孕前及孕早期母体风险因素与早产儿坏死性小肠结肠炎的相关性研究

Relationship between maternal risk factors and occurrence of necrotizing enterocolitis in premature infants before and during the first trimester

背景坏死性小肠结肠炎(necrotizing enterocolitis,NEC)是一种常见的炎症性肠道疾病,若未及时治疗,可能会增加严重感染及死亡的风险.流行病学研究表明,消化道黏膜受损、早产、肠道细菌作用是本病发生的基本条件,同时受肠道屏障功能减弱、高渗奶方喂养、缺氧缺血性损伤、益生菌使用、胎膜早破等诸多危险因均与坏死性小肠结肠炎的发病有关.目的分析孕前及孕早期母体风险因素与早产儿NEC的相关性.方法回顾性研究,收集2017-09/2020-06我院54例早产儿NEC临床资料作为NEC组,另选同期106例非NEC早产儿作为非NEC组.分析早产儿NEC的临床症状,并经单因素、多因素logistic回归模型分析影响早产儿NEC发生的孕前及孕早期母体风险因素.结果54例NEC患儿临床症状以腹胀、肠鸣音减弱、便血为主,分别占比77.78%、74.07%、64.81%;经非条件多项Logistic回归分析证实,孕前吸烟史、孕早期呼吸道感染、肝内胆汁淤积、嗜中性粒细胞/淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)≥3及妊娠期糖尿病可能是诱发NEC的危险因素(OR>1,P<0.05),而孕早期服用维生素D可能是保护因素(OR<1,P<0.05).结论早产儿NEC的发生可能与孕前不良生活习惯及孕早期呼吸道感染、肝内胆汁淤积、NLR等有关,故孕前及孕早期需避免上述风险因素.

BACKGROUND Necrotizing enterocolitis(NEC)is a common inflammatory bowel disease.If not treated timely,NEC may increase the risk of serious infection and death.Epidemiological studies have shown that damage to the gastrointestinal mucosa,premature delivery,and intestinal bacterial action are the basic conditions for the occurrence of this disease.In addition,weakened intestinal barrier function,hypertonic milk formula feeding,hypoxic-ischemic injury,probiotic use,and premature rupture of membranes are also related to the onset of NEC.AIM To analyze the correlation between maternal risk factors and NEC in premature infants before and during the first trimester.METHODS The clinical data of 54 preterm infants with NEC treated at our hospital from September 2017 to June 2020 were collected as an NEC group,and 106 non-NEC preterm infants during the same period were selected as a non-NEC group.The clinical symptoms of NEC in preterm infants were analyzed,and the maternal risk factors affecting the occurrence of NEC in preterm infants were analyzed by univariate and multivariate logistic regression analyses.RESULTS The clinical symptoms of 54 children with NEC were mainly abdominal distension,weakened bowel sounds,and hematochezia,accounting for 77.78%,74.07%,and 64.81%of cases,respectively.The unconditional multiple logistic regression analysis confirmed that history of smoking before pregnancy,respiratory infection in early pregnancy,intrahepatic cholestasis,neutrophil/lymphocyte ratio(NLR)≥h3,and gestational diabetes may be risk factors for NEC(odds ratio[OR]>1,P<0.05),while taking vitamin D in the first trimester may be a protective factor(OR<1,P<0.05).CONCLUSION The occurrence of NEC in premature infants may be related to poor living habits before pregnancy,respiratory infections,intrahepatic cholestasis,NLR,etc;these risk factors should be avoided before and during pregnancy.