Bottos M, Granato T, Allibrio G, Gioachin C, Puato M L
Child Disability Centre, Azienda USL, Bologna, Italy.
Dev Med Child Neurol. 1999 Jan;41(1):26-39. doi: 10.1017/s0012162299000067.
This study examines the prevalence of cerebral palsy (CP) in two north-east Italian provinces, Padua and Rovigo (overall population 1030 000). Six-hundred and ten children with a diagnosis of CP (330 male, 280 female), born between 1965 and 1989, were studied. The prevalence of CP progressively increased from the 1960s to the mid-1980s, and then decreased in the 5-year period, 1985 to 1989. These quantitative changes were associated with qualitative ones. For example, the number of low-birthweight (LBW) infants progressively increased, similar to results of epidemiological studies from other European countries. The clinical features of the types of CP in this study (hemiplegia, diplegia, ataxic diplegia, quadriplegia, pure ataxia, dyskinesia) generally correspond with those described in other studies. However, the prevalence of quadriplegia in this study is higher. The prevalence of types of CP related to preterm birth, such as diplegia, increased over the years, while those associated with term babies, such as dyskinesia, decreased. This study suggests that prenatal factors are associated with some types of CP, while in others, such as diplegia, quadriplegia, and dyskinesia, the perinatal factors are notable. Perinatal factors were associated with LBW children, while prenatal factors were greater for normal-birthweight infants. The variation in the prevalence of CP over the years, with two peaks corresponding with the introduction of neonatal intensive care units in Padua and Rovigo, suggests that changes in neonatal care could influence the levels of CP, independent of the original presence of predisposing prenatal factors.
本研究调查了意大利东北部两个省份帕多瓦和罗维戈(总人口103万)的脑瘫(CP)患病率。研究对象为610名在1965年至1989年期间出生且被诊断为CP的儿童(330名男性,280名女性)。CP的患病率从20世纪60年代到80年代中期逐渐上升,然后在1985年至1989年的5年期间有所下降。这些数量上的变化伴随着质量上的变化。例如,低体重(LBW)婴儿的数量逐渐增加,这与其他欧洲国家的流行病学研究结果相似。本研究中CP类型(偏瘫、双瘫、共济失调型双瘫、四肢瘫、单纯共济失调、运动障碍)的临床特征通常与其他研究中描述的一致。然而,本研究中四肢瘫的患病率更高。与早产相关的CP类型,如双瘫,其患病率多年来有所增加,而与足月儿相关的类型,如运动障碍,则有所下降。本研究表明,产前因素与某些类型的CP有关,而在其他类型中,如双瘫、四肢瘫和运动障碍,围产期因素则较为显著。围产期因素与LBW儿童相关,而产前因素在正常出生体重婴儿中更为突出。多年来CP患病率的变化,有两个峰值分别对应帕多瓦和罗维戈新生儿重症监护病房的设立,这表明新生儿护理的变化可能会影响CP的水平,而与产前易患因素的最初存在无关。