IMPROVED ASCERTAINMENT OF CARDIOVASCULAR MALFORMATIONS IN INFANTS WITH DOWNS-SYNDROME, ATLANTA, 1968 THROUGH 1989 - IMPLICATIONS FOR THE INTERPRETATION OF INCREASING RATES OF CARDIOVASCULAR MALFORMATIONS IN SURVEILLANCE SYSTEMS
IMPROVED ASCERTAINMENT OF CARDIOVASCULAR MALFORMATIONS IN INFANTS WITH DOWNS-SYNDROME, ATLANTA, 1968 THROUGH 1989 - IMPLICATIONS FOR THE INTERPRETATION OF INCREASING RATES OF CARDIOVASCULAR MALFORMATIONS IN SURVEILLANCE SYSTEMS
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DOI：
10.1093/oxfordjournals.aje.a116466
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发表时间：
1992-12-15
影响因子：
5
通讯作者：
ERICKSON, JD
中科院分区：
文献类型：
--
作者：
KHOURY, MJ;ERICKSON, JD
一些出生缺陷监测系统显示，几种先天性心血管畸形的出生患病率呈上升趋势。临床确诊方面的改进被认为是这种增加的原因。几十年来，据报道，40-50%的唐氏综合症婴儿患有与不平衡基因相关的心脏缺陷。因此，在监测系统中，唐氏综合征婴儿心血管畸形确诊频率的长期变化可能有助于改善对这些缺陷的查明。作者研究了1968年至1989年亚特兰大市先天缺陷计划中记录的532例唐氏综合征患者中已查明的心血管畸形频率的变化。总体而言，33%的病例报告了心血管畸形。然而，唐氏综合症婴儿的这些缺陷的频率从20世纪70年代初的约20%急剧增加到80年代末的50%以上(p=0.0001)。这一上升趋势在所有主要类型的心脏缺陷中都可以看到，并在按种族、性别、产妇年龄、出生医院、出生体重和胎龄进行分层后持续。这些结果表明，在监测人群中，唐氏综合征婴儿心血管畸形的确认率有所提高。他们还与心脏缺陷率上升至少部分与人群中对这些缺陷的更好查明有关的假设是一致的。
Several birth defects surveillance systems have shown an upward trend in the birth prevalence of several congenital cardiovascular malformations. Improvements in clinical ascertainment have been suggested as an explanation for this increase. For several decades, 40-50% of infants with Down's syndrome have been reported to have cardiac defects associated with the unbalanced genotype. Therefore, secular changes in the frequency of ascertained cardiovascular malformations among infants with Down's syndrome in surveillance systems could shed light on improvements in the ascertainment of these defects. The authors examined changes in the frequency of ascertained cardiovascular malformations among 532 cases of Down's syndrome recorded in the Metropolitan Atlanta Congenital Defects Program from 1968 through 1989. Overall, 33% of the cases have reported cardiovascular malformations. However, the frequency of these defects in Down's syndrome infants increased dramatically from about 20% in the early 1970s to more than 50% in the late 1980s (p = 0.0001). This upward trend was seen for all major categories of cardiac defects and persisted after the cases were stratified by race, sex, maternal age, hospital of birth, birth weight, and gestational age. These results show improvement in the ascertainment of cardiovascular malformations among Down's syndrome infants in a surveillance population. They are also consistent with the hypothesis that the increasing rates of cardiac defects are related, at least in part, to improved ascertainment of these defects in the population.