杨江帆 许月珍 李萍 杨戎威
［摘 要］ 目的 探讨新生儿先天性心脏病(先心病)患病率和妊娠初期增补叶酸的预防效果。方法 对1992年1月1日至1998年12月31日嘉兴市妇幼保健院出生的全部活婴31 470例，进行先心病前瞻性调查；调查1996年8月1日至1998年7月31日7 445例活产婴儿的母亲孕前1月至孕后3月内增补叶酸情况与先心病的发病关系；调查1994年6月1日至1998年12月31日出生的217例先心病的母亲妊娠初期增补叶酸情况。结果 31 470例新生儿中检得先心病312例，不包括单纯性动脉导管未闭和缺损直径小于5 mm的房间隔缺损(ASD)。其中彩色多普勒超声心动图(CDFM)诊断298例，尸检确诊14例，患病率9.91‰。室间隔缺损(VSD)居首位(51.6%)，患病率5.12‰。重症复杂先心病新生儿期死亡32例，病死率10.3%。7 445例新生儿的母亲孕期增补叶酸情况与先心病患病率关系，增补叶酸组先心病患病率7.43‰，未补组患病率15.17‰。两组患病率差异有显著性意义，(P<0.01)，相对危险度(RR)0.4898，归因危险度(AR)0.00774，归因危险比数(ARP)51.02%。重症复杂先心病患病率未补组为增补组的4.6倍。217例先心病中母亲孕初增补叶酸组占30.9%，未补组占69.1%。重症复杂畸形增补组7例占11.4%，未补组34例占22.7%。结论 应用CDFM是先心病检出率增加的主要原因。妊娠初期增补叶酸可减少先心病尤其重症复杂先心病的发生。作为保护因子在预防先心病中有中等强度的关联关系。
［关 键 词］ 新生儿；先天性心脏病；患病率；叶酸
［中图分类号］ R181.3 ［文献标识码］ A
［文章编号］ 1008-8830(2000)05-0320-03
Incidence of Congenital Heart Disease in Newborns
and Preventive Effect of Folic Acid on Pregnant Women
YANG Jiang-Fan XU Yue-Zhen LI Ping et al
（Department of Neonatology, Maternity and Child Health Hospital of Jiaxing, Jiaxing 314000, China）
Abstract: Objective To determine the incidence of congenital heart disease (CHD) in newborns and the role of folic acid on reducing or preventing CHD in early pregnancy. Methods A prospective study was conducted on all the 31 470 live-births in Jiaxing Maternity and Child Health Hospital from January 1st, 1992 to December 31st, 1998. The relationship between CHD and the maternal consumption of folic acid from 1 month before pregnancy to 3 months after pregnancy was studied. The patients recruited in the study were women who gave birth to a total of 7 445 live-births from August 1st, 1996 to July 31st, 1998. Results We found 312 newborns with CHD (excluding simple PDA and VSD of <5 mm) of the 312 newborns, 298 were detected by color Dopler echocardiogram (CDFM)and 14 by autopsy. The incidence was 9.91‰ with VSD 5.12‰ topping the list of CHD. Thirty-two babies with complex heart disease died in the newborn period, with a mortality of 10.3%. The incidence of CHD was 7.43‰ in the folic acid group, and 15.17‰ in the non-folic acid group. The difference was statistically significont between the 2 groups (P<0.01). RR was 0.4898, AR was 0.00774, and ARP was 51.02%. The incidence of severe complex cardiac deformity in the non-folic acid group was 4.6 times that of the folic acid group. Of the 217 women discharging babies with CHD during January 1st, 1994 and December 31st, 1998, 30.9% belonged to the folic acid group, and 69.1%to the non-folic acid group. Seven severe complex deformity belonged to the folic acid group (11.4%), and 34 the non-folic acid group (22.7%). Conclusions The incidence of CHD was the highest in the newborn period. The incidence decreased with the death of severe complex heart disorders and the spontaneous closure of some cases of VSD and ASD. The main reason of a high detection rate of CHD was due to the application of CDFM. Taking folic acid in early pregnancy may reduce the incidence of CHD, especially the incidence of complex CHD.
Key words: Folic acid; Congenital heart diseases; Incidence; Newborn
为探讨新生儿先天性心脏病(先心病)患病率和妊娠初期增补叶酸预防先心病的效果，对自1992～1998年在嘉兴市出生的31 470例活产婴儿进行前瞻性调查，其中不包括单纯性动脉导管未闭(PDA)伴/或缺损直径小于5 mm的房间隔缺损(ASD)。
1 资料和方法
1.1 对象
1992年1月1日至1998年12月31日嘉兴市妇幼保健院出生的全部活产婴儿计31 470例。男16 215例，女15 255例。1994年6月1日至1998年12月31日检得的先心病患儿的母亲和1996年8月1日至1998年7月31日2年中出生的7 445例活产婴儿的母亲。
1.2 方法
1.2.1 先心病诊断主要依据 每例婴儿自出生至出院期间，每天由儿科医师检查，对气促、青紫、心脏杂音、肺动脉瓣第二心音亢进或减弱、上下肢血压异常、心电图和胸片等有先心病可疑者，应用HP77020AC和IMAGE PORMT彩色多普勒超声心动图仪、5 MHz探头，按超声顺序分段诊断法观察［1］。住院期间死亡者尸检验证。尸检率91.9％。
1.2.2 病例和分组 ①1996年8月1日至1998年7月31日7 445例活产婴儿的母亲根据增补叶酸情况，分为增补组和未补组。增补组包括正规增补组，即从孕前1月至孕后3月内每天服0.4 mg；不正规增补组指上述期限内累计服叶酸超过30天，但不足3个月。未增补组指上述期限内未增补叶酸或增补量累计不足30天。②1994年6月1日至1998年12月31日活产婴儿中检得先心病病例与其母亲妊娠初期增补叶酸的关系，亦分为正规、不正规和未增补3组进行比较。
2 结果
2.1 先心病患病率
检得先心病312例，不包括单纯性PDA和缺损直径小于5 mm的ASD。其中男151例，女161例。CDFM诊断298例，尸检诊断14例，患病率9.91‰，新生儿期死亡32例，病死率10.3%，死亡率1.02‰。1992～1998年每年先心病患病率分别为6.08‰，8.84‰，8.89‰，8.74‰，8.48‰，11.99‰和20.78‰。若除外缺损直径小于5 mm的ASD，7年患病率为7.72‰，每年患病率分别为5.54‰，8.46‰，8.08‰，6.34‰，7.23‰，8.80‰和10.99‰。
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