西藏不同海拔地区儿童先天性心脏病患病率的横断面研究
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摘要
目的探讨西藏不同海拔高度地区生活的儿童,先天性心脏病患病率及患病种类的差别。方法选择2012年10月至2016年10月在西藏自治区不同海拔地区进行先心病筛查的年龄在3～17岁的12 878例藏族儿童,根据居住地海拔不同分为3组:L组、H组、VH组。由临床医生进行体格检查和听诊筛选出疑似病例,再由心脏专科医生进行全面超声心动图检查确诊,最后将患病数据进行统计分析。结果随着海拔的升高,先心病的患病率从4.37/1 000升高至13.35/1 000;女性与男性患病率的比值从1.3升高至3.1。其中,PDA的患病率升高7倍,ASD的患病率升高1.5倍,ASD是海拔<4 200 m最常见的先天性心脏病(56.3%),而PDA是海拔>4 200 m最常见的先心病(60.9%)。结论显示西藏地区先心病的患病率因海拔的不同而存在很大差异(4.37/1 000～13.35/1 000)。而且提示ASD是海拔<4 200 m最常见的先心病,而PDA是>4 200 m最主要的先心病类型。随着海拔的升高,女性患病率的升高更加显著。
Objective To explore the prevalence of congenital heart disease(CHD) and the differences of the types of diseases in children who live in different altitudes region in Tibet.Methods A total of 1,2878, who live in different altitudes region in Tibet with age range being 3～17 years and were screened for CHD from October 2012 to October 2016 were enrolled in the study,who were divided into three groups: group L, group H and group VH according to the different altitudes of the residence place. Firstly, the clinicians performed physical examinations and auscultation to screen out suspected cases, then the cardiologist performed a comprehensive echocardiographic examination to confirm the diagnosis, finally the illness data were statistically analyzed.Results With the altitude increasing, the prevalence of CHD was increased from 4.37/1,000 to 13.35/1,000,and the ratio of female vs male with CHD was increased from 1.3 to 3.1. Among the patients with CHD, the prevalence rate of PDA was increased by 7 times, the prevalence rate of ASD was increased by 1.5 times. ASD was the most common CHD(56.3%) under 4,200 meters above sea level, and PDA was the most common CHD(60.9%) above 4,200 meters above sea level.Conclusion The research results show that the prevalence rate of CHD in Tibet region varies greatly according to different altitudes(from 4.37/1,000 to 13.35/1,000). Moreover, ASD is the most common CHD under 4,200 meters above sea level, and PDA is the most important type of CHD above 4,200 meters. With the altitude increasing, the increase of prevalence rate in females is more significant.
Objective To explore the prevalence of congenital heart disease(CHD) and the differences of the types of diseases in children who live in different altitudes region in Tibet.Methods A total of 1,2878, who live in different altitudes region in Tibet with age range being 3～17 years and were screened for CHD from October 2012 to October 2016 were enrolled in the study,who were divided into three groups: group L, group H and group VH according to the different altitudes of the residence place. Firstly, the clinicians performed physical examinations and auscultation to screen out suspected cases, then the cardiologist performed a comprehensive echocardiographic examination to confirm the diagnosis, finally the illness data were statistically analyzed.Results With the altitude increasing, the prevalence of CHD was increased from 4.37/1,000 to 13.35/1,000,and the ratio of female vs male with CHD was increased from 1.3 to 3.1. Among the patients with CHD, the prevalence rate of PDA was increased by 7 times, the prevalence rate of ASD was increased by 1.5 times. ASD was the most common CHD(56.3%) under 4,200 meters above sea level, and PDA was the most common CHD(60.9%) above 4,200 meters above sea level.Conclusion The research results show that the prevalence rate of CHD in Tibet region varies greatly according to different altitudes(from 4.37/1,000 to 13.35/1,000). Moreover, ASD is the most common CHD under 4,200 meters above sea level, and PDA is the most important type of CHD above 4,200 meters. With the altitude increasing, the increase of prevalence rate in females is more significant.
