脑瘫类型、病因及防治状况等。方法对调查省份的城市以街道为单位，农村以村为单位，以城市儿童和农村儿童各半、各年龄组儿童比例均衡为原则，采用标准化问卷，进行多中心协作、分层整群随机抽样方法入户调查。调查范围为黑龙江、北京、河南、山东、山西、陕西、安徽、湖南、广西、广东、重庆、青海共12省市自治区，样本量为323 858人。结果脑瘫发病率为2.48‰（155/62 591例），患病率为2.46‰（797/323 858例）（1～6岁）。各地区脑瘫患病率有所不同，青海省患病率最高为5.40‰（54/9 998例），山东省患病率最低为1.04‰（47/45 133例）。男童患病率为2.64‰（461/174 391例），女童患病率为2.25‰（336/149 467例），男童患病率高于女童，差异有统计学意义（P〈0.05）。797例脑瘫各型所占比例：痉挛型58.85%（469/797例），混合型13.17%（105/797例），不随意运动型9.79%（78/797例），肌张力低下型8.28%（66/797例），共济失调型6.25%（52/797例），强直型3.39%（27/797例）。排在前3位的主要病因及风险因素：母亲是否长期接触有害物理因素，儿童的同辈、父母辈、（外）祖父母辈等三辈亲属中是否有出生缺陷，新生儿期是否患过重度黄疸或迁延性黄疸。797例脑瘫患者中79.67%能在当地得到及时发现和诊治，19.93%未能得到及时发现和诊治，及时发现和早期诊治的场所以综合医院（42.97%）、妇婴医院（27.03%）和儿童医院（20.31%）为主。797例脑瘫患儿的主要康复途径：34.58%在医院或康复机构接受康复治疗，31.61%在社区（包括家庭）接受康复治疗，33.80%主要在机构接受康复治疗，也可在社区得到一定程度地康复治疗或指导。结论中国脑瘫患病率与国际脑瘫患病率的平均水平接近，男童患病率高于女童，脑瘫类型分布基本符合国际脑瘫类型分布特征，仍有部分脑瘫患儿不能得到及时发现和诊治，康复途径以集中式康复治疗为主，在社区进行一定的康复指导。

Objective To investigate the epidemiological characteristics of cerebral palsy （CP） in children aged 1 - 6 years in China, including the incidence, prevalence, type of CP, etiology, prevention and rehabilitation status. Methods The survey was carried out by standard questionnaires, multi - center collaboration, stratified - cluster random sampling method. The surveyed adopted the following principles ： streets in the city and villages in the rural areas, and the number of the urban and rural children was the same, and the proportion of children in each age group was balanced. The investigation areas included provinces and autonomous regions, including Heilongjiang, Beijing, Henan, Shandong, Shanxi, Shaanxi, Anhui, Hunan, Guaugxi, Guangdong, Chongqing and Qinghai, and 323 858 children were investigated. Results The incidence of CP was 2.48%0 （ 155/62 591 cases）, and the prevalence was 2.46%0 （797/ 323 858 cases） （1 -6 years old）. The prevalence varied in different regions,in which the highest prevalence was 5. 40‰（54/9 998 cases） in Qinghai province, and the lowest prevalence was 1.04‰（47/45 133 cases） in Shandong province. The prevalence of the males （2.64‰,461/174 391 cases） was higher than that of the females （2.25‰, 336/149 467 cases）, and the difference was statistically significant （P 〈 0.05 ）. The types of CP were spastic type （58.85% ,469/797 cases）, mixed type （ 13.17% , 105/797 cases）, dyskinetic （9. 79% , 78/797 cases）, hypotonic （8.28% ,66/797 cases）, ataxia （6.25% ,52/797 cases） and rigid （ 3.39% ,27/797 cases） respectively in 797 CP children. The first three risk factors ＂for CP were long - term exposure to harmful physical factors during pregnancy, whether there were birth defects among the three generations of relatives of the children, such as children＇s peers, parents or grandparents, whether there were birth defects among the children＇ s peers, parents or grandparents, and neonatal jaundice or persistent jaundice. Among 797 CP children,79.67% of the children with CP were timely detected and treated in the local hospitals, while the other 19.93 % of them were not timely treated. The places which could give them timely detection and early diagnosis and treatment were general hospitals （42.97%）, Maternity and Infant Hospitals （27.03%） and Children＇s Hospitals （20.31%）. The main rehabilitation methods for 797 children with CP were 34. 58% in the hospitals or rehabilitation centers ,31.61% in the communities （including at home） ,33.80% mainly in the medical institution, and in the communities they could also receive partially rehabilitation services. Conclusions The prevalence of CP in China is coincident with international levels. The prevalence rate of CP in males is higher than that in females. The types of CP distribution are accorded with international distribution characteristics. There were still some children with CP who could not receive timely detection and treatment. Rehabilitation at the medical institutions is the chief way and proper rehabilitation guidance should be carried out in the communities.