超低出生体重儿合并支气管肺发育不良的危险因素临床研究

Clinical study on risk factors for bronchopulmonary dysplasia in extremely low birth weight infants

摘要

目的 探讨超低出生体重儿(ELBWI)发生支气管肺发育不良(BPD)的危险因素,为临床早期识别与干预提供依据。方法 回顾性收集2019年1月至2024年12月于我院新生儿重症监护病房收治的101例ELBWI的临床资料,根据是否发生BPD分为BPD组(n=66)和非BPD组(n=35)。采用单因素分析比较两组患儿的一般资料、母亲围产期情况、治疗措施及并发症发生率的差异,将单因素分析中P<0.05的变量纳入多因素Logistic回归模型分析BPD的独立危险因素。结果 共纳入101例ELBWI,BPD发病率为65.3%(66/101)。多因素Logistic回归分析显示:男婴(OR=3.368,95%CI:1.073~10.576)、母亲患妊娠期高血压疾病(OR=6.282,95%CI:1.118~21.188)、机械通气时间长(OR=1.102,95%CI:1.041~1.166)为ELBWI发生BPD的独立危险因素(P<0.05),而较高的入院体温(OR=0.093,95%CI:0.019~0.462)及较高的平均动脉压(OR=0.894,95%CI:0.836~0.955)是ELBWI发生BPD的保护因素(P<0.05)。以上5个因素联合预测BPD的受试者工作特征(ROC)曲线下面积为0.907(95%CI:0.846~0.967,P<0.001)。结论 男婴、母亲患妊娠期高血压疾病及机械通气时间延长可增加超低出生体重儿发生支气管肺发育不良的风险,而较高的入院体温及较高的平均动脉压可降低其发生风险。加强体温和平均动脉压管理、缩短机械通气时间,可能有助于降低超低出生体重儿的支气管肺发育不良发生率。

Abstract

Objective To investigate independent risk factors for bronchopulmonary dysplasia (BPD) in extremely low birth weight infants (ELBWIs),so as to provide basis for early identification and intervention of BPD in clinic. Methods The clinical data (electronic records) of 101 ELBWIs who hospitalized in Neonatal Intensive Care Unit (NICU) of Liaocheng People's Hospital from January 2019 to December 2024 were selected and analyzed retrospectively.According to whether the infant had BPD,the infants were divided into BPD group (n=66) and non-BPD group (n=35).Univariate analysis was used to analyze and compare general information of the infants,maternal perinatal data,treatment regimen and incidence rate of complications of the infants between the two groups.Multivariate Logistic regression was used to analyze independent risk factors for BDP from those variables with P<0.05 in univariate analysis. Results Of 101 ELBWIs,66 infants had BPD,the incidence rate of BDP was 65.3%.Multivariate Logistic regression analysis shown that male gender of infant (OR=3.368,95%CI:1.073-10.576),mother suffering from hypertensive disorders of pregnancy (HDP) (OR=6.282,95%CI:1.118-21.188) and prolonged use of mechanical ventilation (OR=1.102,95%CI:1.041-1.166) were independent risk factors for BDP (all P<0.05),whereas high admission temperature (OR=0.093,95%CI:0.019-0.462) and elevated mean arterial pressure (MAP) (OR=0.894,95%CI:0.836-0.955) were protective factors for occurrence of BDP.The area under the curve (AUC) of receiver operating characteristic (ROC) curve of combination of the five indexes above was 0.907 (95%CI:0.846-0.967,P<0.001). Conclusion Male gender of the infant,mother suffering from HDP,and prolonged use of mechanical ventilation increase risk for BPD in ELBWIs,whereas high admission temperature and high MAP can decrease the risk.Strengthening temperature and MAP management,shortening use time of mechanical ventilation may reduce incidence of BPD in this high-risk ELBWIs.

