早产儿嗜酸性粒细胞增多症与支气管肺发育不良的相关性

A study on the correlation between eosinophilia of premature infants and bronchopulmonary dysplasia

目的探讨胎龄<34周早产儿嗜酸性粒细胞增多症的特点及其与支气管肺发育不良(bronchopulmonary dysplasia,BPD)的相关性。方法回顾性分析2018年1月至2020年3月首都儿科研究所附属儿童医院新生儿内科收治的胎龄<34周早产儿生后8周内的临床资料,按照嗜酸性粒细胞增多程度分组,比较各组临床资料的差异,采用Logistic回归模型分析嗜酸性粒细胞增多症与BPD的关系。比较BPD患儿与无BPD患儿在不同胎龄时嗜酸性粒细胞增多症构成比及不同程度BPD患儿生后8周内嗜酸性粒细胞计数(eosinophil count,EC)水平。通过受试者工作特征(receiver operating characteristic,ROC)曲线,分析生后4周内不同时间点EC对BPD的预测价值。结果共纳入234例早产儿,发生嗜酸性粒细胞增多症152例,发生率为65.0%,轻度、中度及重度嗜酸性粒细胞增多症分别占23.7%(36/152)、50.7%(77/152)、25.7%(39/152),生后第4周EC达高峰(1.47×109/L)。EC水平与胎龄、胎膜早破、败血症、BPD、红细胞输注、气管插管及生后类固醇使用等临床特征相关,不同程度嗜酸性粒细胞增多症患儿BPD发生率及严重程度差异有统计学意义(P<0.001)。调整胎龄、出生体重、新生儿呼吸窘迫综合征、败血症、有创呼吸机使用时间等因素后,嗜酸性粒细胞增多症是BPD发生的独立危险因素(OR=11.424, 95%CI2.474~52.742,P=0.002)。生后第3周EC预测BPD发生的敏感度最高(78.1%),ROC曲线下面积最大(AUC=0.731, 95%CI 0.663~0.799,P<0.001)。结论早产儿嗜酸性粒细胞增多症发生率高,EC在生后第4周达高峰,嗜酸性粒细胞增多症与BPD可能相关,生后第3周EC对预测BPD的发生有一定价值。

Objective To study the characteristics of eosinophilia in preterm infants with gestational age(GA)<34 weeks and its correlation with bronchopulmonary dysplasia(BPD).Method From January 2018 to March 2020,preterm infants with GA less than 34 weeks were admitted to our hospital and their clinical data within 8 weeks after birth were reviewed retrospectively.The infants were assigned into different groups according to the degree of eosinophilia.Logistic regression was used to analyze the relationship between eosinophilia and BPD.Eosinophilia in children with and without BPD at different GA were compared.The eosinophil counts(EC)in children with different degrees of BPD within 8 weeks after birth were studied.The predictive value of EC at different time points within 4 weeks after birth for BPD was analyzed using receiver operating characteristic(ROC)curve.Result A total of 234 cases of premature infants were included and 152 cases were diagnosed as eosinophilia,with an incidence of 65.0%.The mild,moderate and severe eosinophilia accounted for 23.7%(36/152),50.7%(77/152)and 25.7%(39/152),respectively and EC peaked(1.47×109/L)at the 4th week after birth.EC levels are related to clinical features including GA,premature rupture of membranes,sepsis,BPD,red blood cell infusion,tracheal intubation,and postnatal steroid use.Statistically significant differences existed in the incidence and severity of BPD among children with different degrees of eosinophilia(P<0.001).After adjusting for multiple factors such as GA,birth weight,RDS,sepsis,invasive ventilator duration and other factors,eosinophilia was an independent risk factor for BPD(OR=11.424,95%CI 2.474~52.742,P=0.002).The EC at the 3rd week after birth had the highest sensitivity to predict the occurrence of BPD(78.1%)and the area under the ROC curve was the largest(95%CI 0.663~0.799,P<0.001).Conclusion The incidence of eosinophilia in premature infants is high,reaching peak at the 4th week after birth.Eosinophilia may be associated with BPD and EC at the 3rd week after birth has clinical value in predicting the occurrence of BPD.