先天性心脏病的流行趋势及流行病学分析

摘要

目的：探讨先天性心脏病（CHD）的流行趋势，分析其流行病学特征和发病危险因素。方法：纳入我院2012年1月至2015年1月间诊断为CHD的患儿共2415例为研究对象。统计CHD的每年检出率，构成类型和各年龄段构成比。采用多因素Logistic回归分析发生CHD的独立危险因素和独立保护因素。结果：2012年、2013年和2014年的CHD检出率分别为19.42％、34.99％和45.59％，呈现明显的逐年升高趋势（P＝0.018，0.107）。统计分析表明CHD 的主要类型房间隔缺损（ASD ）、室间隔缺损（VSD ）和动脉导管未闭（PDA ）分别占37.31％、30.97％和13.71％，居前三位。各年龄段间比较发现1岁以下各类型CHD占比均最高，1岁以上的各类型CHD患病率呈逐渐降低趋势；＜4岁的CHD患儿占CHD患儿的74.95％。多因素Logistic回归分析显示母亲文化程度是CHD的独立保护因素[OR＝0.488， P＝0.011]，先兆流产史、父亲吸烟史和孕期室内装修是CHD的独立危险因素[OR＝1.748～7.151， P＜0.05或＜0.01]。结论：近年我国先天性心脏病的检出率呈逐年上升趋势，定期检查，针对父母情况和环境因素提早进行干预，可达到早期诊断及防治的目的。%Objective:To explore trend of congenital heart disease (CHD) ,analyze its epidemiological features and risk factors .Methods :A total of 2415 children diagnosed as CHD in our hospital from Jan 2012 to Jan 2015 were en‐rolled as CHD group ,another .Detection rate of every year ,constitution type and constituent ratio of each age group for CHD were counted .Multifactor Logistic regression analysis was used to analyze independent risk factors and protective factors of CHD .Results:CHD detection rate of 2012 ,2013 and 2014 was 19.42% ,34.99% and 45.59% respectively ,showing an increasing trend (P=0.018 ,0.107) .The top three types of CHD were atrial sep‐tal defect (ASD , 37.31% ) , ventricular septal defect (VSD , 30.97% ) and patent ductus arteriosus (PDA , 13.71% ) .Comparison among all age groups found that <1 year group occupied the highest proportion for all types of CHD ,prevalence rate of all types of CHD showed a gradual decreasing trend in > 1 year children ;< 4 years CHD children occupied 74. 95% for all CHD children .Multifactor Logistic regression analysis indicated that educa‐tion level of mother was independent protective factor for CHD [OR=0.488 ,P=0.011] ,threatened abortion his‐tory ,smoking history of father and interior renovation during pregnancy were independent risk factors for CHD [OR=1.748~7.151 ,P<0.05 or <0.01] .Conclusion:Detection rate of congenital heart disease shows a gradual increasing trend in recent years ,periodic inspection and early intervention focus on parents status and environmental factors must be performed in order to achieve goals of early diagnosis ,prevention and treatment .