早产儿支气管肺发育不良与宫内感染的相关性

Correlation between bronchopulmonary dysplasia and intrauterine infection in preterm infants

目的探讨早产儿支气管肺发育不良(BPD)与宫内感染的相关性。方法回顾性分析2018年1月至2021年1月在徐州医科大学附属医院出生48小时内入住新生儿重症监护室(NICU)的200例早产儿资料,按是否存在宫内感染分为宫内感染组(n=38例)与非宫内感染组(n=162例),按是否发生BPD分为BPD组(n=77例)与非BPD组(n=123例),比较宫内感染组与非宫内感染组、BPD组与非BPD组的临床特点,通过单因素及多因素分析BPD与宫内感染的关系,并明确各变量间的共线性,通过结构方程模型明确宫内感染与早产儿BPD的因果关联性。结果宫内感染组患儿BPD的发生率显著高于非宫内感染组,且宫内感染组的中重度BPD的发生率显著高于非宫内感染组,差异均有统计学意义(χ^(2)值分别为14.755、16.663,P<0.001)。BPD组妊娠期高血压疾病的发生率显著高于非BPD组,差异有统计学意义(χ^(2)=5.681,P<0.05)。BPD组宫内感染率(32.47%)显著高于非BPD组(10.57%)(χ^(2)=14.755,P<0.001);中重度BPD宫内感染率(75.00%)显著高于轻度BPD(21.31%),差异有统计学意义(χ^(2)=16.663,P<0.001)。BPD组与非BPD组的常频机械通气(χ^(2)=30.491)、高频机械通气(χ^(2)=11.313)、持续气道正压通气(χ^(2)=4.519)、持续气道正压通气时间(t=3.941)、经鼻间歇正压通气(χ^(2)=11.823)、经鼻间歇正压通气时间(t=6.924)、有创通气(χ^(2)=48.198)、无创通气(χ^(2)=31.526)、无创通气时间(t=7.665)比较差异均有统计学意义(P<0.05)。BPD组与非BPD组患儿的出生后入量、尿量、能量摄入的时间效应(F;值分别为733.074、426.164、515.075)和交互效应(F;值分别为10.831、17.823、24.508)及组间效应(F;值分别为507.335、127.054、529.962)比较差异均有统计学意义(P<0.001)。经Logistic逐步回归分析显示,宫内感染与胎龄、有创通气、NRDS、红细胞悬液的使用、D3~D7能量摄入、D1的pH、D1~D3的PCO;、D1~D2的PaO;均是早产儿BPD的影响因素(r=-0.420~0.420,P<0.05),且方差膨胀系数(VIF)均<3,提示各变量不存在共线性。结构方程模型分析显示宫内感染与早产儿BPD相关,关联系数估计值为2.705,t=11.654,P<0.001。结论宫内感染与早产儿BPD相关,存在因果关联性。

Objective To investigate the correlation between bronchopulmonary dysplasia(BPD) and intrauterine infection in preterm infants.Methods The data of 200 preterm infants admitted to the neonatal intensive care unit within 48 hours after birth in the department of pediatrics of the affiliated hospital of Xuzhou Medical University from January 2018 to January 2021 were retrospectively analyzed.According to the presence of intrauterine infection, the patients were divided into the intrauterine infection group(n=38 cases) and non-intrauterine infection group(n=162 cases).In the intrauterine infection group, there were 25 cases of BPD and 13 cases of non-BPD.In the non-intrauterine infection group, there were 52 cases of BPD and 110 cases of non-BPD.According to the occurrence of BPD,the patients were divided into BPD group(n=77 cases) and non-BPD group(n=123 cases).The clinical characteristics of the intrauterine infection group, non-intrauterine infection group, BPD group and the non-BPD group were compared.Through univariate and multivariate analysis, the relationship between BPD and intrauterine infection was explored, the collinearity between the variables was confirmed, and the causal correlation between intrauterine infection and BPD in preterm infants was confirmed by structural equation model.Results The incidence of BPD in the intrauterine infection group was significantly higher than that in the non-intrauterine infection group, and the rate of moderate and severe BPD patients in intrauterine infection group was significantly higher than those in the non-intrauterine infection group, with statistically significant differences(χ^(2)=14.755 and 16.663,respectively, P<0.001).The incidence of gestational hypertension in the BPD group was significantly higher than that in the non-BPD group, with statistically significant difference(χ^(2)=5.681,P<0.05).The rate of intrauterine infection(32.47%) in the the BPD group was significantly higher than that in the non-BPD group(10.57%)(χ^(2)=14.755,P<0.001).The rate of intrauterine infection in the moderate and severe BPD group(75.00%) was also significantly higher than that in the mild BPD group(21.31%),with statistically significant difference(χ^(2)=16.663,P<0.001).There were statistically significant differences in normal frequency mechanical ventilation proportion(χ^(2)=30.491),high frequency mechanical ventilation proportion(χ^(2)=11.313),continuous positive pressure ventilation proportion(χ^(2)=4.519),the time of continuous positive pressure ventilation(t=3.941),trans-nasal intermittent positive pressure ventilation proportion(χ^(2)=11.823),the time of trans-nasal intermittent positive pressure ventilation(t=6.924),invasive ventilation proportion(χ^(2)=48.198),non-invasive ventilation proportion(χ^(2)=31.526),the time of non-invasive ventilation(t=7.665) between the BPD group and the non-BPD group(P<0.05).There were statistically significant differences in postnatal intake, urine volume and energy intake of time effect(F;=733.074,426.164 and 515.075,respectively),interaction effect(F;=10.831,17.823 and 24.508,respectively) and intergroup effect(F;=507.335,127.054 and 529.962,respectively) in the BPD group and the non-BPD group(P<0.001).Logistic stepwise regression analysis showed that intrauterine infection, gestational age, invasive ventilation, NRDS,use of erythrocyte suspension, D3~D7 energy intake, D1 pH,D1~D3 PCO;,and D1~D2 PaO;were all influential factors of BPD in preterm infants(r=-0.420-0.420,P<0.05),and variance inflation factor were all less than 3,which referred there was no collinearity among each variable.Structural equation model analysis showed that intrauterine infection was associated with BPD in preterm infants, and the estimated correlation coefficient was 2.705(t=11.654,P<0.001).Conclusion Intrauterine infection is correlated with BPD in preterm infants, and there is a causal correlation.