Article(id=1241067205908034512, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405322, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1716134400000, receivedDateStr=2024-05-20, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773823079802, onlineDateStr=2026-03-18, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773823079802, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773823079802, creator=13701087609, updateTime=1773823079802, updator=13701087609, issue=Issue{id=1241067197318091153, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773823077754, creator=13701087609, updateTime=1773823268053, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241067995544482681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241067995544482682, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=848, endPage=853, ext={EN=ArticleExt(id=1241067207283765272, articleId=1241067205908034512, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the monitoring results of congenital heart disease in perinatal infants in Xinjiang from 2016 to 2022, columnId=1241067204725232186, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health,Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the incidence and epidemiological characteristics of congenital heart disease (CHD) in perinatal infants in Xinjiang from January 2016 to December 2022.

Methods

A retrospective analysis was conducted on the data of perinatal infants diagnosed with congenital heart disease from various birth defect monitoring hospitals between 2016 and 2022.

Results

A total of 591 849 perinatal infants were monitored in Xinjiang, among which 3 531 cases of congenital heart disease were identified, resulting in an overall incidence rate of 59.66 per 100 000. There were statistically significant differences in annual incidence rates (χ2=754.466, P < 0.001), showing a general upward trend (χ2trend =592.218, P < 0.001). The most common types of congenital heart disease were atrial septal defect (43.72 per 100 000), patent ductus arteriosus (25.53 per 100 000), ventricular septal defect (8.69 per 100 000), atrioventricular septal defect (3.25 per 100 000), and tetralogy of Fallot (0.79 per 100 000). The survival rate of perinatal infants with congenital heart disease showed an upward trend (χ2trend =11.239, P=0.001).

Conclusion

The overall incidence of congenital heart disease in perinatal infants in Xinjiang is on the rise. It is recommended to further strengthen tertiary prevention measures to reduce the risk of congenital heart disease and improve the prognosis of surviving infants.

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目的

分析新疆维吾尔自治区(简称新疆)2016年1月—2022年12月围产儿先天性心脏病发生情况及流行病学特征。

方法

对2016—2022年各出生缺陷监测医院中被诊断为先天性心脏病的围产儿资料进行回顾性分析。

结果

新疆地区共监测围产儿591 849名,其中先天性心脏病患儿3 531例,总发生率59.66/万。各年度发生率差异有统计学意义(χ2=754.466,P<0.001),总体呈上升趋势(χ2趋势=592.218,P<0.001)。病种顺位依次为房间隔缺损(43.72/万)、动脉导管未闭(25.53/万)、室间隔缺损(8.69/万)、房室间隔缺损(3.25/万)、法洛四联征(0.79/万),先天性心脏病围产儿存活率呈现上升趋势(χ2趋势=11. 239,P=0.001)。

结论

新疆地区围产儿先天性心脏病发生率总体呈上升趋势,建议进一步加强三级预防措施,降低先天性心脏病的发生风险,改善存活患儿预后。

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丁桂凤,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=6bQI2QsPy6mZ+2NJaQSNJg==, magXml=r/s+VqX9ZISO0vx+nESWIQ==, pdfUrl=null, pdf=4AnxylpVovQ6TDwrBoyYSg==, pdfFileSize=671998, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=wiUMiLw2Y/NN+UCYMLrguA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=0nwzxuF/REWfdOPmJUMOYA==, mapNumber=null, authorCompany=null, fund=null, authors=

