如皋市出生缺陷病因与死亡原因分析

目的评估如皋市现阶段出生缺陷主要病因及死亡原因。方法对如皋市2007年至2012年出生缺陷监测资料进行回顾性分析与阶段性比较。结果2007年至2012年出生缺陷发生率为6．04％。年平均下降0．21‰。出生缺陷前10位病因为唇裂和腭裂、多指及并指（趾）、心间隔先天畸形、马蹄内翻足、大肠先天性缺如闭锁和狭窄、先天性（外）耳道缺如闭锁和狭窄、小耳、先天性脑积水、尿道下裂、脊柱裂等，占出生缺陷总数的79．14％，其中以肌肉骨骼系统和消化系统的体表缺陷为主。出生缺陷前10位死亡原因为心间隔先天畸形、唇裂和腭裂、心脏的其他先天畸形、先天性脑积水、大肠先天性缺如、闭锁和狭窄、脑及其他短缺畸形、先天性膈疝、先天性肾盂积水、腹裂、脊柱裂等，占出生缺陷死亡数的76．58％，占出生缺陷总数的20．38％，其中以循环系统和神经系统疾病为主。出生缺陷围产期死亡率为1．45‰，婴儿期死亡率为0．74‰。叶酸增补项目对如皋市神经管畸形发生率下降作用并不明显（χ2=0．21，P〉0．05）。男孩出生缺陷发生率高于女孩（χ2=6．12，P〈0．05），孕母年龄≥30岁出生缺陷发生率较高（χ2=6．87，P〈0．05）。结论出生缺陷发生率逐年增长的现象得到纠正，综合干预措施发挥了一定作用。建议推广应用神经系统和循环系统出生缺陷监测的方法，探索当地孕母叶酸水平等影响因素与出生缺陷的关系，并进一步落实出生缺陷三级干预措施。

Analysis of the causes of birth defects and death in Rugao

Objective To evaluate the causes of birth defects and death at present. Methods The data of birth defects from 2007 to 2012 were retrospectively analyzed and periodically compared. Results The incidence rate of birth defects was 6.04‰ from 2007 to 2012, and the average annual decline rate was 0.21‰. The top ten causes of birth defects were cleft lip and cleft palate, polydactyly and syndaetyly, congenital malformations of cardiac septa, talipes equinovarus, congenital stenosis and atresia of the colon, congenital absence atresia and stricture of （external） auditory canal, microtia, congenital hydrocephalus, hypospadias, and hifid spine. They accounted for 79.14% of the total number of birth defects, and the surface defects of musculoskeletal system and digestive system were the majority. The top ten causes of death of birth defects were congenital malformations of cardiac septa, cleft lip and cleft palate, other congenital malformations of heart, congenital hydrocephalus, congenital stenosis and atresia of the colon, other shortage deformities of brain, congenital diaphragmatic hernia, congenital hydronephrosis, gastroschisis, and spina bifida. They accounted for 76.58% of death cases of birth defects and 20.38% of birth defects. Among them diseases of circulatory system and nervous system were the majority. The perinatal mortality rate of birth defects was 1.45‰, and the infant mortality rate of birth defects was 0. 74‰. Folie acid supplementary items could not reduce the incidence of neural tube malformation in Rugao obviously（χ2 =0.21 ,P 〉 0.05 ）. The incidence of birth defects in boys was higher than girls （χ2 = 6.12 ,P 〈 0.05 ）, and that of maternal age ≥ 30 was higher（χ2 = 6.87, P 〈 0.05 ）. Conclusion Increased incidence of birth defects has been corrected, and comprehensive intervention measures play a role. It is suggested that the monitor of birth defects in nervous system and circulatory system should be promoted to explore the relationship between the influencing factors of local maternal folic acid levels and birth defects. Three-grade prevention of birth defects should be further implemented.