昭通市幼托机构和中小学校学生先天性心脏病患病及影响因素分析

方家煜; 朵林; 付宏晨; 杨庆欢; 马敏; 王化丹; 庞林鸿; 何利平

doi:10.16835/j.cnki.1000-9817.2022.11.032

昭通市幼托机构和中小学校学生先天性心脏病患病及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2022.11.032

1.
昆明医科大学公共卫生学院，云南 650500
2.
云南省阜外心血管病医院科研慢病部

基金项目:

云南省科技厅重点研发计划项目 202003AF140012

详细信息

作者简介:
方家煜(1995-)，男，云南玉溪人，在读硕士，主要研究方向为儿童青少年先天性心脏病流行病学

通讯作者:
何利平，E-mail：lipinghe2@126.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G478 R541.1
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- 被引次数: 0
出版历程
- 收稿日期: 2022-04-18
- 修回日期: 2022-08-25
- 网络出版日期: 2022-11-30
- 刊出日期: 2022-11-25

Prevalence and associated factors of congenital heart disease among nursery, primary and middle school students in Zhaotong

1.
School of Public Health, Kunming Medical University, Kunming(650500), China

摘要

摘要: 目的了解昭通市幼托机构和中小学校学生先天性心脏病(congenital heart defects, CHD)患病现状及其影响因素，为制定儿童青少年CHD预防策略提供依据。方法采取分层随机整群抽样方法，于2020年9—11月对昭通市4个乡/镇11 343名幼托机构、小学、初中和高中学校学生进行CHD筛查和问卷调查。结果昭通市幼托机构和中小学校学生CHD患病率为11.99‰(95%CI=9.99‰~13.99‰)，永善县(14.90‰)高于盐津县(10.22‰)，农村(13.30‰)高于城镇(8.21‰)，差异均有统计学意义(χ²值分别为4.95，4.77，P值均 < 0.05)。136例CHD中，室间隔缺损占比最高(41.2%)，其次是房间隔缺损(32.4%)和动脉导管未闭(14.0%)，还有8例(5.9%)复杂CHD和9例(6.6%)其他CHD。CHD学生较晚确诊占比为50.74%。影响因素分析显示，生活在永善县、农村地区、家庭人均年收入在10 000~ < 20 000元、CHD病种为非复杂先心病的学生均有较晚确诊的风险(OR值分别为0.30，0.13，3.67，0.17，P值均 < 0.05)。结论昭通市幼托机构和中小学校学生CHD有患病率高、复杂先心病比重大、较晚确诊人数多以及较晚确诊影响因素复杂等特点，亟需加强学生CHD的预防工作。
- 日托幼儿园 /
- 心脏病 /
- 患病率 /
- 回归分析 /
- 学生
Abstract: Objective To investigate the prevalence and associated factors of congenital heart defects (CHD) among nursery, primary, and middle school students in Zhaotong, and to provide basis for CHD prevention strategies for children and adolescents. Methods Using stratified random cluster sampling, a total of 11 343 nursery, primary and middle school students in 4 towns of Zhaotong were investigated with CHD screening and questionnaire during September to November in 2020. Results The prevalence of CHD among nursery, primary and middle school students in Zhaotong was 11.99‰(95%CI=9.99‰-13.99‰), Yongshan County (14.90‰) > Yanjin County (10.22‰), rural (13.30‰) > urban (8.21‰)(χ²=4.95, 4.77, P < 0.05). Among 136 cases of CHD, the Ventricular Septal Defect (VSD) accounted the highest proportion (41.2%), followed by Atrial Septal Defect (ASD, 32.4%), Patent Ductus Arteriosus (PDA, 14.0%), and Complex Congenital Heart Disease (CCHD, 5.9%) and the other CHD (others, 6.6%). The proportion of late diagnosed CHD was 50.74%, which was associated with living in rural areas of Yongshan County, low annual household income (10 000- < 20 000 yuan), as well as isolated and uncomplicated CHD(OR=0.30, 0.13, 3.67, 0.17, P < 0.05). Conclusion Nursery, primary and middle schools students have the characteristics of high prevalence rate of CHD, large proportion of complex congenital heart disease, large number of late diagnosis and complex influencing factors in Zhaotong. It's in urgent need of strengthening learning prevention of CHD.
- Child day care centers /
- Heart diseases /
- Prevalence /
- Regression analysis /
- Students
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表 1 不同组别学生CHD患病率比较