李依(1999—),女,硕士在读,研究方向:儿少卫生与妇幼保健

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Comparison of trends in congenital heart disease mortality from 1990 to 2017 between China and North America[J].Chinese Journal of Cardiology, 2021, 49(3): 269-275.(In Chinese), articleTitle=Comparison of trends in congenital heart disease mortality from 1990 to 2017 between China and North America, refAbstract=null), Reference(id=1241067226598535976, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, doi=null, pmid=null, pmcid=null, year=2022, volume=20, issue=2, pageStart=97, pageEnd=103, url=null, language=null, rfNumber=[21], rfOrder=35, authorNames=陈寄梅, 庄建, 刘小清, journalName=中国心血管病研究, refType=null, unstructuredReference=陈寄梅,庄建,刘小清,等.先天性心脏病产前产后“一体化”诊疗模式中国专家共识[J].中国心血管病研究202220(2):97-103., articleTitle=先天性心脏病产前产后“一体化”诊疗模式中国专家共识, refAbstract=null), Reference(id=1241067226669839149, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, doi=null, pmid=null, pmcid=null, year=2022, volume=20, issue=2, pageStart=97, pageEnd=103, url=null, language=null, rfNumber=[21], rfOrder=36, authorNames=Chen JM, Zhuang J, Liu XQ, journalName=Chinese Journal of Cardiovascular Research, refType=null, unstructuredReference=Chen JM, Zhuang J, Liu XQ, et al. The integrated pre- and post-natal management program on congenital heart disease: A consensus of Chinese experts[J]. Chinese Journal of Cardiovascular Research, 2022, 20(2): 97-103.(In Chinese), articleTitle=The integrated pre- and post-natal management program on congenital heart disease: A consensus of Chinese experts, refAbstract=null)], funds=[Fund(id=1241067218071515731, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, awardId=2022TSYCTD0016, language=CN, fundingSource=新疆维吾尔自治区科技创新团队(天山创新团队)项目(2022TSYCTD0016), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241067208240066673, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, xref=1., ext=[AuthorCompanyExt(id=1241067208248455283, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, companyId=1241067208240066673, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830000, China), AuthorCompanyExt(id=1241067208256843892, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, companyId=1241067208240066673, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.新疆医科大学公共卫生学院,新疆 乌鲁木齐 830000)]), AuthorCompany(id=1241067208391061634, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, xref=2., ext=[AuthorCompanyExt(id=1241067208399450243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, companyId=1241067208391061634, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.石河子大学医学院)]), AuthorCompany(id=1241067208487530634, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, xref=3., ext=[AuthorCompanyExt(id=1241067208500113550, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, companyId=1241067208487530634, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.新疆围产期疾病临床医学研究中心,乌鲁木齐市妇幼保健院,新疆 乌鲁木齐 830001)])], figs=[ArticleFig(id=1241067216850973169, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=EN, label=Figure 1, caption=Perinatal CHD survival rate in Xinjiang from 2016 to 2022, figureFileSmall=7FXbmxWTMFK5c3L8A1paNg==, figureFileBig=wiUMiLw2Y/NN+UCYMLrguA==, tableContent=null), ArticleFig(id=1241067216951636474, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=CN, label=图1, caption=2016—2022年新疆地区围产儿CHD存活率, figureFileSmall=7FXbmxWTMFK5c3L8A1paNg==, figureFileBig=wiUMiLw2Y/NN+UCYMLrguA==, tableContent=null), ArticleFig(id=1241067217157157390, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=EN, label=Table 1, caption=

Demographic characteristics of children with CHD in Xinjiang from 2016 to 2022 [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量2016年2017年2018年2019年2020年2021年2022年合计
城乡
城镇174(54.37)181(63.96)231(67.54)419(71.38)484(69.84)365(67.34)547(71.60)2 401(68.00)
乡村146(45.63)102(36.04)111(32.46)168(28.62)209(30.16)177(32.66)217(28.40)1 130(32.00)
性别
185(57.81)163(57.60)188(54.97)288(49.06)367(52.96)285(52.58)412(53.93)1 888(53.47)
135(42.19)120(42.40)154(45.03)298(50.77)325(46.90)257(47.42)352(46.07)1 641(46.47)
性别不明0(0.00)0(0.00)0(0.00)1(0.17)1(0.14)0(0.00)0(0.00)2(0.06)
胎数
单胎303(94.69)269(95.05)315(92.11)537(91.48)653(94.23)512(94.46)696(91.10)3 285(93.03)
双胎及以上17(5.31)14(4.95)27(7.89)50(8.52)40(5.77)30(5.54)68(8.90)246(6.97)
产妇年龄(岁)
<2014(4.38)6(2.12)10(2.92)7(1.19)6(0.87)2(0.37)1(0.13)46(1.30)
20~2463(19.69)39(13.78)36(10.53)62(10.56)73(10.53)50(9.23)61(7.98)384(10.88)
25~29102(31.87)118(41.70)141(41.23)259(44.12)257(37.09)204(37.64)252(32.98)1 333(37.75)
30~3476(23.75)71(25.09)100(29.24)179(30.49)235(33.91)207(38.19)309(40.45)1 177(33.33)
≥3565(20.31)49(17.31)55(16.08)78(13.29)115(16.59)79(14.58)140(18.32)581(16.45)
年龄不详0(0.00)0(0.00)0(0.00)2(0.34)7(1.01)0(0.00)1(0.13)10(0.28)
孕周(周)
28~3693(29.06)92(32.51)100(29.24)187(31.86)209(30.16)154(28.41)241(31.54)1076(30.47)
≥37227(70.94)191(67.49)242(70.76)400(68.14)484(69.84)388(71.59)523(68.46)2455(69.53)
诊断依据
超声253(79.06)255(90.11)314(91.81)465(79.22)625(90.19)489(90.22)707(88.02)3 108(88.02)
其他67(20.94)28(9.89)28(8.19)122(20.78)68(9.81)53(9.78)57(11.98)423(11.98)
诊断时间
产前21(6.56)15(5.30)12(3.51)39(6.64)38(5.48)38(7.01)64(8.38)277(6.43)
产后299(93.44)268(94.70)330(96.49)548(93.36)655(93.44)504(92.99)700(91.62)3 304(93.57)
), ArticleFig(id=1241067217266209300, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=CN, label=表1, caption=

