CAJ | 학술논문

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。
목적：평고여고시현계단출생결함주요병인급사망원인。방법대여고시2007년지2012년출생결함감측자료진행회고성분석여계단성비교。결과2007년지2012년출생결함발생솔위6．04‰，년평균하강0．21‰。출생결함전10위병인위진렬화악렬、다지급병지（지）、심간격선천기형、마제내번족、대장선천성결여폐쇄화협착、선천성（외）이도결여폐쇄화협착、소이、선천성뇌적수、뇨도하렬、척주렬등，점출생결함총수적79．14％，기중이기육골격계통화소화계통적체표결함위주。출생결함전10위사망원인위심간격선천기형、진렬화악렬、심장적기타선천기형、선천성뇌적수、대장선천성결여、폐쇄화협착、뇌급기타단결기형、선천성격산、선천성신우적수、복렬、척주렬등，점출생결함사망수적76．58％，점출생결함총수적20．38％，기중이순배계통화신경계통질병위주。출생결함위산기사망솔위1．45‰，영인기사망솔위0．74‰。협산증보항목대여고시신경관기형발생솔하강작용병불명현（χ2＝0．21，P＞0．05）。남해출생결함발생솔고우녀해（χ2＝6．12，P＜0．05），잉모년령≥30세출생결함발생솔교고（χ2＝6．87，P＜0．05）。결론출생결함발생솔축년증장적현상득도규정，종합간예조시발휘료일정작용。건의추엄응용신경계통화순배계통출생결함감측적방법，탐색당지잉모협산수평등영향인소여출생결함적관계，병진일보락실출생결함삼급간예조시。
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 syndactyly , 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 bifid 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‰.Folic 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 .