Table 1. Comparison of the prevalence of CHD among different groups of students

组别	选项	人数	患病人数	χ²值	P值
所属县	永善	4 295	64(14.90)	4.95	0.03
	盐津	7 048	72(10.22)
居住地	城镇	2 925	24(8.21)	4.77	0.03
	农村	8 418	112(13.30)
性别	男	5 787	71(12.27)	0.08	0.78
	女	5 556	65(11.70)
民族	汉族	10 466	124(11.85)	0.23	0.63
	其他民族	877	12(13.68)
家庭人均年	< 10 000	4 113	53(12.89)	1.47	0.48
收入/元	10 000~ < 20 000	5 023	62(12.34)
	≥20 000	2 207	21(9.52)
学段	幼儿园	2 325	25(10.75)	2.42	0.49
	小学	4 765	65(13.64)
	初中	3 339	34(10.18)
	高中	914	12(13.13)
注： ()内数字为患病率/‰。

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表 2 不同组别CHD学生患病病种分布

Table 2. Distribution of CHD diseases among students in different groups

组别	选项	人数	室间隔缺损	房间隔缺损	动脉导管未闭	复杂CHD	其他
确诊情况	既往确诊	67	26(38.8)	22(32.8)	8(11.9)	6(9.0)	5(7.5)
	筛查新确诊	69	30(43.5)	22(31.9)	11(15.9)	2(2.9)	4(5.8)
所属县	永善	64	22(34.4)	23(35.9)	10(15.6)	5(7.8)	4(6.3)
	盐津	72	34(47.2)	21(29.2)	9(12.5)	3(4.2)	5(6.9)
居住地	城镇	24	10(41.7)	10(41.7)	4(16.7)	0	0
	农村	112	46(41.1)	34(30.4)	15(13.4)	8(7.1)	9(8.0)
性别	男	71	33(46.5)	22(31.0)	7(9.9)	4(5.6)	5(7.0)
	女	65	23(35.4)	22(33.8)	12(18.5)	4(6.2)	4(6.2)
民族	汉族	124	51(41.1)	40(32.3)	17(13.7)	8(6.5)	8(6.5)
	其他民族	12	5(41.7)	4(33.3)	2(16.7)	0	1(8.3)
家庭人均年	< 10 000	53	19(35.8)	21(39.6)	4(7.5)	5(9.4)	4(7.5)
收入/元	10 000~ < 20 000	62	29(46.8)	17(27.4)	10(16.1)	3(4.8)	3(4.8)
	≥20 000	21	8(38.1)	6(28.6)	5(23.8)	0	2(9.5)
学段	幼儿园	25	14(56.0)	5(20.0)	5(20.0)	0	1(4.0)
	小学	65	27(41.5)	20(30.8)	9(13.8)	6(9.2)	3(4.6)
	初中	34	10(29.4)	14(41.2)	4(11.8)	1(2.9)	5(14.7)
	高中	12	5(41.7)	5(41.7)	1(8.3)	1(8.3)	0
注： ()内数字为构成比/%。

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表 3 患CHD托幼及中小学生较晚确诊影响因素多因素Logistic回归分析(n=136)

Table 3. Multivariate Logistic regression analysis of associated factors for diagnosis at a later time of students with CHD(n=136)

自变量	选项	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
所属县	永善县					1.00
	盐津县	-1.19	0.43	7.62	0.01	0.30(0.13~0.71)
居住地	农村					1.00
	城镇	-2.06	0.64	10.43	< 0.01	0.13(0.04~0.45)
CHD病种	非复杂					1.00
	复杂	-1.76	0.88	3.99	0.05	0.17(0.03~0.97)
家庭人均年收入/元	< 10 000					1.00
	10 000~ < 20 000	1.30	0.47	7.72	0.01	3.67(1.47~9.19)
	≥20 000	-0.30	0.66	0.20	0.65	0.74(0.20~2.70)

