The Impact of Technology on the Diagnosis of Congenital Malformations.
The Impact of Technology on the Diagnosis of Congenital Malformations.
复制标题
技术对先天畸形诊断的影响。
DOI：
10.1093/aje/kwz153
复制
发表时间：
2019
影响因子：
5
通讯作者：
Hernandez-Diaz,Sonia
中科院分区：
文献类型：
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作者：
Straub,Loreen;Huybrechts,KristaF;Bateman,BrianT;Mogun,Helen;Gray,KathrynJ;Holmes,LewisB;Hernandez-Diaz,Sonia
随着技术的进步和更广泛的使用，越来越多的亚临床先天性畸形被发现。在2000-2013年美国医疗补助分析提取中，我们对1780156名孕妇及其后代进行了队列研究，对比了在生命早期不一定表现出明显临床症状的畸形的时间趋势，这些畸形更有可能通过影像学诊断(二次房间隔缺损、动脉导管未闭、室间隔缺损、肺动脉异常、肺动脉瓣狭窄、脑积水)，伴有不太可能逃避临床诊断的畸形趋势（法洛四联症、主动脉缩窄、大血管转位、左心发育不良综合征、口裂、腹壁缺损）。在评估增加筛查强度的影响时，使用逻辑回归来解释风险因素的趋势。继发性房间隔缺损诊断率由2000-2001年的2.3‰上升至2012-2013年的7.5‰，动脉导管未闭诊断率由1.9‰上升至4.1‰，室间隔缺损诊断率由3.6‰上升至4.5‰。趋势不能用危险因素流行率的变化来解释，但考虑到筛查试验，趋势就减弱了。其他畸形没有时间趋势。研究结果表明，增加筛查部分解释了所观察到的轻度病例诊断增加的常见畸形。
As technology improves and becomes more widely accessible, more subclinical congenital malformations are being detected. Using a cohort of 1,780,156 pregnant women and their offspring nested in the 2000–2013 US Medicaid Analytic eXtract, we contrasted time trends in malformations which do not necessarily present with overt clinical symptoms early in life and are more likely to be diagnosed via imaging (secundum atrial septal defect, patent ductus arteriosus, ventricular septal defect, pulmonary artery anomalies, pulmonary valve stenosis, hydrocephalus) with trends in malformations that are unlikely to escape clinical diagnosis (tetralogy of Fallot, coarctation of the aorta, transposition of the great vessels, hypoplastic left heart syndrome, oral cleft, abdominal wall defect). Logistic regression was used to account for trends in risk factors while assessing the impact of increased screening intensity. Prevalence of the diagnosis of secundum atrial septal defect rose from 2.3‰ in 2000–2001 to 7.5‰ in 2012–2013, of patent ductus arteriosus from 1.9‰ to 4.1‰, and of ventricular septal defect from 3.6‰ to 4.5‰. Trends were not explained by changes in the prevalence of risk factors but were attenuated when accounting for screening tests. The other malformations showed no temporal trends. Findings suggest that increased screening partially explains the observed increase in diagnosis of milder cases of select common malformations.