2016—2022年新疆地区CHD患儿人口学特征情况[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量2016年2017年2018年2019年2020年2021年2022年合计
城乡
城镇174(54.37)181(63.96)231(67.54)419(71.38)484(69.84)365(67.34)547(71.60)2 401(68.00)
乡村146(45.63)102(36.04)111(32.46)168(28.62)209(30.16)177(32.66)217(28.40)1 130(32.00)
性别
185(57.81)163(57.60)188(54.97)288(49.06)367(52.96)285(52.58)412(53.93)1 888(53.47)
135(42.19)120(42.40)154(45.03)298(50.77)325(46.90)257(47.42)352(46.07)1 641(46.47)
性别不明0(0.00)0(0.00)0(0.00)1(0.17)1(0.14)0(0.00)0(0.00)2(0.06)
胎数
单胎303(94.69)269(95.05)315(92.11)537(91.48)653(94.23)512(94.46)696(91.10)3 285(93.03)
双胎及以上17(5.31)14(4.95)27(7.89)50(8.52)40(5.77)30(5.54)68(8.90)246(6.97)
产妇年龄(岁)
<2014(4.38)6(2.12)10(2.92)7(1.19)6(0.87)2(0.37)1(0.13)46(1.30)
20~2463(19.69)39(13.78)36(10.53)62(10.56)73(10.53)50(9.23)61(7.98)384(10.88)
25~29102(31.87)118(41.70)141(41.23)259(44.12)257(37.09)204(37.64)252(32.98)1 333(37.75)
30~3476(23.75)71(25.09)100(29.24)179(30.49)235(33.91)207(38.19)309(40.45)1 177(33.33)
≥3565(20.31)49(17.31)55(16.08)78(13.29)115(16.59)79(14.58)140(18.32)581(16.45)
年龄不详0(0.00)0(0.00)0(0.00)2(0.34)7(1.01)0(0.00)1(0.13)10(0.28)
孕周(周)
28~3693(29.06)92(32.51)100(29.24)187(31.86)209(30.16)154(28.41)241(31.54)1076(30.47)
≥37227(70.94)191(67.49)242(70.76)400(68.14)484(69.84)388(71.59)523(68.46)2455(69.53)
诊断依据
超声253(79.06)255(90.11)314(91.81)465(79.22)625(90.19)489(90.22)707(88.02)3 108(88.02)
其他67(20.94)28(9.89)28(8.19)122(20.78)68(9.81)53(9.78)57(11.98)423(11.98)
诊断时间
产前21(6.56)15(5.30)12(3.51)39(6.64)38(5.48)38(7.01)64(8.38)277(6.43)
产后299(93.44)268(94.70)330(96.49)548(93.36)655(93.44)504(92.99)700(91.62)3 304(93.57)
), ArticleFig(id=1241067217366872604, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=EN, label=Table 2, caption=