引文
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4 Liu X,Liu G,Wang P,et al.Prevalence of congenital heart disease and its related risk indicators among 90,796 Chinese infants aged less than 6 months in Tianjin.International Journal of Epidemiology,2015,44:884-893.
5 Nilda EZ,Soto María Elena,Angel RG,et al.Prevalence of Congenital Heart Disease and Pulmonary Hypertension in Down’s Syndrome:An Echocardiographic Study.Journal of Cardiovascular Ultrasound,2015,23:72.
6 Saxena A,Mehta A,Sharma M,et al.Birth prevalence of congenital heart disease:A cross-sectional observational study from North India.Annals of Pediatric Cardiology,2016,9:205.
7 Hanslik A,Pospisil U,Salzer-Muhar U,et al.Predictors of spontaneous closure of isolated secundum atrial septal defect in children:a longitudinal study.Pediatrics 2006;118:1560-1565.
8 Ma LG,Chen QH,Wang YY,et al.Spatial pattern and variations in the prevalence of congenital heart disease in children aged 4-18 years in the Qinghai-Tibetan Plateau.Science of the Total Environment,2018,627:158-165.
9 Chen QH,Wang XQ,Qi SG.Cross-sectional study of congenital heart disease among Tibetan children aged from 4 to 18 years at different altitudes in Qinghai Province.Chin Med J,2008,121:2469-2472.
10 Tassinari S,Martínez-Vernaza,Samuel,Erazo-Morera N,et al.Epidemiology of congenital heart diseases in Bogotá,Colombia,from 2001 to 2014:Improved surveillance or increased prevalence.Biomédica,2017,38:148-155.
11 Gaynor JW,Parry S,Moldenhauer JS,et al.The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates.European journal of cardio-thoracic surgery:official journal of the European Association for Cardio-thoracic Surgery,2018.
12 Jacobs EG,Leung MP,Karlberg J.Distribution of symptomatic congenital heart disease in Hong Kong.Pediatr Cardiol,2000,21:148-157.
13 Yang XY,Li XF,Lu XD,et al.Incidence of congenital heart disease in Beijing,China.Chin Med J (Engl),2009,122:1128-1132.
14 Fan XJ,Gao JM,Kang YJ,et al.Socioeconomic and Environmental Determinants to Preterm Birth in Tibetan Women:An Analysis Based on the Hierarchically Conceptual Frame.Chinese medical journal.2013,27:193-195.
15 Buse zer Bekmez,Evrim Alyama Dizdar,Nilüfer Okur,et al.Does prenatal diagnosis of critical congenital heart diseases influence the prereferral mortality in a center without surgical intervention.Journal of Maternal-Fetal and Neonatal Medicine,2018,49:1-4.
16 Kawada,Tomoyuki.Fasting plasma glucose as the predictor of morbidity and mortality in patients with symptomatic congenital heart disease.International Journal of Cardiology,2014,177:512.
17 Bibi S,Gilani SYH.Spectrum of congental heart disease in full term neonates.J Ayub Med Coll Abbottabad,2018,30:67-70.
18 Jin XH,Chen QH,Tong YF,et al.Study on the epidemiology of congenital heart disease in Tibetan ethnic children aged from 4 to 18 living at different altitudes in Qinghai province.Zhonghua Liu Xing Bing Xue Za Zhi,2008,29:317-320.
19 Schwartz S,Olsen M,Woo JG,et al.Congenital heart disease and the prevalence of underweight and obesity from age 1 to 15 years:data on a nationwide sample of children.BMJ Paediatrics Open,2017,1:e000127.
20 Dunham-Snary KJ,Hong ZG,Xiong PY,et al.A mitochondrial redox oxygen sensor in the pulmonary vasculature and ductus arteriosus.Pflügers Archiv-European Journal of Physiology,2016,468:43-58.
2 Mertens L,Seri I,Marek J,et al.Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit:practice guidelines and recommendations for training.Writing Group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC).J Am Soc Echocardiogr,2011,24:1057-1078.
