胎盘组织炎症对早产儿脑室内出血发病风险的影响

Risk assessment of placental inflammatory response on the intraventricular hemorrhage of premature infant

目的评价早产儿胎盘组织炎症反应程度及其病程进展对早产儿脑室内出血发病风险的影响。方法收集2008年3月至2009年9月三所医院分娩的493例早产儿临床资料,对其胎盘组织绒毛膜羊膜炎症反应进行分级分期,利用头颅B超、CT和MRI等影像学手段对脑室内出血诊断并分级。结果产妇绒毛膜羊膜炎患病率为30.0%(148/493),早产儿脑室内出血患病率为20.9%(103/493)。在校正了早产儿胎龄、性别、体重、胎膜早破以及分娩方式等因素后,胎盘Ⅱ级和Ⅲ级炎症,以及胎盘Ⅱ期和Ⅲ期炎症分别是早产儿脑室内出血的独立危险因素,其比值比分别为1.33(95%CI:1.02～1.87),2.01(95%CI:1.54～2.73),1.33(95%CI:1.02～1.87)和2.01(95%CI:1.54～2.73)。结论早产儿胎盘绒毛膜羊膜炎组织病理不同分期、分级与早产儿脑室内出血患病风险密切相关。

Objective To evaluate the relationship between the extent and progression of placental inflammatory responses and the risk of intraventricular hemorrhage （IVH） in premature infants. Methods Clinical data were retrospectively collected from 493 premature neonates who were born in one of three hospitals from March 2008 to September 2009. The histological chorioamnionitis （HCA） of maternal placenta was graded and scored. The level of premature infant IVH was diagnosed and graded by imaging study. Results The incidence of maternal HCA was 30. 0% （ 148/493 ） and infant IVH was 20.9% （103/493）. The results are corrected for the factors of gestational age, gender, birth weight, delivery model and preterm premature rupture of the membranes. The grade two or three and stage two or three of placental HCA were independent risk factors of preterm infant IVH and the odds ratios were 1.33 （95% CI：1.02-1.87）, 2.01 （95% CI： 1.54-2.73）, 1.33 （95% CI：1.02-1.87） and 2.01 （95% CI： 1.54 -2.73 ） respectively. Conclusion The IVH risk of preterm infants is significantly associated with the inflammatory level of maternal HCA.