胎龄<32周早产儿支气管肺发育不良的危险因素分析

Risk factors for brochopulmonary dysplasia in premature infants with gestational age<32 weeks

目的探讨胎龄<32周早产儿支气管肺发育不良(BPD)的危险因素,评价组织学绒毛膜羊膜炎(HCA)与BPD的关联性。方法回顾性分析129例胎龄<32周早产儿的临床资料,分为中-重度BPD和(或)死亡组(38例)及轻度BPD和(或)无BPD组(91例)。通过双变量分析和多因素Logistic回归模型校正,以优势比(OR)、校正优势比(aOR)、95%置信区间(CI)估计风险因素与中-重度BPD和(或)死亡之间的关联性。结果在129例胎盘病理诊断完整的早产儿中, HCA的总体发生率为70.5%(91/129)。中-重度BPD和(或)死亡的发生率为29.5%(38/129)。双变量分析显示:HCA不是中-重度BPD和(或)死亡的危险因素[OR=1.5, 95%CI=(0.6, 3.7), P=0.334>0.05]。小于胎龄儿(SGA)、双胎、动脉导管未闭(PDA)、胸部X射线的呼吸窘迫综合征(RDS)征象、败血症、机械通气是中-重度BPD和(或)死亡的危险因素(P<0.05)。经胎龄、性别、产前皮质类固醇激素(AS)校正后,败血症的影响变得不显著。经性别、AS校正后,胎龄每减少1周,中-重度BPD和(或)死亡的风险增加40%[aOR=1.4,95%CI=(1.1, 1.8), P=0.004<0.05]。结论低出生胎龄、SGA、双胎、胸部X射线的RDS征象、机械通气、PDA是BPD的危险因素。HCA与BPD不存在显著的关联。

Objective To discuss the risk factors of bronchopulmonary dysplasia(BPD)in premature infants with gestational age<32 weeks,and to evaluate the correlation between histological chorioamnionitis(HCA)and BPD.Methods A total of 129 premature infants with gestational age<32 weeks were divided into moderate-severe BPD and/or death group(38 cases)and mild BPD and/or non-BPD group(91 cases).Through bivariate analysis and multivariate logistic regression model adjustment,the correlation between risk factors and moderate-severe BPD and/or death was estimated with odds ratio(OR),adjusted odds ratio(a OR),and 95%confidence interval(CI).Results Among the 129 premature infants with a complete pathological diagnosis of the placenta,the overall incidence of HCA was 70.5%(91/129).The incidence of moderate-severe BPD and/or death was 29.5%(38/129).Bivariate analysis showed that HCA was not a risk factor for moderate to severe BPD and/or death[OR=1.5,95%CI=(0.6,3.7),P=0.334>0.05].Small for gestational age(SGA),twins,patent ductus arteriosus(PDA),respiratory distress syndrome(RDS)signs of chest X-ray,sepsis,and mechanical ventilation are risk factors for moderate-severe BPD and/or death(P<0.05).After correction for gestational age,gender,and antenatal steroid(AS),the effect of sepsis became insignificant.After correction for gender and AS,for every 1 week reduction in gestational age,the risk of moderate-severe BPD and/or death increased by 40%[aOR=1.4,95%CI=(1.1,1.8),P=0.004<0.05].Conclusion Small for birth gestational age,SGA,twins,RDS signs of chest X-ray,mechanical ventilation,and PDA are risk factors for BPD.There is no significant correlation between HCA and BPD.