Pei Li-jun, Li Zhu, Li Song, Hong Shi-xin, Ye Rong-wei, Chen Xin, Zheng Jun-chi, Wang Tai-mei, Zhao Xiu-qin, Xiao Lan, Wang Li-na, Zhang Bo-lan, Liu Zhi-xin, Zhou Yong-lan, Jiang Mei-fang, Sun Xia-mei, Chen Hai-lan, Li Min, Yang Xiao-ling, Shen Quan-zhen, Shao Pei-yun, Xie Lian-yun
Institute of Reproductive and Child Health, Peking University, Beijing 100083, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2003 Jun;24(6):465-70.
To describe the epidemiology of neural tube defects (NTDs) in high- and low-prevalence areas of China.
Birth defects surveillance data, collected from 1992 through 1994 was analyzed. These data were collected as part of the Sino-American cooperative project on NTDs prevention. We classified NTDs as anencephaly, encephalocele, high-level and low-level spina bifida (SB) according to location of the lesion (high vs low) and whether the defect was isolated or occurred in association with other birth defects. Rates were compared in the high-prevalence (North) region and the low-prevalence (South) region, after adjusted for classification, urban and rural, season and sex, and calculated the adjusted rate of NTDs.
Among seven hundred and eighty-four NTDs cases in 326 874 recorded births (include in livebirth, stillbirth and fetal death with a gestational age of at least 20 weeks), the overall NTDs prevalence in the North was 5.57/1,000 births, and in the South was 0.88/1 000. There were also significant differences in the prevalence of anencephaly, encephalocele, high-level and low-level SB between North (0.97, 0.49, 2.75 and 1.11/1,000 birth) and South (0.36, 0.15, 0.21 and 0.14/1,000 birth) (P < 0.01), with adjusted prevalences in the North 3 - 7 times higher than those in the South. There were significant difference between urban (2.04) and rural areas (6.57/1,000 birth) in the North (P < 0.01), urban (0.52) and rural areas (0.95/1,000 birth) in the South (P < 0.05). Adjusted prevalence rates in the rural were 3 - 4 times higher than those of urban in the North and 1.6 - 1.9 times higher than in the South; The seasonal rate of high-level SB increased between September and November in the North (3.44/1,000 birth), while the seasonal rate of anencephaly decreased between September and November (0.18/1,000 birth) in the South. However there were no seasonal changes in other classified NTDs both in the South and North.
The birth prevalence of NTDs in the North of China was the highest in the world. There were significant differences between the North and the South, urban and rural. There was seasonal change in high-level SB in the North, which was in accordance to the phenotype of NTDs. It was suggested that there might exist etiological heterogeneity among anecephalus, low- and high-level SB.
描述中国神经管缺陷（NTDs）高、低发病地区的流行病学特征。
分析1992年至1994年收集的出生缺陷监测数据。这些数据是中美神经管缺陷预防合作项目的一部分。根据病变部位（高与低）以及缺陷是孤立存在还是与其他出生缺陷相关联，将神经管缺陷分为无脑儿、脑膨出、高位和低位脊柱裂（SB）。在对分类、城乡、季节和性别进行调整后，比较高发病（北方）地区和低发病（南方）地区的发病率，并计算神经管缺陷的调整发病率。
在326874例有记录的出生中（包括活产、死产和孕龄至少20周的死胎）的784例神经管缺陷病例中，北方神经管缺陷的总体患病率为5.57/1000例出生，南方为0.88/1000例出生。北方（0.97、0.49、2.75和1.11/1000例出生）和南方（0.36、0.15、0.21和0.14/1000例出生）无脑儿、脑膨出、高位和低位脊柱裂的患病率也存在显著差异（P<0.01），北方的调整患病率比南方高3至7倍。北方城市（2.04）和农村地区（6.57/1000例出生）之间存在显著差异（P<0.01），南方城市（0.52）和农村地区（0.95/1000例出生）之间存在显著差异（P<0.05）。北方农村的调整患病率比城市高3至4倍，比南方高1.6至1.9倍；北方高位脊柱裂的季节性发病率在9月至11月间升高（3.44/1000例出生），而南方无脑儿的季节性发病率在9月至11月间下降（0.18/1000例出生）。然而，南方和北方其他分类的神经管缺陷均无季节性变化。
中国北方神经管缺陷的出生患病率为世界最高。北方和南方、城市和农村之间存在显著差异。北方高位脊柱裂存在季节性变化，这与神经管缺陷的表型一致。提示无脑儿、低位和高位脊柱裂之间可能存在病因异质性。