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参考文献(20)

[1]	胡盛寿, 陈义汉, 高润霖, 等. 中国心血管健康与疾病报告2019[M]. 北京: 科学出版社, 2020: 196-201. HU S S, CHEN Y H, GAO R L, et al. Annual report on cardiovascular health and diseases in China 2019[M]. Beijing: Science Press, 2020: 196-201. (in Chinese)
[2]	宋宏琳, 卢江, 周汝芳, 等. 中国五省中小学生社区筛查先心病患病率与海拔及民族关系[J]. 中国公共卫生, 2021, 37(10): 1514-1516. doi: 10.11847/zgggws1130055 SONG H L, LU J, ZHOU R F, et al. Associations of altitude and ethnic groups with congenital heart disease prevalence in primary and secondary school students in five provinces of China: a screening data analysis[J]. Chin J Public Health, 2021, 37(10): 1514-1516. (in Chinese) doi: 10.11847/zgggws1130055
[3]	韩此林, 蒋立虹, 侯宗柳, 等. 云南省不同地区3~18岁人群先天性心脏病流行病学特征调查[J]. 昆明医科大学学报, 2017, 38(8): 30-34. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201708007.htm HAN C L, JIANG L H, HOU Z L, et al. Epidemic characteristics of congenital heart disease of adolescents between 3 to 18 ages among different regions in Yunnan[J]. J Kunming Med Univ, 2017, 38(8): 30-34. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201708007.htm
[4]	滕云, 黄冰鑫, 陈寄梅. 胎儿先天性心脏病的治疗现状和研究进展[J]. 中华胸心血管外科杂志, 2021, 37(7): 443-446. doi: 10.3760/cma.j.cn112434-20200803-00359 TENG Y, HUANG B X, CHEN J M. Current situation of treatment and research progress of fetal congenital heart disease[J]. Chin J Thoracic Cardiovasc Surg, 2021, 37(7): 443-446. (in Chinese) doi: 10.3760/cma.j.cn112434-20200803-00359
[5]	李博宁, 刘琮, 张智伟. 小儿先天性心脏病介入治疗进展[J]. 中华实用儿科临床杂志, 2020, 35(1): 19-23. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201606002.htm LI B N, LIU C, ZHANG Z W. Progress in interventional treatment of children with congenital heart disease[J]. Chin J Appl Clin Pediatr, 2020, 35(1): 19-23. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201606002.htm
[6]	MURNI I K, WIRAWAN M T, PATMASARI L, et al. Delayed diagnosis in children with congenital heart disease: a mixed-method study[J]. BMC Pediatr, 2021, 21(1): 191. doi: 10.1186/s12887-021-02667-3
[7]	潘湘斌, 卢江, 李亚明, 等. 社区儿童先天性心脏病筛查手册[M]. 昆明: 云南科技出版社, 2021: 42-47. PAN X B, LU J, LI Y M, et al. Community childhood congenital heart disease screening manual[M]. Kunming: Yunnan Science and Technology Press, 2021: 42-47. (in Chinese)
[8]	国家卫生计生委妇幼健康服务司, 全国妇幼卫生监测办公室, 全国妇幼卫生年报办公室. 全国妇幼卫生监测及年报通讯[R]. 北京, 2013. Department of Maternal and Child Health Services of the PRC, Office of National Maternal and Child Health Surveillance of the PRC, Office of National Maternal and Child Health Annual Report of the PRC. National maternal and child health surveillance and annual report newsletter[R]. Beijing, 2013. (in Chinese)
[9]	沙金叶, 刘文源, 邹明宇. 基于双低CT扫描技术的儿童复杂先天性心脏病混合现实建模的可行性[J]. 中国医科大学学报, 2022, 51(10): 884-888. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK202210004.htm SHA J Y, LIU W Y, ZOU M Y. Feasibility of mixed reality modeling of complex congenital heart disease in children using the double-low computed tomography scanning technology[J]. J China Med Univ, 2022, 51(10): 884-888. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK202210004.htm
[10]	LINDE D, KONINGS E E, SLAGER M A, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and Meta-analysis[J]. J Am Coll Cardiol, 2011, 58(21): 2241-2247.
