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赵一鸣, 吕兰秋, 史慧静, 严蕙蕙. 宁波市江北区2012 — 2018年自然出生队列< 1岁先天性心脏病累计检出与变化趋势及生后3年内转归情况分析[J]. 中国公共卫生, 2023, 39(10): 1282-1288. DOI: 10.11847/zgggws1141525
引用本文: 赵一鸣, 吕兰秋, 史慧静, 严蕙蕙. 宁波市江北区2012 — 2018年自然出生队列< 1岁先天性心脏病累计检出与变化趋势及生后3年内转归情况分析[J]. 中国公共卫生, 2023, 39(10): 1282-1288. DOI: 10.11847/zgggws1141525
ZHAO Yiming, LÜ Lanqiu, SHI Huijing, YAN Huihui. Annual and cumulative detection rate and three-year outcome of congenital heart disease diagnosed within one year after birth among children born during 2012 – 2018 in Ningbo city[J]. Chinese Journal of Public Health, 2023, 39(10): 1282-1288. DOI: 10.11847/zgggws1141525
Citation: ZHAO Yiming, LÜ Lanqiu, SHI Huijing, YAN Huihui. Annual and cumulative detection rate and three-year outcome of congenital heart disease diagnosed within one year after birth among children born during 2012 – 2018 in Ningbo city[J]. Chinese Journal of Public Health, 2023, 39(10): 1282-1288. DOI: 10.11847/zgggws1141525

宁波市江北区2012 — 2018年自然出生队列< 1岁先天性心脏病累计检出与变化趋势及生后3年内转归情况分析

Annual and cumulative detection rate and three-year outcome of congenital heart disease diagnosed within one year after birth among children born during 2012 – 2018 in Ningbo city

  • 摘要:
      目的  分析自然出生队列中婴幼儿在生后1年内先天性心脏病(以下简称先心病)的累计检出、年度变化趋势和生后3年内的结局转归情况,探索合适的监测时间和影响结局的因素。
      方法   从浙江省宁波市自然出生队列中获取2012 — 2018年在宁波江北出生并完成生后3年随访的28 208例活产儿,收集生后1年内报告的全部先心病个案,描述性分析婴儿期内先心病的累计检出率;以年度变化百分比为主要指标,采用Join Point回归描述先心病检出的变化趋势和类型分布。随访调查1 304例先心病在出生后3年内发生死亡、自然愈合、手术等转归情况;使用多因素logistics回归模型分析转归结局中先心病不能自然愈合的影响因素和Kaplan-Meier生存分析计算自愈时间。
      结果   宁波市2012 — 2018年自然出生队列监测28 208例活产儿,婴儿期内共发现1 304例先心病,每100名活产儿生后1年内的先心病累计检出率为4.62%。2012 — 2018年度累计检出率分别为1.87%、2.58%、3.13%、4.25%、6.20%、6.37%、8.26%,并呈逐年上升趋势,2016年为变化转折点。从先心病分类来看,构成比列前3位的分别是房间隔缺损431例(33.05%)、动脉导管未闭合并卵圆孔未闭232例(17.79%)和房间隔缺损合并卵圆孔未闭196例(15.03%)。出生后3、6、12个月内的先心病累计检出率分别为4.29%、 4.51%和4.62%,约97.62%的先心病在出生后6个月内被发现。全部1 304例先心病病例在出生后3年时间内,发生自然愈合934例(71.63%),MP25P75)自愈时间为8.6个月(7.8,9.4个);接从受先心病手术60例(4.60%);因先心病死亡22例(1.69%);未愈149例(11.43%);另外失访或拒绝随访139例(10.66%)。母亲年龄的增加会降低未愈风险(OR = 0.9342,95%CI = 0.893~0.974);相对本省户籍,外省户籍增加儿童未愈风险(OR = 1.893,95%CI = 1.459~2.456)。先心病类型会显著影响自愈时长,复合型先心病自愈时长显著长于单纯型先心病,女婴愈合时间长于男婴,差异有统计学意义。
      结论  可以延长先心病监测期至生后1年;超70%在出生3年内发生自然愈合,需谨慎选择手术时机。应重点关注外地户籍年轻母亲分娩的患复合型先心病女婴的先心病随访。

     

    Abstract:
      Objective   To analyze annual and cumulative detection rate and three-year outcome of congenital heart disease (CHD) diagnosed within one year after birth among children born during 2012 – 2018 in Ningbo city for developing appropriate measures on diagnosis and treatment of the disease.
      Methods  The data on 28 208 live births during 2012 – 2018 in a district of Ningbo city, Zhejiang province were extracted from a natural birth cohort study conducted in the city. Totally 1 304 cases of CHD diagnosed within one year after birth among the live births were identified and followed up for 3 years after birth to collect the information on their outcomes of CHD. The annual and cumulative detection rate of CHD in the live births were analyzed and the change trend in annual detection rate of CHD were described with annual percentage change using join point regression. Kaplan-Meier survival analysis was used to calculate the duration of spontaneous-healing of CHD and multivariate logistic regression model was adopted to explore factors associated with CHD spontaneous healing of the cases.
      Results  For all the live births, the cumulative detection rate of CHD diagnosed within one year after birth was 4.62 per 100 live births and the annual detection rate for years from 2012 to 2018 were 1.87, 2.58, 3.13, 4.25, 6.20, 6.37, and 8.26 per 100 live births, respectively, indicating an increasing trend. The number (proportion) of top three types of CHD detected were 431 (33.05%) for atrial septal defect, 232 (17.79%) for patent ductus arteriosus and patent foramen ovale, and 196 (15.03%) for atrial septal defect and patent foramen ovale. The cumulative detection rate of CHD diagnosed within 3, 6 , and 12 months after birth were 4.29, 4.51 and 4.62 per 100 live births. Of all the CHD cases, 97.62% were detected within 6 months after birth. The three-year after birth follow-ups revealed that among all the CHD cases, 934 (71.63%) had spontaneous-healing at a median time of 8.6 months (25th percentile: 7.8 months, 75th percentile 9.4 months); 60 (4.60%) underwent surgeries for CHD; 22 (1.69%) died of the disease; 149 (11.43%) were not healed or cured; and 139 (10.66%) were lost or refused to the follow-up. The results of multivariate logistic regression analysis showed that the CHD cases with elder maternal age at the birth were at decreased risk of without spontaneous healing three-year after birth (odd ratio OR = 0.9342, 95% confidence interval 95%CI: 0.893 – 0.974) but the cases with the household registry of other provinces were at an increased risk of the spontaneous-healing compared to the cases with local province household registry (OR = 1.893, 95%CI: 1.459 – 2.456). The time of spontaneous healing of the female cases and the cases with complex CHD were significantly longer than that of male cases and the cases with simple CHD.
      Conclusion  The results of the survey suggest that the CHD surveillance period could be extended to one year after birth among infants, especially among those being female, with younger maternal age at birth or those with household registry other than local province, and more than 70% of the CHD cases diagnosed within one year after birth could have spontaneous healing within three years after birth and this should be concerned in determining the time of surgery for CHD.

     

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