Prevalence of microcephaly in Europe: population based study.
Prevalence of microcephaly in Europe: population based study.
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DOI：
10.1136/bmj.i4721
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发表时间：
2016-09-13
期刊：
影响因子：
--
通讯作者：
Dolk H
中科院分区：
文献类型：
--
作者：
Morris JK;Rankin J;Garne E;Loane M;Greenlees R;Addor MC;Arriola L;Barisic I;Bergman JE;Csaky-Szunyogh M;Dias C;Draper ES;Gatt M;Khoshnood B;Klungsoyr K;Kurinczuk JJ;Lynch C;McDonnell R;Nelen V;Neville AJ;O'Mahony MT;Pierini A;Randrianaivo H;Rissmann A;Tucker D;Verellen-Dumoulin C;de Walle HE;Wellesley D;Wiesel A;Dolk H
目的：提供当前欧洲小头畸形患病率的估计值，确定欧洲各地小头畸形的诊断是否一致，并评估是否可以使用EUROCAT（欧洲先天性畸形监测）进行的欧洲监测检测到患病率的变化。设计问卷调查和基于人群的观察性研究。建立24个EUROCAT登记处，每年覆盖15个国家的570 000例出生。研究对象与遗传条件无关的活产婴儿、妊娠20周后胎儿死亡和任何妊娠期因胎儿异常终止妊娠的小头畸形病例。主要结局指标小头畸形的患病率（2003年1月1日至2012年12月31日），采用随机效应Poisson回归模型进行分析，以解释登记研究间的异质性。结果16个登记中心回答了问卷，其中44%（7/16）使用了EUROCAT对小头畸形的定义（颅骨周长比性别、年龄和种族平均值低3 SD以上的大脑尺寸减小），19%（3/16）使用2 SD截止值，31%（5/16）依赖于个体临床医生使用的标准，其中一个在2003年到2012年间改变了标准。欧洲的小头畸形患病率为1.53（95%置信区间为1.16 - 1.96）/10000例出生，登记率为0.4（0.2 - 0.7）-4.3（3.6 - 5.0）/10000（χ2=338，df=23，I2=93%）。采用3 SD临界值的登记研究报告的患病率为1.74/10000（0.86 - 2.93），而采用不太严格的2 SD临界值的登记研究报告的患病率为1.21/10000（0.21 - 2.93）。在欧洲，小头畸形的患病率需要在一年内增加35%以上，或者在一个登记处增加300%以上，才能达到统计学显著性（P<0.01）。结论EUROCAT可以检测到寨卡病毒导致的小头畸形患病率增加，其幅度与巴西相似。然而，由于小头畸形的罕见性和不一致的诊断标准，预计在欧洲的较小增加可能不会被检测到。必须在整个欧洲采用明确的小头畸形诊断标准。
Objectives To provide contemporary estimates of the prevalence of microcephaly in Europe, determine if the diagnosis of microcephaly is consistent across Europe, and evaluate whether changes in prevalence would be detected using the current European surveillance performed by EUROCAT (the European Surveillance of Congenital Anomalies). Design Questionnaire and population based observational study. Setting 24 EUROCAT registries covering 570 000 births annually in 15 countries. Participants Cases of microcephaly not associated with a genetic condition among live births, fetal deaths from 20 weeks’ gestation, and terminations of pregnancy for fetal anomaly at any gestation. Main outcome measures Prevalence of microcephaly (1 Jan 2003-31 Dec 2012) analysed with random effects Poisson regression models to account for heterogeneity across registries. Results 16 registries responded to the questionnaire, of which 44% (7/16) used the EUROCAT definition of microcephaly (a reduction in the size of the brain with a skull circumference more than 3 SD below the mean for sex, age, and ethnic origin), 19% (3/16) used a 2 SD cut off, 31% (5/16) were reliant on the criteria used by individual clinicians, and one changed criteria between 2003 and 2012. Prevalence of microcephaly in Europe was 1.53 (95% confidence interval 1.16 to 1.96) per 10 000 births, with registries varying from 0.4 (0.2 to 0.7) to 4.3 (3.6 to 5.0) per 10 000 (χ2=338, df=23, I2=93%). Registries with a 3 SD cut off reported a prevalence of 1.74 per 10 000 (0.86 to 2.93) compared with those with the less stringent 2 SD cut off of 1.21 per 10 000 (0.21 to 2.93). The prevalence of microcephaly would need to increase in one year by over 35% in Europe or by over 300% in a single registry to reach statistical significance (P<0.01). Conclusions EUROCAT could detect increases in the prevalence of microcephaly from the Zika virus of a similar magnitude to those observed in Brazil. Because of the rarity of microcephaly and discrepant diagnostic criteria, however, the smaller increases expected in Europe would probably not be detected. Clear diagnostic criteria for microcephaly must be adopted across Europe.
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3.8
作者：
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通讯作者：
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作者：
Schuler-Faccini, Lavinia;Ribeiro, Erlane M.;Sanseverino, Maria Teresa V.
通讯作者：
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