支气管肺发育不良早产儿合并肺外并发症的高危因素分析

Analysis of high risk factors in premature infants with bronchopulmonary dysplasia complicated with extrapulmonary complications

目的研究支气管肺发育不良(BPD)早产儿合并肺外并发症的发生情况及高危因素,分析累计补充氧暴露(CSO)是否可作为预测指标。方法收集2020年1月至2022年12月在中国医科大学附属盛京医院第一新生儿内科病房住院治疗、出生胎龄<32周、出生体重<1500 g的早产儿临床资料、实验室检查结果、并发症及治疗情况。根据是否发生BPD及BPD严重程度将所有患儿分为非BPD组、轻度BPD组及中重度BPD组;根据有无并发症将BPD患儿分为脑白质损伤(WMI)/早产儿视网膜病(ROP)/代谢性骨病(MBDP)组及无WMI/ROP/MBDP组,总结3种并发症在BPD患儿中的发生情况及危险因素,通过单因素分析及Logistic回归分析提出预测指标。结果共纳入405例早产儿,包括非BPD组206例、轻度BPD组128例和中重度BPD组71例,BPD早产儿胎龄及出生体重较非BPD早产儿小,且中重度BPD早产儿与轻度BPD及非BPD早产儿相比,窒息、多剂(两剂及以上)肺表面活性物质使用、动脉导管未闭以及新生儿败血症的发生率增高,累计氧疗时间、有创机械通气时间也较轻度BPD及非BPD早产儿长,差异均有统计学意义(P<0.05)。199例BPD患儿中,WMI组68例,无WMI组131例;ROP组89例,无ROP组110例;MBDP组131例,无MBDP组68例。经单因素及多因素Logistic回归分析,1-28CSO(OR=2.042,95%CI 1.102~3.783,P=0.023)、累计氧疗时间(OR=1.044,95%CI 1.009~1.080,P=0.012)、男性(OR=2.711,95%CI 1.123~6.544,P=0.027)是BPD患儿合并ROP的危险因素。1-28CSO(OR=2.124,95%CI 1.193~3.784,P=0.011)、出生体重(OR=0.040,95%CI 0.005~0.352,P=0.004)、晚发型败血症(OR=2.165,95%CI 1.027~4.567,P=0.042)是BPD患儿合并MBDP的危险因素。受试者工作特征曲线分析显示,1-28CSO对BPD合并ROP及MBDP的曲线下面积分别为0.872(95%CI 0.824~0.921)、0.779(95%CI 0.711~0.846),灵敏度分别为70.8%、77.9%,特异度分别为88.2%、72.0%,临界值分别为2.900、2.125。结论累计氧疗时间增加及男性会升高BPD合并ROP的风险,低出生体重及晚发型败血症的发生会升高BPD合并MBDP的风险,而高1-28CSO是两者共同的危险因素,且1-28CSO在早期评估BPD合并ROP及MBDP方面具有较高的预测价值。

Objective To study the occurrence and high risk factors of extrapulmonary complications in premature infants with bronchopulmonary dysplasia(BPD),by calculating cumulative supplementary oxygen exposure(CSO)as a predictive value for reference.Methods The clinical data,laboratory results,incidence and treatment of complications of premature infants with gestational age<32 weeks and birth weight<1500g in the First Neonatal Internal Medicine Ward at Shengjing Hospital of China Medical University from January 2020 to December 2022 were collected.According to the occurrence of BPD and the severity of BPD,all children were divided into non-BPD group,mild BPD group and moderate to severe BPD group.According to the complications,children with BPD were divided into white matter injury(WMI)/retinopathy of prematurity(ROP)/metabolic osteopathy(MBDP)group and non-WMI/ROP/MBDP group.The occurrence and risk factors of these three complications in children with BPD were summarized.And the prediction index was put forward by single factor analysis and Logistic regression analysis.Results A total of 405 premature infants were included,including 206 cases in non-BPD group,128 cases in mild BPD group and 71 cases in moderate to severe BPD group.The gestational age and birth weight of BPD preterm infants were smaller than those of non-BPD preterm infants,and the incidences of asphyxia,multi-dose(two or more)pulmonary surfactant use,patent ductus arteriosus and septicemia in moderate to severe BPD group were higher than those in mild BPD group and non-BPD group.The cumulative oxygen therapy time and invasive mechanical ventilation time in moderate to severe BPD group were also longer than those in mild BPD group and non-BPD group.The differences were all statistically significant(P<0.05).Among 199 cases of BPD,there were 68 cases in WMI group and 131 cases in non-WMI group,89 cases in ROP group and 110 cases in non-ROP group,131 cases in MBDP group and 68 cases in non-MBDP group.In multivariate Logistic regression analysis,1-28CSO(OR=2.042,95%CI 1.102-3.783,P=0.023),cumulative oxygen therapy time(OR=1.044,95%CI 1.009-1.080,P=0.012)within 28 days after birth and male(OR=2.711,95%CI 1.123-6.544,P=0.027)were the risk factors of ROP in children with BPD.1-28CSO(OR=2.124,95%CI 1.193-3.784,P=0.011),birth weight(OR=0.040,95%CI 0.005-0.352,P=0.004)and late-onset sepsis(OR=2.165,95%CI 1.027-4.567,P=0.042)were the risk factors of MBDP in children with BPD.The receiver operating characteristic curve analysis showed that the areas under the curve of 1-28CSO for BPD combined with ROP and MBDP were 0.872(95%CI 0.824-0.921)and 0.779(95%CI 0.711-0.846),respectively,the sensitivities were 70.8%and 77.9%,the specificities were 88.2%and 72.0%,respectively,and the critical values was 2.900 and 2.125,respectively.Conclusion The increase of cumulative oxygen therapy time and male may increase the risk of BPD with ROP,low birth weight and the occurrence of late-onset sepsis may increase the risk of BPD with MBDP,and 1-28CSO is a common risk factor for both.1-28CSO has a high predictive value in early evaluation of BPD with ROP and MBDP.