静脉输注丙种球蛋白与新生儿溶血病患儿坏死性小肠结肠炎发生的关系

The relationship between intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease

目的探讨静脉输注丙种球蛋白(IVIG)与新生儿溶血病(HDN)患儿坏死性小肠结肠炎(NEC)发生的关系。方法收集重庆医科大学附属儿童医院2013年1月1日至2014年1月1日确诊为HDN患儿的临床资料,采用倾向评分配比法建立回顾性队列研究,根据是否使用IVIG分为IVIG组和非IVIG组,比较两组患儿NEC发生情况。进一步以配比后病例建立病例对照研究,探讨溶血病患儿发生NEC的危险因素。结果共1 217例HDN患儿纳入研究,其中40例合并NEC,309例进行IVIG。进行1∶2的倾向评分配比后,共有199对匹配成功,其中NEC组25例,非NEC组572例。结果显示,倾向评分配比后,IVIG治疗并未增加溶血病患儿NEC的发生率,4.5%(9/199)vs 4.0%(16/398),χ2=0.083,P=0.773。单因素分析显示,早产、低出生体重、多胎、胎膜早破、产前糖皮质激素、静脉营养、先天性心脏病、最高胆红素值与溶血病患儿发生NEC有关。二元Logistic回归显示,先天性心脏病是溶血病患儿发生NEC的独立危险因素(OR:4.021,95%CI:1.286~12.578)。结论 IVIG治疗不增加溶血病患儿发生NEC的概率,合并先天性心脏病的HDN患儿更易发生NEC。

Objective To evaluate whether intravenous immunoglobulin（IVIG）treatment for newborns with hemolytic disease contributes to necrotizing enterocolitis（NEC）.Methods A retrospective cohort study was conducted based on propensity score（PS）matching.Newborns admitted in our neonatal department between Jan 1,2013 and Jan 1,2014,suffering from hemolytic disease due to blood type incompatibility,were divided into two groups according to IVIG usage.The NEC incidence of both groups was analyzed.The risk factors of NEC in newborns with hemolytic disease were analyzed based on case-control study in the PSmatched cases.Results Among the total 1,217 neonates,40 patients were diagnosed as having concurrent NEC and 309 received IVIG.With a 1∶2 PS-matching,199 pairs were matched,including 25 patients with NEC and 572 patients without NEC.After PS-matching,the NEC incidence in IVIG group did not increase,comparing with non-IVIG group[4.5%（9/199）vs 4.0%（16/398）,χ2=0.083,P= 0.773].The risk factors of NEC in newborns with hemolytic disease included premature,low birth weight,multiple pregnancy,premature rupture of membranes,antenatal glucocorticoid,parenteral nutrition,congenital heart disease and maximum total serum bilirubin.Logistic regression analysis showed congenital heart disease was the independent risk factor of NEC in patients with hemolytic disease（OR：4.021,95%CI：1.286-12.578）.Conclusion IVIG treatment did not increase the NEC incidence in newborns with hemolytic disease,while patients with hemolytic disease complicated with congenital heart disease were more vulnerable to NEC.