Meta-analysis of the effect of pulmonary ureaplasma urealyticum infection on bronchopulmonary dysplasia

doi:10.11852/zgetbjzz2020-1298

Abstract

Abstract: Objective To analyze the effect of pulmonary ureaplasma urealyticum (UU) infection on bronchopulmonary dysplasia (BPD), so as to provide evidence for preventing BPD in preterm infants. Methods Eight databases including PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP and China Biomedical Database (CBM) were searched to collect the cohort study on the effect of pulmonary UU infection on BPD, and the source of samples were endotracheal. The retrieval time was from the establishment of the database to April 15th, 2020. Meta-analysis was carried out by using stata 15.1 software. Results A total of 21 cohort studies were included, 18 of which assessed outcomes at the 28th days after birth, 9 of which assessed outcomes at the 36th weeks of adjusted gestational age. Totally 3 039 subjects were included, 831 of whom were in UU infection group and 2 085 were in UU non-infection group. Random effect model indicated that UU infection did not increase the risk of BPD (assessment on the 28^th days after birth RR=1.69, 95%CI: 1.42 - 2.01; assessment on the adjusted gestational age of 36 weeks RR=1.20, 95%CI: 0.91 - 1.58). Conclusions Based on the existing research data, it can not be determined that UU infection is the influencing factor of BPD. A unified diagnostic standard of BPD and higher quality cohort studies are warranted to explore the relationship between UU infection and BPD.

Key words: ureaplasma urealyticum, bronchopulmonary dysplasia, neonatal chronic lung disease, Meta-analysis

摘要： 目的分析肺部解脲脲原体(UU)感染对支气管肺发育不良(BPD)的影响,为早产儿BPD的防治提供依据。方法检索Pubmed、Embase、Web of Science、Cochrane Library、中国知网、万方、维普及中国生物医学数据库(CBM)8个数据库,收集关于肺部UU感染对BPD影响的队列研究,检验标本为气管内分泌物,检索时间为自建库至2020年4月15日,采用Stata 15.1软件对纳入研究进行Meta分析。结果共纳入21项研究,均为队列研究,其中18篇文献以生后28 d为评估结局,9篇文献以校正胎龄36周为评估结局,共包含研究对象3 039例,其中UU感染组831例,非UU感染组2 085例。随机效应模型显示,UU感染不会增加BPD的发病风险(出生后28 d评估:RR=1.69, 95%CI:1.42~2.01, 矫正胎龄36周评估:RR=1.20, 95%CI:0.91~1.58)。结论基于现有研究数据,不能确定UU感染是BPD的影响因素,尚需统一的BPD诊断标准以及更高质量的队列研究来探索UU感染与BPD之间的关系。

关键词: 解脲脲原体, 支气管肺发育不良, 新生儿慢性肺疾病, Meta分析

CLC Number:

R722.6

LI He-jia, HAO Ling, MIAO Jia-li, HUANG Jia-yu, MENG Jin-feng, REN Chang-jun. Meta-analysis of the effect of pulmonary ureaplasma urealyticum infection on bronchopulmonary dysplasia[J]. Chinese Journal of Child Health Care, 2021, 29(12): 1333-1338.

李贺嘉, 郝玲, 苗佳丽, 黄嘉瑜, 孟金凤, 任常军. 肺部解脲脲原体感染对支气管肺发育不良影响的Meta分析[J]. 中国儿童保健杂志, 2021, 29(12): 1333-1338.

