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中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (01) : 61 -68. doi: 10.3877/cma.j.issn.1673-5250.2023.01.009

论著

2017—2021年北京市先天性心脏病流行病学资料分析
张雯, 徐宏燕, 张彦春, 刘凯波†()   
  1. 首都医科大学附属北京妇产医院/北京妇幼保健院围产保健科，北京　100026
  • 收稿日期:2022-05-10 修回日期:2022-12-14 出版日期:2023-02-01
  • 通信作者: 刘凯波

Epidemiological analysis of congenital heart disease in Beijing from 2017 to 2021

Wen Zhang, Hongyan Xu, Yanchun Zhang, Kaibo Liu†()   

  1. Department of Perinatal Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University · Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
  • Received:2022-05-10 Revised:2022-12-14 Published:2023-02-01
  • Corresponding author: Kaibo Liu
  • Supported by:
    Project of Research on the Prevention and Control of Reproductive Health and Major Birth Defects of the Ministry of Science and Technology(2018YFC1002304)
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引用本文：

张雯, 徐宏燕, 张彦春, 刘凯波. 2017—2021年北京市先天性心脏病流行病学资料分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(01): 61-68.

Wen Zhang, Hongyan Xu, Yanchun Zhang, Kaibo Liu. Epidemiological analysis of congenital heart disease in Beijing from 2017 to 2021[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(01): 61-68.

目的

探讨近年北京市胎儿/新生儿群体的先天性心脏病(CHD)流行病学特征及分析。

方法

选择2017年1月至2021年12月北京市出生缺陷监测系统内纳入监测的985 603例围产儿中，被诊断为CHD的11 356例胎儿/新生儿，包括宫内死胎、治疗性引产胎儿与活产、死产及7 d内死亡新生儿中的CHD患儿为研究对象。2017—2021年，各年被诊断为CHD的胎儿/新生儿与纳入监测的围产儿依次为：2 113与243 438、2 276与214 333、2 426与218 922、2 192与161 605及2 349与147 305例。采取流行病学描述性分析方法，对北京市出生缺陷监测系统胎龄为13周至生后7 d内(观察期)与胎龄为28周至生后7 d内(围产期)的胎儿/新生儿群体的CHD总体发生率与CHD不同分型发生率进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。

结果

①2017—2021年，北京市出生缺陷监测系统观察期内的胎儿/新生儿群体的CHD总体发生率为1.15%(11 356/985 603)，2017—2021年各年的CHD发生率依次为0.87%(2 113/243 438)、1.06%(2 276/214 333)、1.11%(2 426/218 922)、1.36%(2 192/161 605)、1.59%(2 349/147 305)，并且呈逐年增高趋势。被确诊的11 356例CHD胎儿/新生儿的染色体异常率为3.90%(444例)，位居前3位的依次为18-三体(127例，28.60%)，21-三体(104例，23.42%)与22q11.2缺失综合征(19例，4.28%)；合并心外畸形的发生率为11.91%(1 351/11 356)，心血管及循环系统之外各系统畸形占比从高到低依次为肌肉骨骼系统(326例，24.13%)，泌尿系统(248例，18.36%)和神经系统(202例，14.95%)；危重先天性心脏病(CCHD)发生率为0.20%(1 938/985 603)。②被确诊的11 356例CHD胎儿/新生儿中，围产期确诊者为8 882例，围产期CHD总体发生率为0.90%(8 882/985 603)。2017—2021年各年的围产期CHD发生率依次为0.62%(1 520/243 438)、0.82%(1 868/214 333)、0.86%(1 892/218 922)、1.12%(1 808/161 605)、1.30%(1 910/147 305)，亦呈逐年增高趋势。2021年围产期CHD胎儿/新生儿单纯房间隔缺损发生率为0.36%(527/147 305)，是2017年(0.08%，201/243 438)的4.33倍，其发生率绝对增加值占围产期CHD总体发生率绝对增加值的40.18%。围产期前5位CHD分型依次为房间隔缺损(2 704例)、室间隔缺损(2 592例)、动脉导管未闭(2 233例)、卵圆孔未闭(1 767例)、永存左上腔静脉(478例)。围产期CCHD发生率为0.04%(433/985 603)。

结论

2017—2021年，北京市观察期、围产期CHD发生率呈逐年增高趋势，其发生率增高主要集中在单纯房间隔缺损；围产期CCHD发生率处于较低水平。

关键词: 先天性心脏病, 危重先天性心脏病, 发病率, 流行病学研究, 房间隔缺损, 室间隔缺损, 动脉导管未闭, 卵圆孔，未闭, 围产期, 胎儿, 婴儿，新生
Objective

To explore the epidemiological characteristics of fetal and neonatal congenital heart disease (CHD) in Beijing by analyzing the surveillance data of CHD in recent years.

