基于人群监测和医院监测的高发地区出生缺陷流行病学特征比较

目的比较中国出生缺陷高发地区人群监测和医院监测出生缺陷流行病学特征的差异。方法在中国出生缺陷高发的山西省选择2个高发县作为研究地区,对该地区2002年1月1日至2004年12月31日孕满20周及以上胎儿及婴幼儿出生缺陷的发生水平进行分析。人群监测采用社区调查和医院登记相结合的方法,医院监测来自当地医院妇产科及B超检查的登记册,比较两种监测方法出生缺陷发生率及顺位,孕20周至生后7d或至3岁时的差异。结果 2002至2004年医院监测累积出生4855人,出生缺陷113例,出生缺陷发生率为232.7/万出生;人群监测累积出生6420人,出生缺陷223例,出生缺陷发生率为347.4/万出生,差异有显著统计学意义（P〈0.001）。在孕20周至生后7d的常规监测年龄段,医院和人群监测资料出生缺陷均以神经系统畸形为主,神经系统、耳部畸形、泌尿生殖系统以及皮肤缺陷发生率均为人群监测高于医院监测。人群与医院监测的前5位出生缺陷顺位一致,依次为无脑儿、脊柱裂、先天性脑积水、脑膨出、唇和（或）腭裂。当人群监测年龄延长至3岁时,出生缺陷发生率高达844.2/万出生,是孕20周至生后7d人群监测数据的2.43倍,是医院监测数据的3.63倍。人群监测孕20周至3岁时出生缺陷顺位变化较大,前5位依次为腹股沟疝、无脑畸形、先天性智力低下、先天性心脏病和脊柱裂。结论出生缺陷的水平和顺位与监测方法和时段密切相关,在常规人群出生缺陷监测基础上,可将部分出生缺陷监测时间延长至3岁,可发现更多常规监测以外的出生缺陷种类,为出生缺陷预防提供可靠依据。

Comparison of epidemiological features of birth defects between population-based and hospital-based surveys in high-prevalence areas of China

Objective To compare the birth defects data from two different birth defect（BD） survey methods in high-prevalence areas of China.Methods Two counties of Shanxi province with high prevalence of BDs were selected as survey fields.The BDs among fetuses and live births born after 20 weeks’ gestational age from 2002 through 2004 were assessed by two survey methods,population-based and hospital-based BDs surveys.The population-based data were collected from hospital records and field survey,while the hospital-based data from registry records of department of obstetrical,B ultrasonics in the local hospitals and maternal and child health centers.Results There were 4 855 births reported in hospital-based birth source and 6 420 births in population-based birth source.For pregnancy from prenatal 20th week to postnatal 7 days,the incidence of BDs was 232.7 per 10 000 births in hospital-based survey,which was significantly lower than that from population-based survey（232.7 vs 347.4 per 10 000 births,P〈0.001）.Considering the category of BDs during prenatal 20th week to postnatal 7 days,the prevalence of some malformations including the malformation involved in nervous system,ear,urinary system and skin malformation was higher in population-based survey compared with hospital-based survey.The top ranked BDs were same at this monitoring period in two different surveys,with anencephalus,spina bifida,congenital hydrocephalus,encephalocele and lip and/or cleft palate being the top five.With the survey monitoring period extending to postnatal 3 years,the BD prevalence from population-based survey source increased by 2.43 folds,and 3.63 times of that from hospital-based survey source.Inguinal hernia ranked top of BDs,followed by anencephalus,congenital mental retardation,congenital heart disease and spina bifida.Conclusions The incidence of BDs and ranking were impacted by the monitoring method and range of monitoring ages.It may need to extend the monitoring period to 3 years old from the routine Chinese monitoring in order to obtain complete BDs data and provide a reliable basis for the BD prevention.