| BackgroundIntussusception is due to part of the intestine and its mesenteric forward into the adjacent intestine resulting in intestinal obstruction,divided into primary intussusception and secondary intussusception.Diagnosis or treatment not timely is not only affect the treatment effect,but also can cause intestinal perforation,intestinal necrosis or peritonitis and other serious complications,even life-threatening.Intussusception is most commonly occured in children,cases are mainly primary intussusception(hereinafter referred to as "intussusception"),and children intussusception has become a global public health problem.The current study of the causes of intussusception in children is generally associated with anatomical factors,dietary changes,gastrointestinal hormones,viral infections,rotavirus vaccines.The study of the influencing factors of disease is related to factors such as obesity,family economic level and environmental factors(temperature,precipitation).The incidence is relatively high in Asian region,the patients focused on below age of 2 year old,boys more than girls,most studies have shown that there are seasonal feature more focused on April-October.However,we have reported less research on the burden,epidemiological characteristics,clinical features,and the factors affecting children.Therefore,this study retrospectively reviewed the incidence of intussusception in children under 2 years old in Jinan City,described the epidemiological characteristics and clinical characteristics of the disease,to explore the factors affecting the disease,so as to provide scientific basis for the prevention and control of the disease.Objectives1.To grasp the incidence of children's intussusception under 2 years old in Jinan City.2.To analyze the time,area and population distribution of children's intussusception under 2 years old in Jinan from 2011 to 2015.3.To identify the main clinical features of children's intussusception under 2 years old in Jinan City;4.To explore the influencing factors of intussusception in children under 2 years old in Jinan City.Research objectAccording to the intussusception is one of the serious acute abdomen symptom in children,generally choose secondary and above hospitals.For this reason,this study selected all the above two le-vel hospitals(a total of 63)in Jinan City as the investigation site.According to the International Classification of Diseases-10,define the children under 2 years old in Jinan City,which was diagnosed as K56.1(intussusception),as the subject of this study.Research contentand and Methods1.Estimate the incidenceThe incidence of intussusception in children was estimated and the morbidity was compared.The demographic information of children under 2 years old was from the Statistical Yearbook of Jinan Municipal Bureau of Statistics.2.Describe epidemiological and clinical featuresThe demographic information and clinical diagnostic information of the case was collected through the hospital case information system(HIS)by questionnaire(appendix ?),descriptive epidemiological methods were used to describe the demographic characteristics,clinical features and time distribution and the regional distribution.3.Analysis of influencing factors1:1 matched case-control study was used to explore the influencing factors of disease.Calculate the required sample size according to the 1:1 matched case-control study sample size calculation formula.A total of 93 newly diagnosed intussusception cases under 2 years old diagnosed by secondary and above hospitals from January 1,2016 to June 30,2016 were selected as cases group,the controls were collected from the same hospital and the same department of non-intussusception children as cases group with the same sex,age difference less 3 months,and the date of hospitalization within 3 days.Based on the previous findings,both of experts consultation and the cases interview method were conducted to construct the research content of the influencing factors.Self-designed questionnaires,training investigators,the use of HIS system to collect case information,for the information can not be obtained by telephone survey form to add.Statistical AnalysisTo establish database by Epidata 3.0 software according to the questionnaire,using SPSS 17.0 for statistical analysis.Enumerationdata expressed by ratio and rate,enumerationdata comparison by ?2 test,P<0.05 for the test criteria.Using the geographic information system ArcGIS9.3 for visualization show,OpenGeoda software was used for spatial autocorrelation analysis,P<0.05 for the test criteria.Conditional logistic regression was used for case-control study analysis,included univariate analysis and multivariate analysis.The significance level was P<0.1,and the significant variables were included in the COX regression model.The COX regression model was used for multivariate analysis to obtain the influencing factors and the OR(Odds Ratio)and its 95%CI(95%Confidence Interval).Results1.Incidence rateA total of 574 inpatient cases of children with intussusception were collected from 2011 to 2015 in Jinan.The incidence rate was 86.32 per 100 000,the highest incidence in 2011,reaching 117.63 per 100 000,the incidence rate showed a downward trend year by year.2.Clinical featuresThe mainly clinical manifestations of the 574 cases were abdominal pain and vomiting,accounting for 80.8%(464/574)and 63.4%(364/574)respectively.Imaging techniques used by abdominal ultrasound 77.00%(442/574)diagnosis,air enema reduction 77.87%(447/574)is taken to the main treatment.Among the 123 cases of intestinal nesting,the ileum-colon type(37.40%)and the ileal-ileal-colon type(30.89%)were prone to intussusception.69.69%(400/574)cases have no complications,of 174 complications cases,mesenteric lymphadenitis is the most common,accounting for 39.66%(69/174).3.Epidemical characteristics(1)Time characteristicsCases occurred throughout the year,the incidence peak in March,June,and November,accounting for 9.23%,10.80%and 11.50%,respectively.The incidence peak of 0-12 months of age in June and November,the incidence of 13-24 months of age show no significant peak,incidence in January,September and October incidence is relatively small.