不同妊娠期人巨细胞病毒感染与新生儿并发呼吸窘迫综合征的关系

Relationship between human cytomegalovirus infection during different gestational periods and neonatal respiratory distress syndrome

目的探究不同时间人巨细胞病毒(HCMV)感染与新生儿并发呼吸窘迫综合征(NRDS)的关系。方法选择2020年8月至2023年5月于华中科技大学协和深圳医院产科生产的单胎孕妇(1190例)为研究对象,纳入训练集;分析不同时间HCMV感染阳性率,根据感染(106例)时间不同,分为孕前期组(65例)、孕早期组(17例)和孕中晚期组(24例)。另选同期未发生HCMV感染的单胎孕妇60例为对照组以及HCMV阳性单胎孕妇60例纳入验证集。对比分析孕妇和患儿的临床资料。多因素Logistic回归分析危险因素,计算危险因素比值比(OR)。使用逐步回归方法筛选关联因素,用于构建列线图预测模型并评价。结果孕前期HCMV感染率显著低于孕早期及孕中晚期(均P<0.05)。孕早期HCMV感染、胎膜早破(PROM)、1 min和5 min Apgar评分<7分,均为NRDS发生的危险因素(P<0.05);产前使用糖皮质激素(GC)以及胎龄大,均为保护因素(P<0.05)。逐步回归分析筛选出产前使用GC、PROM、孕早期HCMV感染和5minApgar评分<7分与NRDS关联最大。列线图预测模型验证前后曲线下面积(AUC)分别为0.918和0.911,绘制校准曲线平均绝对误差均为0.015,可作为风险工具以预测NRDS发生概率。相关性分析结果显示,NRDS严重程度与不同时间HCMV感染无明显相关性(P>0.05)。结论孕早期HCMV感染与NRDS关联较大,是NRDS发生的危险因素。但NRDS严重程度与不同时间HCMV感染无明显相关性。

Objective Explore the relationship between human cytomegalovirus(HCMV)infection and neonatal respiratory distress syndrome(NRDS)at different times.Methods The single pregnant women(1190 cases)who gave birth in the obstetrics department of Huazhong University of Science and Technology Union Shenzhen Hospital from August 2020 to May 2023 were selected as the research object.Analyze the positive rates of HCMV infection at different times and divide them into the pre pregnancy group(65 cases),early pregnancy group(17 cases),and mid to late pregnancy group(24 cases)based on the different infection(106 cases)times.60 singleton pregnant women who did not experience HCMV infection during the same period were selected as the control group,and 60 singleton pregnant women who were HCMV positive were included in the validation set.Compare and analyze the clinical data of pregnant women and children.Multivariate Logistic regression analysis of risk factors and calculation of risk factor odds ratio(OR).Stepwise regression method was used to screen associated factors and construct nomogram prediction model for evaluation.Results The infection rate of HCMV in early pregnancy was significantly lower than that in early and late pregnancy(all P<0.05).Early pregnancy HCMV infection,premature rupture of membrane(PROM),and Apgar scores<7 at 1 and 5 min were all risk factors for the occurrence of NRDS(P<0.05).Prenatal use of glucocorticoid(GC)and gestational age were protective factors(P<0.05).Stepwise regression analysis showed that the use of GC before delivery,PROM,early pregnancy HCMV infection,and a 5 min Apgar score of<7 were most associated with NRDS.The area under curve(AUC)before and after the validation of the nomogram prediction model was 0.918and 0.911,respectively,and the average absolute error of the calibration curve plotted was 0.015,which can be used as a risk tool to predict the probability of NRDS occurrence.The correlation analysis results showed that there was no significant correlation between the severity of NRDS and HCMV infection at different times(P>0.05).Conclusion HCMV infection in early pregnancy is significantly associated with NRDS and is a risk factor for the occurrence of NRDS.However,there is no significant correlation between the severity of NRDS and HCMV infection at different times.