摘要
目的探讨早产儿坏死性结肠炎发病和母体风险因素及胎盘炎症病变之间的相关性。方法回顾性分析2006年7月至2015年7月期间180例存活单胎早产儿及孕产妇（妊娠期〈32周），记录产妇的年龄、BMI、经产情况、产前类固醇和抗生素使用情况。对母体血液白细胞计数及差异计数和胎盘组织进行检测。根据Bell分级标准Ⅱa级及以上定义为患有早产儿坏死性小肠结肠炎。基于双变量模型和多变量回归模型对数据进行统计分析。结果所有纳入研究的早产儿中14例诊断患有坏死性结肠炎（7．8％，包括11例Ⅱ级和3例Ⅲ级），其中有1例死亡（7．1％）。母体血液嗜中性粒细胞／淋巴细胞比率（OR=1．07，P=0．002）、经产（OR=3．39，P=0．013）和早产儿出生体重（OR：0．06，P=0．01）可以作为早产儿坏死性小肠结肠炎发病的重要预测因子；出生后24h内早产儿血液嗜中性粒细胞／淋巴细胞比率（P：0．65）不能作为早产儿坏死性小肠结肠炎发病的预测因子；临床绒毛膜羊膜炎（P≥0．99）和组织学绒毛膜羊膜炎（P=0．46）及脐带炎症（P=0．21）不能作为早产儿坏死性小肠结肠炎发病的预测因子。结论母体血液嗜中性粒细胞／淋巴细胞比率、经产、早产儿出生体重和早产儿坏死性小肠结肠炎发病之间存在相关性，而早产儿血液嗜中性粒细胞／淋巴细胞比率、临床和组织学绒毛膜羊膜炎及脐带炎症与早产儿坏死性小肠结肠炎发病之间无相关性。
Objective To investigate the association of risks related to maternal factors with the subsequent development of nccrotizing enterocolitis （NEC） in very preterm infants and to determine whether the placental inflammatory lesions were also related to the NEC. Methods This retrospective cohort study examined newborns born at 〈 32 weeks （n = 180） between July 2006 and July 2015 and their mothers at our hospital ,recorded the maternal age, body mass index （BMI） , muhiparity situation, and the usage of prenatal steroids or antibiotics. Medical records of eligible newborns and their mothers were reviewed. Maternal blood white blood cell and differential counts were measured at admission and the placentas were examined histologically after delivery. The primary outcome measure was NEC Bell Stage Ⅱa. Bivariate analyses and multivariate logistic regression were used for the statistical analyses. Results NEC was diagnosed in 14 of 180 very preterm infants （7.8%） , including 11 Stage II and 3 Stage III infants, and the overall mortality rate of these infants was 7.1% （n = 1 ）. Multivariate regression analysis identified maternal neu-trophil-to-lymphocyte ratio （ OR = 1.07, P = 0. 002 ）, muhiparity （ OR = 3.39, P = O. 013 ）, and birth weight （OR =0. 06, P =0. 01 ） were significantly associated with an increased risk of NEC development. Neonatal neutrophil-to-lymphocyte ratio （NLR） as measured within 24 hours of birth （ P = 0. 65 ） was not associated with NEC development. Clinical chorioamnionitis （P〉0. 99 ） and histological chorioamnionitis （P =0. 46） and funisitis （P =0. 21 ） could not be used as significant predictors of NEC. Conslusions The development of NEC in very preterm infants is associated with the maternal NLR, parity, and birth weight, not with clinical and histological chorioamnionitis and funisitis.
作者
黄娟娟
李华
张利平
张娟
高霞
Huang Juanjuan Li Hua Zhang Liping Zhang Juan Gao Xia(Department of Obstetrics, Yanhn University Affiliated Hospital, Yan＇an 716000, China)
出处
《中国医师杂志》
CAS
2017年第6期848-851,共4页
Journal of Chinese Physician
基金
陕西科技惠民计划项目（2015HM-01-02）