[11]	VILLASECA-ROJAS Y, VARELA-MELO J, TORRES-CASTRO R, et al. Exercise capacity in children and adolescents with congenital heart disease: a systematic review and Meta-analysis[J]. Front Cardiovasc Med, 2022, 9: 874700.
[12]	何清, 杨义, 蒋亮, 等. 遵义地区新生儿先天性心脏病的影响因素研究及患病风险预测[J]. 中国卫生统计, 2021, 38(3): 422-424. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT202103027.htm HE Q, YANG Y, JIANG L, et al. Study on the influencing factors and risk prediction of neonatal congenital heart disease in Zunyi Area[J]. Chin J Health Stat, 2021, 38(3): 422-424. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT202103027.htm
[13]	王旭, 卢晓峰, 张朋宾, 等. 先天性心脏病与高原地区低氧环境相关性的研究进展[J]. 实用临床医药杂志, 2021, 41(11): 109-113. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202111027.htm WANG X, LU X F, ZHANG P B, et al. Research progress on correlation between congenital heart disease and hypoxia environment in plateau area[J]. J Clin Med Pract, 2021, 41(11): 109-113. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202111027.htm
[14]	CHUN H, YUE Y, WANG Y B, et al. High prevalence of congenital heart disease at high altitudes in Tibet[J]. Eur J Prev Cardiol, 2019, 26(7): 756-759.
[15]	张兴, 苏忠剑, 刘洪玉, 等. 不同高原海拔地区动脉导管未闭儿童肺动脉压力特点[J]. 临床儿科杂志, 2021, 39(1): 22-25. https://www.cnki.com.cn/Article/CJFDTOTAL-LCAK202101009.htm ZHANG X, SU Z J, LIU H Y, et al. Evaluation of the characteristics of pulmonary artery pressure in children with patent ductus arteriosus at different altitudes[J]. J Clin Pediatr, 2021, 39(1): 22-25. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-LCAK202101009.htm
[16]	李振, 叶青, 何彪华, 等. 2015年至2016年云南昭通地区3个县儿童和青少年先天性心脏病流行病学调查[J]. 昆明医科大学学报, 2018, 39(3): 77-80. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201803015.htm LI Z, YE Q, HE B H, et al. Epidemiological investigation on children and teenagers with congenital heart disease in three counties in Zhaotong area from 2015 to 2016[J]. J Kunming Med Univ, 2018, 39(3): 77-80. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201803015.htm
[17]	景涛, 仝识非, 郭艳丽, 等. 重庆市石柱县12 014名少年儿童先天性心脏病患病率的普查[J]. 重庆医学, 2012, 41(5): 472-473, 476. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201205022.htm JING T, TONG S F, GUO Y L, et al. Congenital heart disease prevalence survey of 12 014 children in Chongqing Shizhu County[J]. Chongqing Med, 2012, 41(5): 472-473, 476. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201205022.htm
[18]	CHANG R K, GURVITZ M, RODRIGUEZ S. Missed diagnosis of critical congenital heart disease[J]. Arch Pediatr Adolesc Med, 2008, 162(10): 969-974.
[19]	肖罗茜. 中国西部社区先心病患儿确诊延迟现状及相关影响因素分析研究[D]. 昆明: 昆明医科大学, 2021. XIAO L X. An analysis of delayed diagnosis status and related influencing factors in children with congenital heart disease in western China[D]. Kunming: Kunming Medical University, 2021. (in Chinese)
[20]	张婷. 黔北地区儿童先心病就医延迟及其术后生存质量现状及影响因素研究[D]. 遵义: 遵义医科大学, 2021. ZHANG T. Study on the delay of medical treatment and the quality of life in children with congenital heart disease in Northern Guizhou and its influencing factors[D]. Zunyi: Zunyi Medical University, 2021. (in Chinese)