Methods

From January 2017 to December 2021, a total of 985 603 perinatal infants were monitored in the Beijing Birth Defects Surveillance System, among which 11 356 fetuses/newborns were diagnosed with CHD, including intrauterine stillbirth, therapeutic induction of labor fetus and live birth, stillbirth and neonatal death within 7 d after birth. These 11 356 CHD fetuses/newborns were selected in study. From 2017 to 2021, the number of diagnosed CHD fetuses/newborns and monitored perinatal infants were 2 113 cases vs 243 438 cases, 2 276 cases vs 214 333 cases, 2 426 cases vs 218 922 cases, 2 192 cases vs 161 605 cases, and 2 349 cases vs 147 305 cases, respectively. By means of descriptive epidemiological analysis method, the overall incidence of CHD and the incidence of different types of CHD were analyzed in fetal/newborn population with gestational age of 13 weeks to 7 d after birth (observation period) and gestational age of 28 weeks to 7 d after birth (perinatal period) in Beijing Birth Defects Surveillance System. The procedures followed in this study were in line with World Medical Association Declaration of Helsinki revised in 2013.

Results

①From 2017 to 2021, the overall incidence of CHD in fetal/neonatal population was 1.15% (11 356/985 603) during observation period of Beijing Birth Defects Surveillance System. And the incidence of CHD during observation period from 2017 to 2021 was 0.87% (2 113/243 438), 1.06% (2 276/214 333), 1.11% (2 426/218 922), 1.36% (2 192/161 605) and 1.59% (2 349/147 305) respectively, which showed an increasing trend. The chromosomal abnormality rate of 11 356 CHD fetuses/newborns was 3.90% (444 cases), and the top three chromosomal abnormality were trisomy 18 (127 cases, 28.60%), trisomy 21 (104 cases, 23.42%) and 22q11.2 deletion syndrome (19 cases, 4.28%). The incidence of extracardiac malformations of 11 356 CHD fetuses/newborns was 11.91% (1 351/11 356), and the proportion of malformations other than cardiovascular and circulatory system in descending order was musculoskeletal system (326 cases, 24.13%), urinary system (248 cases, 18.36%) and nervous system (202 cases, 14.95%). The incidence of severe congenital heart disease (CCHD) was 0.20% (1 938/985 603). ②Among 11 356 CHD fetuses/newborns, 8 882 cases were diagnosed in perinatal period, and the overall incidence of perinatal CHD was 0.90% (8 882/985 603). The incidence of perinatal CHD from 2017 to 2021 was 0.62% (1 520/243 438), 0.82% (1 868/214 333), 0.86% (1 892/218 922), 1.12% (1 808/161 605), 1.30% (1 910/147 305) respectively, which also showed an increasing trend. The incidence of isolated atrial septal defect of perinatal CHD fetuses/newborns in 2021 was 0.36% (527/147 305), which was 4.33 times higher than that in 2017 (0.08%, 201/243 438), and its absolute increase in incidence accounted for 40.18% of the total absolute increase in the incidence of perinatal CHD. The top five CHD types in perinatal period were atrial septal defect (2 704 cases), ventricular septal defect (2 592 cases), patent ductus arteriosus (2 233 cases), patent foramen ovale (1 767 cases), and permanent left superior vena cava (478 cases). The incidence of perinatal CCHD was 0.04% (433/985 603).

Conclusions

From 2017 to 2021, the incidences of CHD in observation period and perinatal period in Beijing both show an increasing trend. The increase in incidence of CHD is mainly concentrated in simple atrial septal defect. The incidence of perinatal of CCHD is at a low level.

Key words: Congenital heart diseases, Critical congenital heart defects, Incidence, Epidemiologic studies, Heart septal defects, atrial, Heart septal defects, ventricular, Ductus arteriosus, patent, Foramen ovale, patent, Peripartum period, Fetus, Infant, newborn
表1 2017—2021年，观察期与围产期内北京市出生缺陷监测系统对985 603例围产儿不同分型CHD胎儿/新生儿监测结果
不同分型CHD 观察期 围产期
例数 发生率(×10－4) 例数 发生率(×10－4)
房间隔缺损 2 742 27.82 2 704 27.43
室间隔缺损 3 490 35.41 2 592 26.30
动脉导管未闭 2 233 22.66 2 233 22.66
卵圆孔未闭 1 767 17.93 1 767 17.93
永存左上腔静脉 677 6.87 478 4.85
右位主动脉弓 336 3.41 233 2.36
肺动脉/肺动脉瓣狭窄 425 4.31 179 1.82
法洛四联症 547 5.55 125 1.27
主动脉狭窄 236 2.39 97 0.98
完全性大动脉转位 270 2.74 82 0.83
完全性肺静脉异位引流 105 1.07 44 0.45
肺动脉闭锁 212 2.15 27 0.27
主动脉弓离断 98 0.99 22 0.22
右心室双出口 247 2.51 17 0.17
三尖瓣下移 44 0.45 17 0.17
永存动脉干 119 1.21 11 0.11
单心室 217 2.20 8 0.08
左心发育不良 171 1.73 7 0.07
三尖瓣闭锁 39 0.40 5 0.05
房室间隔缺损 270 2.74 35 0.36
心律失常 43 0.44 22 0.22
横纹肌瘤 61 0.62 37 0.38
心肌疾病 26 0.26 14 0.14
其他分型CHD 410 4.16 240 2.44
图1 2017—2021年北京市围产期单纯动脉导管未闭、卵圆孔未闭、房间隔缺损、室间隔缺损及轻型CHD、CHD总体发生率变化趋势图注：轻型CHD指单纯房间隔缺损/卵圆孔未闭/室间隔缺损/动脉导管未闭。CHD为先天性心脏病
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