目的 探讨组织学绒毛膜羊膜炎(HCA)对早产儿并发症及1岁时神经发育的影响,为围产儿管理及早期干预提供依据。方法 选取2017年1月-2022年12月江油市人民医院出生的342例早产儿为研究对象,根据其是否暴露于HCA及其严重程度分为对照组214例、轻度HCA组38例、中度HCA组56例和重度HCA组34例,比较4组早产儿并发症和纠正胎龄1岁时神经发育状况,并分析不同程度HCA对早产儿神经发育的影响。结果 4组早产儿的胎龄、出生体重、剖宫产和胎膜早破发生率差异有统计学意义 (F=6.546、14.780、χ2=5.427、6.215,P＜0.05)。在并发症方面,4组早产儿的早发型败血症(EOS)和Ⅱ级以上脑室内出血(IVH)发生率差异有统计学意义(χ2=1.273、2.457,P<0.05)。4组早产儿纠正胎龄1岁时大运动和精细动作发育差异有统计学意义(F=14.89、10.23,P＜0.05);进一步组间两两比较,与对照组相比,重度HCA组适应性、大运动和精细动作发育均落后(P<0.05),中度HCA组大运动和精细动作落后(P＜0.05);与轻度HCA组相比,重度HCA组适应性和大运动落后(P＜0.05),中度HCA组大运动发育落后(P＜0.05);与中度HCA组相比,重度HCA组大运动发育落后(P＜0.05)。Logistic多元回归分析显示,与对照组相比,重度HCA组适应性(OR=1.559,95%CI:1.084~2.869)和大运动(OR=2.958,95%CI:1.824~4.662)发育落后的风险相对较高(P＜0.05),中度HCA组大运动发育落后风险增高(OR=1.428,95%CI:1.014~3.752,P＜0.05)。结论 HCA与早产儿EOS和Ⅱ级以上IVH的发生有关,且会增加早产儿1岁时神经发育异常的风险,尤其是中-重度HCA。
Abstract
Objective To investigate the impact of histological chorioamnioitis (HCA) on complications and neurodevelopment in premature infants at 1 year of age,in order to provide reference for perinatal management and early intervention. Methods A total of 342 premature infants born at Jiangyou People's Hospital from January 2017 to December 2022 were selected as study subjects.Then the participants were divided into a control group(n=214),a mild HCA group(n=38),a moderate HCA group(n=56),and a severe HCA group(n=34) based on their exposure to HCA and severity.The complications of premature infants and the neurological development status at corrected gestational age of 1 year were compared among the four groups,and the effects of different degrees of HCA on the neurological development of premature infants were analyzed. Results There were statistically significant differences in gestational age(F=6.546),birth weight(F=14.780),the rates of cesarean section(χ2=5.427) and premature rupture of membranes (χ2 =6.215)among the four groups of premature infants (P＜0.05).In terms of complications,there was significant difference in the incidence of early onset sepsis (EOS) and >grade Ⅱ intraventricular hemorrhage (IVH) among four groups of premature infants (χ2=1.273,2.457,P<0.05).There were significant differences in gross and fine motor development at 1 year of corrected gestational age among four groups of premature infants (P<0.05).Further pairwise comparison between groups showed that compared with the control group,the severe HCA group had delayed adaptability,gross and fine motor development (P<0.05),while the moderate HCA group had delayed gross and fine motor development (P<0.05);compared with the mild HCA group,the severe HCA group lagged behind in adaptability and gross motor development (P<0.05),moderate HCA group lagged behind in gross motor development (P<0.05);compared with moderate HCA group,severe HCA group had lower score of gross motor (P<0.05).Multivariate Logistic regression analysis showed that compared with the control group,the severe HCA group had a relatively higher risk in adaptability (OR=1.559,95%CI: 1.084 - 2.869) and gross motor development delay(OR=2.958,95%CI: 1.824 - 4.662),while the moderate HCA group had an increased risk of gross motor development delay(OR=1.428,95%CI: 1.014 - 3.752,P＜0.05). Conclusion HCA is associated with the occurrence of EOS and IVH above grade Ⅱ in premature infants,and may increase the risk of neurodevelopmental abnormalities in premature infants at 1 year old,especially moderate to severe HCA.
关键词
组织学绒毛膜羊膜炎 /
早产儿 /
并发症 /
神经发育
Key words
histological chorioamnioitis /
complications /
neurodevelopment /
preterm
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