不同诊断标准下早产儿支气管肺发育不良诊断及预后分析

A comparison of the clinical diagnosis and outcome in preterm infants with bronchopulmonary dysplasia under two different diagnostic criteria

目的:探讨两种支气管肺发育不良(BPD)诊断及分度标准对早产儿BPD诊断和预后判断的影响。方法:采用回顾性病例分析研究,研究对象为2015年1月至2018年12月浙江大学医学院附属儿童医院新生儿重症监护病房收治的157例出生胎龄<32周、存活>14 d且诊断符合2001年美国国立儿童健康与人类发育研究所(NICHD)定义(简称2001标准)的中重度BPD或14日龄至校正胎龄36周前因肺实质性疾病或呼吸衰竭而死亡的早产儿,根据2018年美国NICHD的新诊断标准(简称2018标准)重新分度(Ⅰ、Ⅱ、Ⅲ及ⅢA度)。采用t检验、非参数检验或χ^2检验比较两种BPD标准分度患儿的临床特征及预后。结果:157例患儿中男100例,根据2001标准诊断为中度62例、重度84例、无法分度11例;根据2018标准诊断为Ⅰ度51例、Ⅱ度29例、Ⅲ度66例、ⅢA度11例。2018标准的Ⅱ度患儿总用氧时间、正压通气、气管插管持续时间均明显大于2001标准的中度BPD患儿[80(65,95)比65(59,77)d,52(38,58)比30(19,48)d,10(2,17)比4(0,12)d,Z=-2.995,-3.750,-2.073,P均<0.05]。2001标准中重度BPD的病死率为10.3%(15/146),2018标准BPD的病死率为16.6%(26/157);2018标准Ⅲ及ⅢA度患儿的病死率为33.8%(26/77),明显高于2001标准重度BPD的病死率[17.9%(15/84),χ^2=5.357,P<0.05]。结论:2001年NICHD的BPD定义及分度标准可导致重度BPD患儿的漏诊或无法分度,使重度BPD患儿的发生率和病死率被低估。

Objective To compare the clinical diagnosis and outcomes of preterm infants with bronchopulmonary dysplasia(BPD)under two different diagnostic criteria.Methods A retrospective study was performed in 157 preterm infants who were admitted to Neonatal Intensive Care Unit of the Children′s Hospital,Zhejiang University School of Medicine from January 2015 to December 2018.Enrolled infants,with gestational age<32 weeks and survived>14 days,met the 2001 National Institute of Child Health and Human Development(NICHD)definition of moderate and severe BPD or died between 14 days of postnatal age and 36 weeks owing to persistent parenchymal lung disease and respiratory failure.The severities of BPD were revaluated according to the 2018 revised definition of BPD proposed by NICHD.Characteristics and outcomes of these infants were compared with the two different diagnostic criteria with t-test,nonparametric test or Chi-square test.Results In the 157 enrolled infants(100 males),severities of BPD were classified as moderate in 62,severe in 84 and unclassifiable in 11 according to the 2001 NICHD criteria,while gradeⅠin 51,Ⅱin 29,Ⅲin 66 andⅢA in 11 infants respectively according to the 2018 NICHD criteria.Duration of oxygen therapy,positive pressure ventilation and endotracheal intubation in gradeⅡinfants of 2018 criteria were much longer than that in moderate infants of 2001 criteria(80(65,95)vs.65(59,77)d,52(38,58)vs.30(19,48)d,10(2,17)vs.4(0,12)d,Z=-2.995,-3.750,-2.073,all P<0.05).Mortality of moderate and severe infants in 2001 criteria was 10.3%(15/146),while mortality of BPD in 2018 criteria was 16.6%(26/157).Mortality of gradeⅢandⅢA BPD in 2018 criteria was much higher than mortality of severe BPD in 2001 criteria(33.8%(26/77)vs.17.9%(15/84),χ^2=5.357,P<0.05).Conclusion Definition and classification of BPD based on 2001 NICHD criteria may cause missed or unclassified cases,resulting in the underestimation of the morbidity and mortality of infants with severe BPD.