Analysis of perinatal CHD incidence and trends in Xinjiang from 2016 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)围产儿数患儿数发生率(/万)
201679 11732040.45
2017123 60028322.90
201885 65934239.93
201977 44658775.79
202075 79869391.43
202169 16354278.37
202281 06676492.24
合计591 8493 53159.66
χ2趋势592.218
P<0.001
), ArticleFig(id=1241067217509478951, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=CN, label=表2, caption=

2016—2022年新疆地区围产儿CHD发生率及变化趋势分析

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)围产儿数患儿数发生率(/万)
201679 11732040.45
2017123 60028322.90
201885 65934239.93
201977 44658775.79
202075 79869391.43
202169 16354278.37
202281 06676492.24
合计591 8493 53159.66
χ2趋势592.218
P<0.001
), ArticleFig(id=1241067217652085299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=EN, label=Table 3, caption=

Perinatal CHD parity and incidence in Xinjiang from 2016 to 2022 (/10 000)

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)第一位第二位第三位第四位第五位
2016房间隔缺损
(27.27)
动脉导管未闭
(12.00)
室间隔缺损
(4.80)
房室间隔缺损
(4.29)
法洛四联征
(0.76)
2017房间隔缺损
(16.57)
动脉导管未闭
(6.14)
房室间隔缺损
(3.23)
室间隔缺损(1.94)法洛四联征
(0.24)
2018房间隔缺损
(33.44)
动脉导管未闭
(16.54)
室间隔缺损
(5.24)
房室间隔缺损
(1.98)
法洛四联征
(0.35)
2019房间隔缺损
(42.09)
动脉导管未闭
(41.70)
室间隔缺损
(13.64)
房室间隔缺损
(1.93)
法洛四联征
(1.03)
2020房间隔缺损
(73.30)
动脉导管未闭
(37.70)
室间隔缺损
(9.72)
房室间隔缺损
(4.20)
法洛四联征
(1.58)
2021房间隔缺损
(60.61)
动脉导管未闭
(31.67)
室间隔缺损
(16.27)
房室间隔缺损
(2.30)
法洛四联征
(1.01)
2022房间隔缺损
(71.29)
动脉导管未闭
(45.52)
室间隔缺损
(14.23)
房室间隔缺损
(4.79)
法洛四联征
(0.98)
合计房间隔缺损
(43.72)
动脉导管未闭
(25.53)
室间隔缺损
(8.69)
房室间隔缺损
(3.25)
法洛四联征
(0.79)
), ArticleFig(id=1241067217769525818, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=CN, label=表3, caption=

2016—2022年新疆地区围产儿CHD顺位情况及发生率(/万)

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)第一位第二位第三位第四位第五位
2016房间隔缺损
(27.27)
动脉导管未闭
(12.00)
室间隔缺损
(4.80)
房室间隔缺损
(4.29)
法洛四联征
(0.76)
2017房间隔缺损
(16.57)
动脉导管未闭
(6.14)
房室间隔缺损
(3.23)
室间隔缺损(1.94)法洛四联征
(0.24)
2018房间隔缺损
(33.44)
动脉导管未闭
(16.54)
室间隔缺损
(5.24)
房室间隔缺损
(1.98)
法洛四联征
(0.35)
2019房间隔缺损
(42.09)
动脉导管未闭
(41.70)
室间隔缺损
(13.64)
房室间隔缺损
(1.93)
法洛四联征
(1.03)
2020房间隔缺损
(73.30)
动脉导管未闭
(37.70)
室间隔缺损
(9.72)
房室间隔缺损
(4.20)
法洛四联征
(1.58)
2021房间隔缺损
(60.61)
动脉导管未闭
(31.67)
室间隔缺损
(16.27)
房室间隔缺损
(2.30)
法洛四联征
(1.01)
2022房间隔缺损
(71.29)
动脉导管未闭
(45.52)
室间隔缺损
(14.23)
房室间隔缺损
(4.79)
法洛四联征
(0.98)
合计房间隔缺损
(43.72)
动脉导管未闭
(25.53)
室间隔缺损
(8.69)
房室间隔缺损
(3.25)
法洛四联征
(0.79)
), ArticleFig(id=1241067217878577731, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=EN, label=Table 4, caption=

