孕母合并HCA应用产前糖皮质激素与早产儿预后相关性分析

Study on the relationship between antenatal corticosteroids application and the prognosis of premature infants whose mother with histological chorioamnionitis

目的探讨适于胎龄(AGA)的单胎早产儿孕母合并组织学绒毛膜羊膜炎(HCA)、应用产前糖皮质激素(ACS)与新生儿结局之间的关系。方法回顾性分析2014年1月至2018年12月期间在扬州大学医学院附属盐城市妇幼保健院分娩的孕母,及其胎龄为24+0~33+6周的单胎AGA早产儿的临床资料。根据HCA是否存在,分为HCA组和无HCA组;根据ACS的应用情况,将其分为最佳ACS(OACS,产前≥24小时、<7天应用)、次优ACS(SACS,产前<24小时、≥7天)及未应用ACS(NACS)三组。对孕母及早产儿相关临床资料采用Firth惩罚似然法进行多元Logistic回归分析。结果在纳入的268例早产儿中,合并HCA者(HCA+组)117例(43.7%),无HCA者(HCA-组)151例(56.3%)。HCA+组中,OACS组38例,SACS组65例,NACS组14例;HCA-组中,OACS组55例,SACS组79例,NACS组17例。纠正胎龄、性别、剖宫产等混杂因素后,Logistic多因素分析显示,合并HCA的孕母,应用ACS可降低子代早产儿重度支气管肺发育不良(BPD)和生后7天内低血压的发生率,但增加其动脉导管未闭(PDA)的治疗率和败血症的发生率。在OACS组中,重度BPD发生率(OR=0.035,95%CI:0.019~0.426)、生后7天内低血压发生率(OR=0.027,95%CI:0.010~0.268)均低于NACS组;但PDA治疗率(OR=8.147,95%CI:1.201~55.248)和败血症发生率(OR=6.853,95%CI:1.020~46.071)均高于NACS组,均P<0.05。在未合并HCA的早产儿中,ACS者仅PDA治疗率较低(OR=0.228,95%CI:0.070~0.650,P<0.05)。结论当孕母合并HCA时,应用ACS可降低子代早产儿重度BPD发生率,但可增加其败血症的发生率。

Objective To explore the association between antenatal corticosteroid(ACS)application and neonatal outcomes of appropriate for gestational age(AGA)and singleton preterm infants whose mother with histologic chorioamnionitis(HCA).Methods A retrospective study was performed with singleton AGA neonates of 24+0 to 33+6 weeks’gestation born in Yancheng Maternity and Child Health Care Hospital Affiliated of Yangzhou University Medical College from 2014 to 2018 and their mother.All of them were divided into HCA+group and HCA-group according to whether they had HCA or not.Meanwhile,according the application of ACS,they were also divided into 3 groups:infants and their mothers who applied ACS 2-7 days before birth(optimal ACS,OACS),infants and their mothers applied ACS within 24 hours or at least 7 days before delivery(suboptimal ACS,SACS)and no application of ACS(no ACS,NACS).Multivariate logistic regression with Firth’s penalized likelihood was performed to analyze the related clinical data of premature infants and their mothers.Results Among 186 premature infants,117(43.7%)neonates were with HCA(HCA+group),while 151(56.3%)neonates were without HCA(HCA-group).In HCA+group,there were 38 cases in OACS group,65 cases in SACS group and 14 cases in NACS group.And in HCA-group,there were 55 cases in OACS group,79 cases in SACS group and 17 cases in NACS group.After adjusting for gestational age,sex,and cesarean section,multivariate analysis showed that ACS use was associated with reduced incidence of severe bronchopulmonary dysplasia(BPD)and hypotension within 7 postnatal days,but associated with increased treatment rate of patent ductus arteriosus(PDA)and risk of sepsis.In OACS group,the incidence of severe BPD(aOR=0.035,95%CI:0.019-0.426)and hypotension(aOR=0.027,95%CI:0.010-0.268)were lower,but the treatment rate of PDA(aOR=8.147,95%CI:1.201-55.248)and the incidence of sepsis(aOR=6.853,95%CI:1.020-46.071)were higher than NACS group.In HCCA-group,only the treatment rate of PDA for ACS patients was lower.Conclusions When HCA occurs in pregnant women,prenatal use of ACS can reduce the incidence of severe BPD,but increase the incidence of sepsis.