中国6省及自治区小儿脑性瘫痪危险因素的研究

目的: 探讨中国1～6岁小儿脑瘫的危险因素,为病因和防治措施研究奠定基础. 方法 :1997年5月至1998年12月在中国江苏等6个省(自治区)对1～6岁小儿脑性瘫痪进行了以人群为基础的1∶2病例对照研究. 结果: 共调查1～6岁儿童1 047 327名,发现1～6岁儿童脑瘫病例共2 009例;对1 968例脑瘫及其对照者的危险因素研究结果表明,脑瘫的危险因素主要包括28个,其中分娩前期15个,分娩过程5个,新生儿期8个;新生儿期危险因素包括缺氧缺血性脑病(OR=26.4, 95%CI=4.6, 152.2)、高胆红素脑病(OR=14.2,95%CI=5.3,38.2)、新生儿脑膜炎(OR=267.6, 95%CI=21.2,3 372)和颅内出血(OR=133.1,95%CI=25.4,697.7)等与脑瘫关联最强,分娩过程因素其次,分娩前因素最弱.分娩前因素包括父母是近亲(OR=3.1,95%CI=1.4,6.8)、亲属中有智力低下者(OR=5.4,95%CI=3.1,9.4)、胎儿宫内发育迟缓(OR=6.6,95%CI=2.5,16.7)、出生体重轻(OR=5.3,95%CI=3.2,8.9)、出生孕周小(OR=7.6,95%CI=4.2,13.7)、母孕期服用药品(OR=7.9,95%CI=2.6,23.2)等,虽然与脑瘫关联程度有限,但数目多,而且可能与新生儿期危险因素有因果关系. 结论:新生儿期危险因素与脑瘫的关联程度较强,但分娩前及分娩中有关危险因素与新生儿期某些不利表现之间的关系值得进一步研究.

Risk factors for childhood cerebral palsy in six provinces in China

SUMMARY Objective: To evaluate risk factors for childhood cerebral palsy(CP) in China. Methods: We conducted a population based case control study among children in six provinces in China. They were 1-6 years old children with CP Two controls were selected for each child; controls were selected from children of same sex, same age, and living in the same township. Information on pregnancy, labor, delivery, and the neonatal period was obtained. Results: 1 047 327 children aged 1-6 years old were enrolled and 2 009 children of CP were found.Cases were much more likely than controls to experience hypoxic ischemic encephalopathy ( OR = 26.4, 95%CI = 4.6, 152.2 ), hyperbilirubinemia(OR=14.2,95%CI=5.3,38.2), intracranial hemorrhage(OR=133.1,95%CI= 25.4,697.7) , and neonatal meningitis (OR=267.6, 95%CI=21.2,3 372) in the neonatal period. Prenatal or intradelivery factors such as family history of mental retardation(OR=5.4, 95%CI=3.1, 9.4), poor maternal nutrition status(OR=1.9, 95%CI=1.6,2.4), maternal fever(OR=1.9, 95%CI=1.4,2.5) and drug exposure(OR=7.8, 95%CI=2.6,23.2), intrauterine growth retardation(OR=6.6, 95%CI=2.5,16.7), premature labor(OR=7.6, 95%CI=4.2,13.7), and low birth weight(OR=5.3, 95%CI=3.2,8.9); and demographic factors such as poor socioeconomic status(OR= 1.8, 95%CI=1.4,2.5) and exposure to cigarette smoke(OR=1.5, 95%CI=1.1,1.9) were with lower odds ratio. Conclusion: In this study, adverse events occurring during the neonatal period were more strongly associated with development of CP than were prenatal or demographic factors; however, the influence of prenatal or demographic factors on neonatal events needs further study.