Perinatal CHD regression and composition ratio in Xinjiang from 2016 to 2022 [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)存活死胎死产0~6 d死亡
2016295(92.19)15(4.69)10(3.13)
2017267(94.35)13(4.59)3(1.06)
2018329(96.20)7(2.05)6(1.75)
2019557(94.89)21(3.58)9(1.53)
2020672(96.97)17(2.45)4(0.58)
2021518(95.57)18(3.32)6(1.11)
2022741(96.99)18(2.36)5(0.65)
合计3 379(95.69)109(3.09)43(1.22)
), ArticleFig(id=1241067217966658123, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067205908034512, language=CN, label=表4, caption=

2016—2022年新疆地区围产儿CHD转归情况及构成比[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)存活死胎死产0~6 d死亡
2016295(92.19)15(4.69)10(3.13)
2017267(94.35)13(4.59)3(1.06)
2018329(96.20)7(2.05)6(1.75)
2019557(94.89)21(3.58)9(1.53)
2020672(96.97)17(2.45)4(0.58)
2021518(95.57)18(3.32)6(1.11)
2022741(96.99)18(2.36)5(0.65)
合计3 379(95.69)109(3.09)43(1.22)
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2016—2022年新疆地区围产儿先天性心脏病监测结果分析
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李依 1 , 何金芳 2 , 高越 3 , 再努热·库尔班 1 , 丁桂凤 3
现代预防医学 | 儿少卫生与妇幼保健 2025,52(5): 848-853
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(5): 848-853
2016—2022年新疆地区围产儿先天性心脏病监测结果分析
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李依1, 何金芳2, 高越3, 再努热·库尔班1, 丁桂凤3
作者信息
  • 1.新疆医科大学公共卫生学院,新疆 乌鲁木齐 830000
  • 2.石河子大学医学院
  • 3.新疆围产期疾病临床医学研究中心,乌鲁木齐市妇幼保健院,新疆 乌鲁木齐 830001
  • 李依(1999—),女,硕士在读,研究方向:儿少卫生与妇幼保健

通讯作者:

丁桂凤,E-mail:
Analysis of the monitoring results of congenital heart disease in perinatal infants in Xinjiang from 2016 to 2022
Yi LI1, Jin-fang HE2, Yue GAO3, ZAINUR · Kuerban1, Gui-feng DING3
Affiliations
  • School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830000, China
出版时间: 2025-03-10 doi: 10.20043/j.cnki.MPM.202405322
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目的

分析新疆维吾尔自治区(简称新疆)2016年1月—2022年12月围产儿先天性心脏病发生情况及流行病学特征。

方法

对2016—2022年各出生缺陷监测医院中被诊断为先天性心脏病的围产儿资料进行回顾性分析。

结果

新疆地区共监测围产儿591 849名,其中先天性心脏病患儿3 531例,总发生率59.66/万。各年度发生率差异有统计学意义(χ2=754.466,P<0.001),总体呈上升趋势(χ2趋势=592.218,P<0.001)。病种顺位依次为房间隔缺损(43.72/万)、动脉导管未闭(25.53/万)、室间隔缺损(8.69/万)、房室间隔缺损(3.25/万)、法洛四联征(0.79/万),先天性心脏病围产儿存活率呈现上升趋势(χ2趋势=11. 239,P=0.001)。

结论

新疆地区围产儿先天性心脏病发生率总体呈上升趋势,建议进一步加强三级预防措施,降低先天性心脏病的发生风险,改善存活患儿预后。

先天性心脏病  /  围产儿  /  发生率  /  影响因素  /  监测
Objective

To analyze the incidence and epidemiological characteristics of congenital heart disease (CHD) in perinatal infants in Xinjiang from January 2016 to December 2022.

Methods

A retrospective analysis was conducted on the data of perinatal infants diagnosed with congenital heart disease from various birth defect monitoring hospitals between 2016 and 2022.

Results

A total of 591 849 perinatal infants were monitored in Xinjiang, among which 3 531 cases of congenital heart disease were identified, resulting in an overall incidence rate of 59.66 per 100 000. There were statistically significant differences in annual incidence rates (χ2=754.466, P < 0.001), showing a general upward trend (χ2trend =592.218, P < 0.001). The most common types of congenital heart disease were atrial septal defect (43.72 per 100 000), patent ductus arteriosus (25.53 per 100 000), ventricular septal defect (8.69 per 100 000), atrioventricular septal defect (3.25 per 100 000), and tetralogy of Fallot (0.79 per 100 000). The survival rate of perinatal infants with congenital heart disease showed an upward trend (χ2trend =11.239, P=0.001).

