目的 分析绒毛膜羊膜炎及脐带炎与早产儿生后常见疾病的相关性。方法 选取在本院产科分娩且住新生儿科<34周早产儿151例,根据胎盘病理结果分为绒毛膜羊膜炎(CA)(-)脐带炎(FV)(-)组33例,CA(+)FV(-)组61例,CA(+)FV(+)组57例,收集孕妇及患儿围生期相关资料,比较各组患儿生后常见疾病发生率及各感染指标差异。结果 3组比较,各疾病发生率随炎症进展逐渐增高,且肺炎、呼吸窘迫综合征(RDS)、颅内出血、坏死性小肠结肠炎(NEC)发生率差异有统计学意义(P<0.05)。母亲产前发热、白细胞数、C反应蛋白及新生儿降钙素原各组比较差异有统计学意义(P<0.05),且随感染指标增高,CA及FV发生率随之增高,而产前中性粒细胞百分比及患儿感染指标差异均无统计学意义(P>0.05)。结论 绒毛膜羊膜炎、脐带炎暴露时,可导致早产儿生后常见疾病发生率增加,且与肺炎、RDS、NEC发生密切相关。母亲产前C反应蛋白(CRP)及早产儿生后新生儿降钙素原(PCT)水平可作为预测绒毛膜羊膜炎发生的一项指标。
Abstract
Objective To investigate the relationship between chorioamnionitis or funisitis and diseases in preterm infants with gestational age less than 34 weeks. Method A total of 151 premature infants with gestational ages less than 34 weeks were enrolled.According to placental pathology,subjects were divided into CA(-)FV(-)group,CA(+)FV(-)group,and CA(+)FV(+)group.Incidence of diseases and the infection parameters among three groups were compared. Result The incidence of diseases increased with the progress of inflammation,and the incidence rates of pneumonia,respiratory distress syndreme (RDS),intracranial hemorrhage,and necrotizing enterocolitis (NEC) in three groups were significantly different (P<0.05).Prenatal fever,white blood cell count(WBC) of prenatal maternal infection,C reactive protein (CRP) and neonatal calcitonin peptide(PCT)were significantly different (P<0.05).With the increasing of the infection index,tissue type chorioamnionitis and funisitis increased gradually,while the difference of the prenatal N% and infection index of preterm infants was not significant (P>0.05). Conclusion Exposure to chorioamnionitis or funisitis will lead to higher incidence of organ damage in preterm infants of gestational age less than 34 weeks.Also,the incidence rates of pneumonia,RDS,intracranial hemorrhage,NEC are closely correlated with chorioamnionitis or funisitis.The levels of WBC,C reactive protein(CRP) and neonatal calcitonin peptide(PCT)could be an indicator to predict the occurrence of chorioamnionitis or funisitis in preterm infants.
关键词
绒毛膜羊膜炎 /
脐带炎 /
早产儿 /
疾病
Key words
chorioamnionitis /
funisitis /
premature /
diseases
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参考文献
[1] 李娟,王庆红,吴红敏,等.2005年中国城市产科新生儿出生状况调查[J].中国当代儿科杂志,2012,14(1):7-10.
[2] Yoon BH,Romero R,Park JS,et al.The relationship among inflammatory lesions of the umbilical cord (funisitis),umbilical cord plasma interleukin 6 concentration,amniotic fluid infection,and neonatal sepsis[J].Am J Obstet Gynecol,2000;183(5):1124.
[3] 朱燕,陈超.出生早产儿流行病学特征的前瞻性多中心调查[D].上海:复旦大学,2012.
[4] Kim CJ,Romero R,Chaemsaithong P,et al.Acute chorioamnionitis and funisitis:definition,pathologic feathures,and clinica significace[J].Am J Obstet Gynecol,2015,213(4Suppl):s29-s52.
[5] Redline RW,Faye-Petersen O,Heller D,et al.Amniotic infection syndrome:nosology and reproducibility of placental reaction patterns[J].Pediatr Dev Pathol,2003,6(5):435-48.
[6] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2010.
[7] 刘晓巍,范玲,张为远等.新生儿宫内感染 43 例的相关因素分析[J].中华临床医师杂志:电子版,2011,5(5):3027-3030.
[8] 单若冰.宫内感染与新生儿肺疾病[J].中国小儿急救医学,2016,23(5):304-311.
[9] 史学凯,农绍汉,高平明,等,胎盘组织炎症对早产儿脑室内出血发病风险的影响[J],中国新生儿科杂志,2010,25(3):139-142.
[10] Liu Z,Tang Z,Li J,et a1.Effects of placental inflammation on neonatal outcome in preterm infants[J].Pediatr Neonatol,2014,55(1):35-40.
[11] Sase M,Miwa I,Sumie M,et al.Ontogeny of gastric emptying patterns in the human fetus[J].J Matern Fetal Neonatal Med,2005,17(3):213-217.
[12] Perrone G,Anceschi MM,Capri O,et al.Maternal C-reactive protein at hospital admission is a simple predictor of funisitis in preterm premature rupture of embranes[J].Gyneeol Obstet Inves,2012,74(2):95-99.
[13] 王月英,申丽红,韩专叶,等.血清C反应蛋白、白介素-6在绒毛膜羊膜炎诊断中的价值分析[J].临床合理用药,2015,8(12A):167-168.
[14] 彭凤梅.Hs-CRP、CRP预测胎膜早破早产儿宫内感染的价值及菌群分布情况研究[J].中国妇幼保健,2015,30(24):4149-4152.
[15] 高芳,单若冰.C-反应蛋白检测在新生儿感染性疾病中的应用价值[J].吉林医学,2010,31(15):2188.
[16] 袁仕伟,张跃军,郑卫东,等.降钙素原、C-反应蛋白及IL-6、在早产胎膜早破新生儿败血症中的诊断价值[J].中国医药导报,2012,9(15):114-118.
基金
山东省卫生厅医药卫生科技发展项目(2013WS0017)
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