(2)Regional characteristicsAll districts in Jinan City were covered by cases.The incidence of urban areas was significantly higher than the suburbs.The top three of 10 districts incidence are clustered in central city,Tianqiao district get the first incidence 209.18 per 100 000,and the second in Licheng district with an incidence of 152.44 per 100 000,and third was Shizhong district with an incidence of 131.56 per 100 000,respectively.Global spatial autocorrelation analysis showed that the cases were randomly distributed in the districts and counties,and there was no regional clustering.(3)Population characteristicsMost of 574 cases were male,accounting for 65.51%,the ratio of male to female was 1.9:1.The average annual incidence of males was 106.89 per 100 000,which was significantly higher than that of females(63.21 per 100 000)(?2 =13.76,P<0.001).The youngest case was 28 days after birth,and the peak of 23.69%(136/574)was in 6-9 months old.The same distribution characteristic of age was observed in different years.The incidence rate was 102.14 per 100 000 in 0-12 months cases,which was significantly higher than that of 13-24 months(70.36 per 100 000)(?2 = 19.46,P<0.001),4.Influencing factor1:1 matched case-control study was conducted in 93 cases and 93 controls,The univariate regression model analysis showed that the cases had an overweight of 10%than the standard compared with normal(OR =3.600,95%CI:1.787-7.254),mixed feeding(OR =3.448,95%CI:7.295-135.469),food supplement before illness(OR=10.476,95%CI:4.270-25.701)and food supplemented before 6 months old(OR=14.559,95%CI:6.473-32.747)were significantally associated with illness.Multivariate regression model analysis found that cases had an overweight of 10%than the standard compared with normal(OR =4.573,95%CI:1.149-18.202),mixed feeding(breast milk mixed with milk powder or milk)(OR =9.676,95%CI:1.376-68.067),food supplemented before 6 months old(OR =16.092,95%CI:1.888-137.148)were the risk factors of intussusception in children.Conclusions1.The total of 574 intussusception cases in children under 2 years old in Jinan City was collected and with no death cases.The average annual incidence rate of 5 years was 86.32 per 100 000,which was higher than that of the United States and Britain,lower than that of Korea and Japan,and also lower than two domestic citys Suzhou and Linyi.2.Cases occurred throughout the year,most of cases occurred in November up to 11.50%,three months of March,June and November have the peak incidence.The peak incidence of 0-12 month cases was in June and November,and different with 13-24 months cases,which showed no significant peak characters and lower incidence was in January,September and October.3.Cases distributed in all districs and counties of Jinan city,but without space aggregation.A difference incidence was found between urban and rural areas,urban area has a higher incidence than rural.Three districs of Tianqiao district,Licheng district and Shizhong district had the mostly higher incidence.4.The number of male cases was more than that of females.The priority of age distribution was less than 12 months old.The minimum age of onset was 28 days after birth and the peak appeared at 6-9 months old.The gender and age distribution of the cases were basically the same in different years.5.Abdominal pain and vomiting were the primary and major clinical symptoms of cases complained.Most eases had no complications,clinical diagnosis technology mainly rely on abdominal ultrasound,treatment methods using air enema reduction surgery.6.Cases had an overweight of more 10%than the standard compared with normal,mixed feeding(breast milk mixed with milk powder or milk)compared with breastfeeding,food supplemented before 6 months old were the risk factors in children with intussusception.7.The history of rotavirus vaccines was not founded to increase the occurrence of children intussusception.Suggestions1.Established a comprehensive monitoring system to capture the children intussusceptions and strengthen the study of the burden and influencing factors of intussusception in children.2.Enhanced the attention of children intussusceptions in clinicians and parents.A timely hospital visiting should be initiated for the parents when they found their children suddenly have the following two common symptoms with no reasons,abdominal pain and vomiting.3.Promoted a nature feeding of breastfeeding and carny out variety health educations to the parents.Gerneral suggestion of food supplement after 6 months old could be practicable to maintain a healthy weight.4.Explored the association of rotavirus vaccine and children intussusception in the further studies.5.Involved the adervese effect of intussusception into the system of abnormal response to vaccination.6.Performed a cohort study on population with rotavirus infection history to verify the relation of rotavirus infection and intussusception. |
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