Conclusion

The overall incidence of congenital heart disease in perinatal infants in Xinjiang is on the rise. It is recommended to further strengthen tertiary prevention measures to reduce the risk of congenital heart disease and improve the prognosis of surviving infants.

Congenital heart disease  /  Perinatal infants  /  Incidence  /  Influencing factors  /  Monitoring
李依, 何金芳, 高越, 再努热·库尔班, 丁桂凤. 2016—2022年新疆地区围产儿先天性心脏病监测结果分析. 现代预防医学, 2025 , 52 (5) : 848 -853 . DOI: 10.20043/j.cnki.MPM.202405322
Yi LI, Jin-fang HE, Yue GAO, ZAINUR · Kuerban, Gui-feng DING. Analysis of the monitoring results of congenital heart disease in perinatal infants in Xinjiang from 2016 to 2022[J]. Modern Preventive Medicine, 2025 , 52 (5) : 848 -853 . DOI: 10.20043/j.cnki.MPM.202405322
先天性心脏病(congenital heart disease,CHD) 是最常见的先天缺陷疾病之一,指在胚胎发育时期由于心脏及大血管的形成障碍或发育异常而引起的心脏解剖结构异常,或出生后应自动关闭的通道未能闭合所产生的疾病[1]。在过去的30年中,全球CHD死亡人数下降了近50%,但各国之间,尤其是发达地区和发展中地区之间的差异却在不断扩大[2-3]。2019年全球疾病负担研究结果显示,CHD在活产儿中的发病率达2.3%,位居出生缺陷疾病首位,全世界现存患者超过1 300万,成为关乎社会经济稳定和可持续发展的全球性问题[4]。中国新发CHD的生命周期总经济负担已超过126亿元[5]。自1986年起,我国建立了一套基于医院的出生缺陷监测系统[2],监测时间从孕28周持续到胎儿出生后7 d。该系统获得的围产期CHD发生率主要反映了出生时临床明显可辨认的CHD的发生水平,这一数据在一定程度上受到了诊断技术和监测周期等因素的影响[6]。2020年新疆维吾尔自治区(简称新疆)5岁以下儿童死亡监测结果分析报告显示,CHD在新生儿死因别排在第三位,死亡率为2.93/万;在1~11月龄婴儿死因别中排名第三,死亡率为2.49/万[7]。新疆地区幅员辽阔,人口流动性大,近几年尚未有学者对新疆地区进行大规模、系统的CHD流行病学研究。本研究通过分析2016年1月—2022年12月新疆地区围产儿CHD医院监测数据,了解新疆地区CHD的发生率和流行病学特征,旨在为新疆地区制定CHD的防治工作提供参考依据。
本研究数据来源于2016年1月1日—2022年12月31日新疆妇幼健康云平台中14个地区(州、市)5 050个出生缺陷监测机构上报的《出生缺陷个案报告卡》及《出生缺陷监测医院分娩情况报表》。严格按照《中国出生缺陷医院监测实施方案》[7]和《中国出生缺陷监测畸形图谱》[8]中的规范要求进行监测统计,监测内容主要包括母亲的社会人口学特征、CHD患儿出生情况、缺陷的诊断与转归情况等。本研究通过乌鲁木齐市妇幼保健院伦理委员会审查(XJFYLL2024007202)。
选取2016—2022年各出生缺陷监测机构上报的《出生缺陷个案报告卡》中孕满28周到产后7 d内被明确诊断为CHD的围产儿。统一采用国际疾病分类第10版( international classification of diseases-10,ICD-10)标准编码,纳入ICD-10编码为Q20~Q26的CHD患儿共3 531例。CHD包括房间隔缺损、室间隔缺损、动脉导管未闭、卵圆孔未闭、大血管异位、法洛四联征等。根据《全国妇幼健康监测工作手册(2021版)》的上报要求,排除无临床意义的心内畸形,包括单纯动脉导管未闭或卵圆孔未闭早产儿,或者生后24 h后超声检查动脉导管或卵圆孔直径<3 mm的单纯动脉导管未闭或卵圆孔未闭足月儿。监测数据实行区县级每月自查、地市级每季度核查、省级每年抽查的三级质量控制,各级单位定期对监测数据进行督导质控,保证监测数据的完整性和准确性。