References

[1] 丁国芳. 支气管肺发育不良患儿出院后管理[J]. 中国实用儿科杂志, 2014,29(1):15-18.
[2] Silwedel C, Speer CP, Glaser K. Ureaplasma-associated prenatal, perinatal, and neonatal morbidities[J]. Expert Rev Clin Immunol, 2017,13(11):1073-1087.
[3] Horowitz S, Landau D, Shinwell ES, et al. Respiratory tract colonization with Ureaplasma urealyticum and bronchopulmonary dysplasia in neonates in southern Israel[J]. Pediatric Infect Dis J, 1992,11(10): 847-851.
[4] 陈正. 早产儿呼吸道解脲脲原体感染的临床特点分析[D]. 杭州:浙江大学, 2009.
[5] 鲍毓, 赵正言, 施丽萍, 等. 解脲脲原体感染在早产儿支气管肺发育不良中的临床意义[J]. 中华儿科杂志, 2012,50(10): 767-777.
[6] 李笑. 早产儿支气管肺发育不良与解脲支原体临床分析[D].昆明:昆明医科大学, 2012.
[7] Eun HS, Lee SM, Park MS,et al. Serological investigation of ureaplasma urealyticum in Korean preterm infants[J]. Korean J Pediatr, 2013, 56(11):477-481.
[8] 陈幽, 马丽亚, 黄艳, 等. 呼吸窘迫综合征极低出生体重儿解脲脲原体感染与支气管肺发育不良的关系[J]. 中国当代儿科杂志, 2014,16(5):469-472.
[9] 郑拉洁, 苏卫东, 黄育丹. 34周以下早产儿解脲脲原体感染临床特征分析[J]. 临床儿科杂志, 2016,34(1):1-6.
[10] 熊小玉. 解脲脲原体对早产儿支气管肺发育不良的发病影响[J]. 影像研究与医学应用, 2017,1(13):234-236.
[11] Mahallei M, Hosseini MB, Esmaili H, et al. Relationship between Ureaplasma urealyticum colonization and bronchopulmonary dysplasia in very low birth weight premature infants: a prospective cohort study[J]. Iranian Journal of Neonatology, 2019,10(4):12-18.
[12] Jonsson B, Karell AC, Ringertz S, et al. Neonatal Ureaplasma urealyticum colonization and chronic lung disease[J]. Acta Pdiatrica, 1994,83(9):927-930.
[13] Iles R, Lyon A, Ross P, et al. Infection with ureaplasma urealyticum and mycoplasma hominis and the development of chronic lung disease in preterm infants[J]. Acta Pediatrica, 1996,85(4):482-484.
[14] Lacour AG, Zamora S, Bertrand R, et al. Colonization by ureaplasma urealyticum and chronic lung disease in premature newborn infants under 32 weeks of gestation[J]. Arch Pediatr, 2001,8(1): 39-46.
[15] Ollikainen J, Korppi M, Heiskanen-Kosma T, et al. Chronic lung disease of the newborn is not associated with ureaplasma urealyticum[J]. Pediatric Pulmonology, 2001,32(4):303-304.
[16] Kafetzis DA, Skevaki CL,Skouteri V, et al. Maternal genital colonization with Ureaplasma urealyticum promotes preterm delivery: association of the respiratory colonization of premature infants with chronic lung disease and increased mortality[J]. Clin Infect Dis, 2004,39(8):1113-1122.
[17] Aaltonen R, Vahlberg T, Lehtonen L, et al. Ureaplasma urealyticum: no independent role in the pathogenesis of bronchopulmonary dysplasia [J]. Acta obstetricia et gynecologica Scandinavica, 2006,85(11):1354-1359.
[18] Perzigian RW, Adams JT, Weiner GM, et al. Ureaplasma urealyticum and chronic lung disease in very low birth weight infants during the exogenous surfactant era[J]. Pediatr Infect Dis J, 1998,17(7): 620-625.
[19] Heggie AD, Bar-Shain D, Boxerbaum B, et al. Identification and quantification of ureaplasmas colonizing the respiratory tract and assessment of their role in the development of chronic lung disease in preterm infants[J]. Pediatr Infect Dis J, 2001, 20(9):854-859.
[20] Castro-Alcaraz S, Greenberg EM, Bateman DA, et al. Patterns of colonization with ureaplasma urealyticum during neonatal intensive care unit hospitalizations of very low birth weight infants and the development of chronic lung disease[J]. Pediatrics, 2002,110(4):e45.
[21] Mhanna MJ, Delong LJ, Aziz HF. The value of Ureaplasma urealyticum tracheal culture and treatment in premature infants following an acute respiratory deterioration[J]. J Perinatol, 2003,23(7):541-544.
[22] Bowman ED, Dharmalingam A, Fan WQ, et al. Impact of erythromycin on respiratory colonization of ureaplasma urealyticum and the development of chronic lung disease in extremely low birth weight infants[J]. Pediatr Infect Dis J, 1998,17(7):615-620.
[23] Hannaford K, Todd DA, Jeftery H, et al. Role of ureaplasma urealyticum in lung disease of prematurity[J]. Archives of disease in childhood: fetal and neonatal edition, 1999,81(3):F162-F167.
[24] Viscardi RM. Ureaplasma species: Role in diseases of prematurity[J].Clin Perinatol, 2010,37(2):393.
[25] Waites KB, Katz B, Schelonka RL. Mycoplasmas and ureaplasmas as neonatal pathogens[J]. Clin Microbiology Rev, 2005,18(4):757-789.
[26] Cassell GH, Waites KB, Crouse DT, et al. Association of ureaplasma urealyticum infection of the lower respiratory tract with chronic lung disease and death in very-low-birth-weight infants[J]. Lancet, 1988,2(8605):240-245.
[27] Bancalari E, Claure N, Sosenko IRS. Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition[J]. Seminars in Neonatology, 2003,8(1):63-71.
[28] 刘敬. 早产儿支气管肺发育不良研究中存在的问题与思考[J]. 中国儿童保健杂志, 2019,27(10):1045-1046.
[29] Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia: executive summary of a workshop[J]. J Pediatr, 2018,197:300-308.
[30] 朱建幸. 支气管肺发育不良定义和诊断标准的演变、现状及思考[J]. 中国实用儿科杂志, 2020,35(2):93-97.
[31] 刘子云, 富建华. 大环内酯类抗生素防治早产儿支气管肺发育不良的研究进展[J]. 中国实用儿科杂志, 2019,34(8):710-713.
[32] Mandy GT, Brand MC, Arora S, et al. Optimum detection of ureaplasma in premature infants[J]. Pediatr Infect Dis J, 2018,37(12):1294-1298.
[33] Viscardi RM, Kallapur SG. Role of ureaplasma respiratory tract colonization in bronchopulmonary dysplasia pathogenesis[J]. Clin Perinatol, 2015,42(4):719-738.