早产和低出生体重及小于胎龄儿与脑性瘫痪发病的关系

目的 明确早产、低出生体重及小于胎龄儿(SGA)与脑性瘫痪(简称脑瘫)的关联程度。方法 1997年5—7月对江苏省7个市的1～6岁儿童进行了现况普查,共查305263名,并对其胎龄、出生体重及胎龄别出生体重与脑瘫的关系进行了分析。结果 本组儿童共发现脑瘫484例,发生率为1．59‰。早产儿及过期产儿脑瘫发生率相对危险性(RR)分别为足月儿的25．16倍及2．40倍;低出生体重及巨大儿的脑瘫发生率RR分别为正常出生体重儿的19．63倍及1．34倍;SGA及大于胎龄儿(LGA)脑瘫发生率RR为适于胎龄儿(AGA)的4．34倍及0．84倍。先按胎龄别出生体重分层再按胎龄分组,发现各层内早产儿脑瘫发生率均较足月儿高,RR最高AGA层为28．34倍,其次LGA层为21．41倍,最低SGA层为9．29倍,各层内过期产儿脑瘫发生率也较足月儿高,RR最高AGA层为2．63倍,其次SGA层为1．90倍,最低LGA层为1．55倍;先按胎龄分层再按胎龄别出生体重分组发现各层内SGA脑瘫发生率均较AGA高,RR最高足月儿层为4．41倍,其次过期产儿层为3．19倍,最低早产儿层为1．45倍,各层内LGA脑瘫发生率均不比AGA高,除足月儿层相近为0．98倍外,早产儿及过期产儿层均较AGA低,RR分别为0．74倍和0．58倍。按胎龄大小及胎龄别出生体重大小联合分成9组进行比较,发现多数组脑瘫发生率均较足月AGA组高,RR按次序为早产SGA40．99倍、早产AGA28．34倍、早产LGA21．08倍、过期SGA8．39倍、足月SGA4．41倍、过期AGA2．63倍、过期LGA1．53倍、足月LGA0．98倍;前6组差异均有显著性,后2组倍数接近1．0,差异无显著性。结论 早产及SGA两种因素均与小儿脑瘫发生率增加关联,这两个因素分别为小儿脑瘫独立的危险因素;过期产与脑瘫的关联很弱,LGA则与脑瘫的发生率增加无关。

Premature, low birth weight, small for gestational age and childhood cerebral palsy

Objective To investigate the relationship between perinatal risk factors such as premature, low birth weight, small for gestational age and childhood cerebral palsy(CP). Methods A cross sectional survey was carried out among 305 263 children aged 1-6 years old in seven cities of Jiangsu Province, China from May to July 1997. The perinatal risk factors were analysed. Results Four hundred and eighty-four cases of CP were found among this population. The prevalence of CP for children aged 1-6 years old was 1.59 per thousand. The prevalence of CP were strongly correlated to prematurity (RR=25.16), low birth weight (RR=19.63), and also highly correlated to small for gestational age (RR=4.34). For smaller groups divided by small for gestational age (SGA), appropriate for gestational age (AGA), large for gestational age (LGA) and then by gestational age, prematurity was found to be at high risk in SGA (RR=9.29), AGA (RR=28.34) and LGA (RR=21.41) groups. For groups divided by gestational age and then by SGA, AGA and LGA, SGA was found to have significantly high risk in premature (RR=1.45), mature (RR=4.41) and postmature (RR=3.19) groups. Nine groups were divided by the gestational age along with SGA, AGA and LGA, rates of CP were found to be significantly higher in most groups than in the term AGA group. Compared with the rate of CP in the term AGA group, the RR were calculated and showed as followings (from higher to lower), premature SGA (RR=40.99), premature AGA (RR=28.34), premature LGA (RR=21.08), postmature SGA(RR=8.39), mature SGA(RR=4.41) and postmature AGA (RR=2.63). Conclusion Prematurity and small for gestational age are both independent risk factors for cerebral palsy. Postmaturity and large for gestational age are not!risk factors.