根据《中国妇幼卫生监测工作手册(2019版)》中CHD的定义,结合临床特征、描述、临床观察、体检、辅助检查诊断,CHD的诊断依据《超声心动图学(第8版)》,即综合临床症状、查体结果及超声心动图对CHD进行诊断。通过测量心脏腔室和血管尺寸评估血流动力学,并判断心脏解剖异常及疾病的严重程度。
围产儿CHD发生率(perinatal prevalence rate)定义为每万例围产儿中鉴别到的CHD例数。运用Excel 2017 和SPSS 26.0 软件建立数据库,进行数据清洗和统计分析。符合正态分布的计量资料采用(均数±标准差)进行描述;对计数资料采用频数、构成比进行描述。使用χ2检验进行构成比或患病率的组间比较,应用趋势χ2检验评估发生率的时间趋势,检验水准α=0.05。
2016—2022年新疆地区共监测围产儿591 849名,出生缺陷围产儿13 615例,CHD围产儿3 531例,占比25.9%。其中城镇2 401例(68.00%),乡村1 130例(32.00%);男婴1 888例(53.47%),女婴1 641例(46.47%)。见表1
2016—2022年新疆地区围产儿CHD总发生率为59.66/万。年度发生率由2016年的40. 45 /万上升至2022年的92.24 /万,上升128.03%,差异有统计学意义(χ2=754.466,P<0.001),且总体呈上升趋势(χ2趋势=592.218,P<0.001)。见表2
2016—2022年新疆地区围产儿CHD发生率前五位的种类依次为房间隔缺损(43.72/万)、动脉导管未闭(25.53/万)、室间隔缺损(8.69/万)、房室间隔缺损(3.25/万)、法洛四联征(0.79/万);其中,房间隔缺损一直稳定在第一顺位,见表3。2016—2022年房间隔缺损、室间隔缺损、动脉导管未闭、法洛四联征发生率均呈上升趋势(房间隔缺损χ2趋势=508.063,P<0.001;室间隔缺损χ2趋势=141.068,P<0.001;动脉导管未闭χ2趋势=397.311,P<0.001;法洛四联征χ2趋势=5.416,P=0.021)。房室间隔缺损发生率呈波动状态,无明显趋势(房室间隔缺损χ2趋势=0.431,P=0.511)。
在CHD围产儿的转归中,存活儿3 379例(95.7%),死胎死产109例(3.1%),0~6 d死亡43例(1. 2%)。CHD围产儿存活率呈现上升趋势(χ2趋势=11.239,P=0.001)。见表4图1
中国是世界上CHD发生率较高的国家之一,CHD在多地均位居出生缺陷首位,其检出率存在地区差异,多为2.9‰~16.0‰[9]。《中国出生缺陷报告(2012)》中提出我国CHD发生率呈上升趋势,每年新增患者10~15万,总患病人数约200万[5]。但过去30年间,我国CHD的防治工作取得巨大成就,CHD粗死亡率下降79%,标化死亡率下降65%,CHD死亡风险在出生队列中呈现持续下降的趋势,和美国等发达国家地区之间的差距在不断缩小[2]
本研究显示,2016—2022年新疆地区CHD总发生率为59.66/万,发生率总体高于全国水平[9],新疆地区6年间CHD发生率总体呈上升趋势,与广东省[10]、柳州市[11]、上海市[12]、陕西地区[13]等地的趋势变化基本一致。新疆地区CHD发生率上升可能与产前诊断技术的提升及筛查项目的普及有关,2019年自治区卫健委制定的《自治区出生缺陷综合防治方案》中要求健全完善自治区、地州市、县市区产前筛查与诊断服务网络,广泛开展产前筛查,逐步实现怀孕妇女孕28周前在自愿情况下至少接受1 次产前筛查;指导高危孕妇及时到有资质的医疗机构接受产前诊断服务,着力推动贫困地区免费产前筛查服务。产前诊断技术的提升及心脏超声检查仪器的改良,让越来越多不明显的微小缺损CHD病例被及时检出,使得围产儿CHD的检出率不断提高。
