绒毛膜炎与早产儿神经发育结局的关系
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福建医科大学 附属漳州市医院新生儿科,漳州363000

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收稿日期: 2019-10-29
基金项目: 福建省卫生厅青年科研课题(2012-2-113)作者简介: 许丽萍,女,副主任医师,医学硕士. Email: zzsyxlp@163.com


The Relationship between Chorioamnionitis, and Neurodevelopmental Outcome in Preterm Infants
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Department of Paediatrics, Zhangzhou Municipal Hospital Affiliated to Fujian Medical University, Zhangzhou 363000, China

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    目的探讨绒毛膜炎与早产儿神经发育结局的关系。方法收集早产儿(28~34周)201例,通过头颅MR检查判定是否存在脑损伤,采用队列研究估计性别、胎龄、出生体质量、1 min及5 min的Apgar评分、新生儿呼吸窘迫综合征(RDS)、组织学绒毛膜羊膜炎(HCA)对脑损伤的效应。出院后随访至纠正胎龄2周岁,行Gesell评分以评定其神经行为发育水平。结果201例中,完成完全随访194例,孕周<32周、出生体质量< 1 500 g、RDS、1 min及 5 min的Apgar评分≤7分、HCA对早产儿脑损伤的优势比(OR)值分别为3.07( 1.72~5.49), 2.93(1.59~5.40),6.20(3.14~12.25),2.97(1.54~5.72),11.4(2.53~51.35),3.38( 1.79~6.02)(P<0.05),性别对早产儿脑损伤的OR值为1.26(0.72~2.21)(P>0.05)。孕周每减少2周,脑损伤的风险增加1.21倍[ 2.21(1.51~3.22)]; HCA每增加1度,脑损伤的风险增加0.92倍[1.29(1.34~2.75)]。脑损伤增加了早产儿纠正胎龄至2周岁期间神经发育障碍的风险[5.69(1.80~18.02)]。结论小孕周、低出生体质量、RDS、1 min及5 min的 Apgar评分≤7分、HCA是早产儿脑损伤的危险因素; 脑损伤对预测早产儿纠正胎龄至2周岁期间的神经发育障碍有一定的价值。

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    ObjectiveTo discover the relationship between chorioamnionitis, and neurodevelopmental outcome in preterm infants.MethodsPremature newborns(≤34 weeks)were selected in our hospital during from March 2014 to March 2016.All the infants were checked by magnetic resonance imaging(MRI)to determine whether there is brain injury.The gender, gestational age, birth weight, Apgar score of 1 and 5 minute, RDS, and chorioamnionitis were analyzed through team study to find the risk factors of premature brain injury.All the premature babies were followed up covering the time from discharge to 2 years old of corrected gestational age and received Gesell accessment.Result194 individuals completed the follow-up.OR value of brain injury for less than 32 weeks, less than 1 500 g, present of RDS, less than 7 score at 1 or 5 minute and present of chorioamnionitis are 3.07(1.72-5.49), 2.93(1.59-5.40),6.20(3.14-12.25),2.97(1.54-5.72),11.4(2.53-51.35), 3.38(1.79-6.02)respectively, P<0.05.OR value of brain injury for gender is 1.26(0.72-2.21), P>0.05.The incidence of brain injure increased 1.21 times while the gestational age decreased 2 weeks.The incidence of brain injure increased 0.92 times while the chorioamnionitis increased one degree.Brain injure increase the neurodevelopmental disorders at 2 years old of corrected gestational age.ConclusionsSmall gestational age, light birth weight, RDS, lower Apgar scores at 1 or 5 minute and chorioamnionitis are related to increasing incidence of brain injury.Brain injury has certain predictive value for developmental disorders of premature infants.

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许丽萍, 陈雯雯, 许淳, 林丽聪, 方小红.绒毛膜炎与早产儿神经发育结局的关系[J].福建医科大学学报自然版,2020,(4):260-263

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