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阿普加评分与癫痫的长期风险。

Apgar scores and long-term risk of epilepsy.

作者信息

Sun Yuelian, Vestergaard Mogens, Pedersen Carsten Bøcker, Christensen Jakob, Olsen Jørn

机构信息

The Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, Aarhus.

出版信息

Epidemiology. 2006 May;17(3):296-301. doi: 10.1097/01.ede.0000208478.47401.b6.

Abstract

BACKGROUND

Low Apgar scores are associated with high risk of neonatal death, cerebral palsy, and mental retardation, but the association between Apgar scores and long-term risk of epilepsy remains unresolved.

METHODS

We carried out a population-based cohort study of 1,538,732 live newborns in Denmark between 1 January 1978 and 31 December 2002 by using national registers. The Apgar scores at 1 or 5 minutes were recorded by midwives following standardized procedures. We obtained information on epilepsy by linking the cohort with the National Hospital Register. Cohort members were followed from birth until onset of epilepsy, death, emigration, or 31 December 2002, whichever came first.

RESULTS

The incidence rate of epilepsy increased consistently with decreasing Apgar scores. The incidence rate of epilepsy was 628 per 100,000 person-years for those with 5-minute Apgar scores of 1 to 3 and 86 per 100,000 person-years for those with a score of 10; the resulting incidence rate ratio was 7.1 (95% confidence interval = 5.8-8.8). The incidence rate ratios of epilepsy associated with low Apgar scores were particularly high in early childhood but remained high into adulthood. The association did not change after excluding children with cerebral palsy, congenital malformations, or a parental history of epilepsy.

CONCLUSIONS

Neonates with a suboptimal Apgar score have a higher risk of epilepsy that lasts into adult life. These findings suggest that prenatal or perinatal factors play a larger role in the etiology of epilepsy than has previously been recognized.

摘要

背景

低阿氏评分与新生儿死亡、脑瘫和智力迟钝的高风险相关,但阿氏评分与癫痫长期风险之间的关联仍未明确。

方法

我们利用国家登记册对1978年1月1日至2002年12月31日期间丹麦的1,538,732例活产新生儿进行了一项基于人群的队列研究。助产士按照标准化程序记录1分钟或5分钟时的阿氏评分。我们通过将该队列与国家医院登记册相链接来获取癫痫相关信息。对队列成员从出生开始随访,直至癫痫发作、死亡、移民或2002年12月31日(以先发生者为准)。

结果

癫痫发病率随阿氏评分降低而持续增加。5分钟阿氏评分为1至3分者的癫痫发病率为每10万人年628例,评分为10分者为每10万人年86例;由此得出的发病率比为7.1(95%置信区间 = 5.8 - 8.8)。与低阿氏评分相关的癫痫发病率比在幼儿期特别高,但在成年期仍居高不下。排除患有脑瘫、先天性畸形或有癫痫家族史的儿童后,这种关联没有改变。

结论

阿氏评分欠佳的新生儿患癫痫的风险更高,且这种风险会持续至成年期。这些发现表明,产前或围产期因素在癫痫病因中所起的作用比之前认为的更大。

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