在病种顺位上,2016—2022年新疆地区CHD监测类型位居前三位的依次是房间隔缺损(43.72/万)、动脉导管未闭(25.53/万)、室间隔缺损(8.69/万),其中房间隔缺损的发生率始终维持在2016—2022年CHD病种发生率的首位。病种前三顺位与河南省[14]、安徽省淮河流域[15]观察到的结果相同,房间隔缺损的发生率低于安徽省淮河流域。陕西地区[13]的病种前三位为房间隔缺损、动脉导管未闭、房室间隔缺损,北京市[6]、南京市[16]、宁波市[17]的病种前三位为房间隔缺损、室间隔缺损、动脉导管未闭,皆与本文研究结果略有不同。目前大部分的简单型CHD可以通过产前筛查检出[18],但某些孕期无法依靠超声诊断的特殊类型先天性心脏病,需要在生后及时检查进行诊断和治疗[19]。2020年,自治区卫健委印发《自治区新生儿先天性心脏病筛查项目工作方案》,分别在伊犁哈萨克自治州、阿勒泰地区、阿克苏地区、喀什地区、和田地区的10个县(市)启动新生儿CHD筛查工作,随着新疆地区新生儿CHD筛查项目的广泛开展,越来越多的CHD患儿得到了早期诊断及有效救治。对于预后良好、后期可能自发闭合的CHD病种,确诊后需要进行定期随访,追踪其自发闭合和预后情况,随访未闭合的患儿应督促其及时进行临床治疗,提高其生活质量。
本次研究显示,在CHD围产儿的转归中,存活儿达到3 379例(95.7%)、死胎死产109例(3.1%)、0~6 d死亡43例(1. 2%)。新疆地区围产儿CHD存活率从2016年的92.19%上升至2022年的96.99%,2016—2022年CHD围产儿存活率总体呈现上升趋势,提示新疆地区针对CHD的三级干预防控措施得到有效落实并取得显著成效,后期应继续加强CHD的防治力度和孕产妇围产期管理。
2016—2022年新疆地区CHD围产儿有93.57%为产后确诊,仅有6.43%为产前确诊,但2022年的产前确诊率相较于2016年有了明显提高。随着新生儿CHD筛查项目的开展和普及,以及超声技术的不断提升,越来越多的CHD患儿可在出生后及时得到诊断,大部分患儿可通过择期介入或手术治疗治愈,但仍有部分复杂重症CHD患儿往往因未能在胎儿期和出生后早期获得诊疗而夭折[20]。诊断时机是重大CHD预后的关键因素,产前诊断可改善临床结果,降低新生儿CHD发生率和死亡率,因此早期诊断及治疗仍是目前最有效的防治策略。各医疗卫生机构应积极探索CHD产前产后“一体化”诊疗模式[21],使我国CHD的诊疗从产后前移至产前,实现CHD早期诊断和优化治疗,提高复杂重症CHD的救治率、成功率及长期存活率。
综上所述,2016—2022年新疆地区CHD发生率总体呈上升趋势,提示新疆地区仍需提高CHD防治水平,以一级预防为基础,二级预防为重点。建议新疆地区各医疗卫生结构积极开展健康教育,把优生指导服务落实到生育之前;加强对CHD危险因素筛查及对其致病机制的研究;提高新生儿先天性疾病筛查力度,改善存活患儿预后,提高患儿生存质量。
  • 新疆维吾尔自治区科技创新团队(天山创新团队)项目(2022TSYCTD0016)
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doi: 10.20043/j.cnki.MPM.202405322
  • 接收时间:2024-05-20
  • 首发时间:2026-03-18
  • 出版时间:2025-03-10
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  • 收稿日期:2024-05-20
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新疆维吾尔自治区科技创新团队(天山创新团队)项目(2022TSYCTD0016)
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    1.新疆医科大学公共卫生学院,新疆 乌鲁木齐 830000
    2.石河子大学医学院
    3.新疆围产期疾病临床医学研究中心,乌鲁木齐市妇幼保健院,新疆 乌鲁木齐 830001

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种数
Number of
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Percentage of total
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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