3 Bartsch P,Gibbs JS.Effect of altitude on the heart and the lungs.Circulation,2007,116:2191-2202.
4 Liu X,Liu G,Wang P,et al.Prevalence of congenital heart disease and its related risk indicators among 90,796 Chinese infants aged less than 6 months in Tianjin.International Journal of Epidemiology,2015,44:884-893.
5 Nilda EZ,Soto María Elena,Angel RG,et al.Prevalence of Congenital Heart Disease and Pulmonary Hypertension in Down’s Syndrome:An Echocardiographic Study.Journal of Cardiovascular Ultrasound,2015,23:72.
6 Saxena A,Mehta A,Sharma M,et al.Birth prevalence of congenital heart disease:A cross-sectional observational study from North India.Annals of Pediatric Cardiology,2016,9:205.
7 Hanslik A,Pospisil U,Salzer-Muhar U,et al.Predictors of spontaneous closure of isolated secundum atrial septal defect in children:a longitudinal study.Pediatrics 2006;118:1560-1565.
8 Ma LG,Chen QH,Wang YY,et al.Spatial pattern and variations in the prevalence of congenital heart disease in children aged 4-18 years in the Qinghai-Tibetan Plateau.Science of the Total Environment,2018,627:158-165.
9 Chen QH,Wang XQ,Qi SG.Cross-sectional study of congenital heart disease among Tibetan children aged from 4 to 18 years at different altitudes in Qinghai Province.Chin Med J,2008,121:2469-2472.
10 Tassinari S,Martínez-Vernaza,Samuel,Erazo-Morera N,et al.Epidemiology of congenital heart diseases in Bogotá,Colombia,from 2001 to 2014:Improved surveillance or increased prevalence.Biomédica,2017,38:148-155.
11 Gaynor JW,Parry S,Moldenhauer JS,et al.The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates.European journal of cardio-thoracic surgery:official journal of the European Association for Cardio-thoracic Surgery,2018.
12 Jacobs EG,Leung MP,Karlberg J.Distribution of symptomatic congenital heart disease in Hong Kong.Pediatr Cardiol,2000,21:148-157.
13 Yang XY,Li XF,Lu XD,et al.Incidence of congenital heart disease in Beijing,China.Chin Med J (Engl),2009,122:1128-1132.
14 Fan XJ,Gao JM,Kang YJ,et al.Socioeconomic and Environmental Determinants to Preterm Birth in Tibetan Women:An Analysis Based on the Hierarchically Conceptual Frame.Chinese medical journal.2013,27:193-195.
15 Buse zer Bekmez,Evrim Alyama Dizdar,Nilüfer Okur,et al.Does prenatal diagnosis of critical congenital heart diseases influence the prereferral mortality in a center without surgical intervention.Journal of Maternal-Fetal and Neonatal Medicine,2018,49:1-4.
16 Kawada,Tomoyuki.Fasting plasma glucose as the predictor of morbidity and mortality in patients with symptomatic congenital heart disease.International Journal of Cardiology,2014,177:512.
17 Bibi S,Gilani SYH.Spectrum of congental heart disease in full term neonates.J Ayub Med Coll Abbottabad,2018,30:67-70.
18 Jin XH,Chen QH,Tong YF,et al.Study on the epidemiology of congenital heart disease in Tibetan ethnic children aged from 4 to 18 living at different altitudes in Qinghai province.Zhonghua Liu Xing Bing Xue Za Zhi,2008,29:317-320.
19 Schwartz S,Olsen M,Woo JG,et al.Congenital heart disease and the prevalence of underweight and obesity from age 1 to 15 years:data on a nationwide sample of children.BMJ Paediatrics Open,2017,1:e000127.
20 Dunham-Snary KJ,Hong ZG,Xiong PY,et al.A mitochondrial redox oxygen sensor in the pulmonary vasculature and ductus arteriosus.Pflügers Archiv-European Journal of Physiology,2016,468:43-58.