摘要：目的 探讨儿童全面性发育落后(GDD)的主要高危因素、临床特征和预后,为降低GDD的发病率及早期诊断、早期干预,改善其预后提供科学依据.方法选择2011年10月至2013年9月安徽医科大学第一附属医院小儿神经康复中心首次确诊并进行干预治疗的185例GDD患儿,分析其主要高危因素、临床特征及预后,同时对患儿做了2年的随访,随访过程中对未正常发育的患儿持续干预治疗,采用x2检验比较不同临床特征GDD患儿的高危因素及预后情况,应用多因素Logistic回归模型分析影响预后的高危因素.结果 185例GDD患儿以运动合并语言发育落后(119例,64.3％)最常见,其次为运动、语言和认知发育均落后(30例,16.2％)及语言合并认知发育落后(22例,11.9％),以运动合并认知发育落后(14例,7.6％)最少见.主要高危因素依次为新生儿窒息、早产、病理性黄疸、官内发育迟缓、宫内窘迫、新生儿缺氧缺血性脑病(HIE)、新生儿感染和妊娠高血压病,其中早产、宫内发育迟缓及宫内窘迫患儿临床特征分类差异有统计学意义(x2=3.195,P =0.018;x2=2.701,P=0.028;x2 =6.516,P=0.039).2年随访结果发现,40例(21.6％)已正常,145例(78.4％)仍异常,其中97例(52.5％)为GDD患儿,经干预后均有明显好转,发展为智力发育障碍30例(16.2％),脑性瘫痪18例(9.7％),不同临床特征GDD患儿预后差异有统计学意义(x2=60.960,P=0.017);Logistic回归模型分析结果显示,影响预后的主要危险因素依次为官内发育迟缓[β=0.777,优势比(OR)=2.174]、宫内窘迫(β=0.706,OR=2.026)、新生儿HIE(β=0.547,OR=1.729)和新生儿窒息(β=0.070,OR=1.073).结论 GDD的病因复杂,预后不良,且不同临床特征患儿病因及预后也有差异.提高围生期保健水平,早期诊断、早期干预,对减少GDD的发生和改善其预后有重要意义.%Objective To discuss the main high-risk factors,clinical features and prognosis of global developmental delay(GDD),so as to provide effective basis for reducing incidence of children with GDD,early diagnosis,early intervention and improving prognosis.Methods One hundred and eighty-five cases of children with GDD,who were first diagnosed and treated in the Pediatric Neurology Rehabilitation Center,the First Affiliated Hospital of Anhui Medical University from October 2011 to September 2013,were included and high-risk factors,clinical features,and prognosis were analyzed.At the same time,the patients were followed up for 2 years and the children with abnormal development received continuous intervention and treatment during the follow-up.x2 test was used to compare high-risk factors and prognosis of different clinical features and Logistic regression models were selected to analyze high-risk factors influencing prognosis.Results In 185 cases with GDD,there were 119 children (64.3％) with motor and language developmental delay,which were the most common features,and followed by types of motor combined cognitive and language developmental delay which make up 30 cases (16.2％) and cognitive merged language developmental delay which make up 22 cases (11.9％) and the rarest type of 14 cases (7.6％) was motor and cognitive developmental delay.The main high-risk factors included neonatal asphyxia,premature birth,pathologic jaundice,intrauterine growth retardation,intrauterine hypoxia,neonatal hypoxic-ischemic encephalopathy (HIE),neonatal infection and pregnancy-induced hypertension syndrome and the differences of various clinical features with premature birth,intrauterine growth retardation,pathologic jaundice were statistically significant.Up to 2 years of follow-up,40 cases (21.6％) turned normal,but 145 children (78.4％) were still abnormal,including 97 children (52.5％) having significantly improved after intervention,30 cases(16.2％)of intellectual developmental disorder and 18 cases (9.7％) of cerebral palsy.The differences in various clinical features showed statistically significance (x2=60.960,P=0.017).The main high-risk factors affecting prognosis were intrauterine growth retardation [β=0.777,odds ratio (OR)=2.174],intrauterine hypoxia (β=0.706,OR=2.026),HIE(β=0.547,OR=1.729) and neonatal asphyxia (β=0.070,OR =1.073).Conclusion Causes of GDD are complex and prognosis is poor and the etiology and prognosis of children with different clinical features are also different.It is important to enhance perinatal care,early diagnosis and intervention for reducing the incidence of GDD and improving prognosis.
