胎盘组织学绒毛膜羊膜炎对早产儿临床结局的影响

Effect of placental histological chorioamnionitis on clinical outcome of preterm infants

目的 研究胎盘组织学绒毛膜羊膜炎(histological chorioamnionitis,HCA)的孕期危险因素及HCA对早产儿出生结局的影响。方法 选取2019年1月至2022年1月大连市妇女儿童医疗中心NICU收治的早产儿为对象进行回顾性研究,根据胎盘病理结果,将其分为HCA早期组(n=234)、HCA中晚期组(n=120)及对照组(无HCA)(n=66),收集产母一般信息(产母年龄、初产、受孕方式、分娩方式、羊水情况、妊娠期糖尿病、妊娠期高血压、胎膜早破、产前激素、产前感染以及产前抗生素暴露情况),早产儿一般信息(出生胎龄、体重、头围、Apgar评分)以及早产儿出生合并症情况,包括新生儿低血糖症、新生儿呼吸窘迫综合征(newborn respiratory distress syndrome, NRDS)、颅内出血、贫血、早发性败血症、新生儿坏死性小肠结肠炎(necrotizing enterocolitis of newborn,NEC),记录入院首次白细胞计数及住院天数等。对孕母一般资料及早产儿临床结局进行比较,同时对引起孕母HCA加重的危险因素进行分析。结果 HCA中晚期组及HCA早期组剖宫产率(67.6%, 68.8%)均低于对照组(92.42%), HCA中晚期组及HCA早期组产前感染(14.17%, 7.69%)、胎膜早破(47.50%, 43.95%)及产前抗生素暴露(41.67%, 41.03%)明显高于对照组(0, 15.15%, 18.18%),差异均有统计学意义(P<0.05)。HCA中晚期组早产儿出生胎龄32.25(31.81,32.68)周、体重1 918(1 826,2 009)g、头围(30.02±2.62)cm、5分钟Apgar评分(8.99±0.91)分均低于HCA早期组(9.24±0.90)分及对照组(9.32±1.07)分;HCA中晚期组早产儿住院天数为(28.63±20.85)d,明显高于HCA早期组(20.90±17.32)d及对照组(16.77±9.84)d,差异有统计学意义(P<0.05)。HCA中晚期组早发性败血症及贫血发生率(62.5%,53.3%)明显高于HCA早期组(42.3%,33.3%)及对照组(43.9%,27.3%),差异有统计学意义(P<0.05)。其余指标各组间差异无统计学意义(P>0.05)。多因素二元logistic回归分析显示产前感染、胎膜早破、产前抗生素使用是引起孕母HCA加重的独立危险因素(P<0.05)。结论 产前感染、胎膜早破、产前抗生素暴露是引起孕母HCA加重的危险因素,HCA可增加早产儿临床不良结局风险。

Objective To study the risk factors of placental histological chorioamnionitis(HCA) during pregnancy and the effect of HCA on preterm infants outcomes. Methods Preterm infants admitted to the NICU of Dalian Women’s and Children’s Medical Center from January 2019 to January 2022 were selected for a retrospective study and were divided into early HCA group(n=234), mid-late HCA group(n=120) and control group(no HCA, n=66) according to the placental pathological findings. The general maternal information(including maternal age, primigravida, mode of conception, mode of delivery,amniotic fluid, gestational diabetes, gestational hypertension, premature rupture of membranes, antenatal corticosteroids,prenatal infections, and prenatal antibiotic exposure), general information on the preterm infants(gestational age at birth, head circumference, birth weight, Apgar score), and birth outcomes of the preterm infants(neonatal hypoglycemia, newborn respiratory distress syndrome, intracranial hemorrhage, anemia, early onset sepsis, necrotizing enterocolitis of newborn, first admission WBC result and length of hospitalization) were collected. The general maternal data and clinical outcomes of preterm infants were compared, and the risk factors for exacerbation of HCA in pregnant mothers were analyzed. Results The cesarean delivery rates in both the mid-late HCA group and early group(67.6% and 68.8%) were lower compared with the control group(92.42%), the prenatal infection(14.17% and 7.69%), the proportion of prenatal membrane rupture(47.50% and 43.95%) and prenatal antibiotic exposure(41.67% and 41.03%) in the mid-late HCA group and the early HCA group were significantly higher than those in the control group(0, 15.15%, and 28.79%)(P< 0.05). Regarding the preterm outcome, the gestational age32.25(31.81, 32.68) weeks, birth weight 1 918(1 826, 2 009) g, head circumference(30.02±2.62) cm, and 5-minute Apgar score(8.99±0.91) in the mid-late HCA group were lower than those in the early HCA group and the control group, and the length of hospitalization of preterm infants in the mid-late HCA group(28.63±20.85) days was significantly longer than those in the early HCA group(20.90±17.32) days and the control group(16.77±9.84) days(P<0.05). The incidence of early onset sepsis and anemia in the mid-late HCA group(62.5%, 53.3%) was significantly higher than those in the early HCA group(42.3%, 33.3%)and the control group(43.9%, 27.3%)(P< 0.05), while there were no differences in the rest of the information. Logistic regression analysis revealed that premature rupture of membranes, prenatal infection and prenatal antibiotic exposure were independent risk factors for exacerbation of HCA in pregnant mothers(P<0.05). Conclusion Prenatal infection, premature rupture of membranes and prenatal antibiotic exposure are risk factors for exacerbation of HCA in pregnant mothers, and HCA may increase the risk of adverse clinical outcomes in preterm infants.