关键词

超低出生体重儿 / 早产儿 / 支气管肺发育不良 / 危险因素

Key words

extremely low birth weight infant / premature infant / bronchopulmonary dysplasia / risk factor

参考文献

[1] Wang B, Sun J, Sun Y, et al. A clinical analysis of very and extremely low birth weight preterm infants[J]. Am J Transl Res, 2021, 13(8): 9395-9403.

[2] 苏志文, 梁少珍, 黄小霞, 等. 不同性别超低出生体重儿临床结局及其死亡危险因素分析[J]. 中华新生儿科杂志, 2022, 37(2): 138-142.

[3] 巴瑞华, 唐丽霞, 沈蔚, 等. 极早产儿支气管肺发育不良危险因素的全国多中心研究[J]. 中国小儿急救医学, 2022, 29(6): 433-439.

[4] 李炎, 温园香. 产妇与新生儿多维度因素对早产儿支气管肺发育不良风险及分级影响分析[J]. 中国妇幼健康研究, 2025, 36(8): 84-90.

[5] Gad A, Mesilhy R, Maveli T, et al. Outcomes of extremely preterm infants with bronchopulmonary dysplasia:a retrospective cohort study[J]. Sci Rep, 2025, 15(1): 26651.

[6] 中华医学会儿科学分会新生儿学组, 中华儿科杂志编辑委员会. 早产儿支气管肺发育不良临床管理专家共识[J]. 中华儿科杂志, 2020, 58(5): 358-365.

[7] Higgins R D, Jobe A H, Koso-Thomas M, et al. Bronchopulmonary dysplasia:executive summary of a workshop[J]. J Pediatr, 2018, 197: 300-308.

[8] 华克勤, 徐丛剑. 实用妇产科学[M].4版. 北京: 人民卫生出版社, 2018: 133-235.

[9] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M].5版. 北京: 人民卫生出版社, 2019: 510-860.

[10] 虞竹梅, 刘安诺, 肖娟, 等. 早产儿支气管肺发育不良危险因素的Meta分析[J]. 中国全科医学, 2023, 26(3): 356-366.

[11] 鲁元元, 方欣, 赵小林, 等. 新生儿支气管肺发育不良高危因素的研究进展[J]. 中国妇幼健康研究, 2020, 31(12): 1739-1743.

[12] 闫维恒, 姜苗苗, 郑军. 早产儿肺发育和支气管肺发育不良的性别差异研究进展[J]. 中华新生儿科杂志, 2020, 35(5): 389-392.

[13] Aldahmash W, Aljerian K, Alwasel S. Prevalence of fetal inflammatory response syndrome and villitis of unknown etiology in the placenta of Saudi women and their association with baby sex[J]. Life (Basel), 2024, 14(1): 79.

[14] Holzfurtner L, Shahzad T, Dong Y, et al. When inflammation meets lung development:an update on the pathogenesis of bronchopulmonary dysplasia[J]. Mol Cell Pediatr, 2022, 9(1): 7.

[15] 王媛媛, 王思璐, 张军, 等. 妊娠期高血压病对早产儿脐血血红蛋白、铁蛋白及其结局的影响[J]. 中华实用儿科临床杂志, 2022, 37(8): 615-620.

[16] Tang J R, Karumanchi S A, Seedorf G, et al. Excess soluble vascular endothelial growth factor receptor-1 in amniotic fluid impairs lung growth in rats:linking preeclampsia with bronchopulmonary dysplasia[J]. Am J Physiol Lung Cell Mol Physiol, 2012, 302(1): L36-L46.

[17] Goldsmith J P, Keels E. Recognition and management of cardiovascular insufficiency in the very low birth weight newborn[J]. Pediatrics, 2022, 149(3): e2021056051.

[18] Faust K, Härtel C, Preuß M, et al. Short-term outcome of very-low-birthweight infants with arterial hypotension in the first 24 h of life[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(5): F388-F392.

[19] Jia L, Liao M, Mou A, et al. Rheb-regulated mitochondrial pyruvate metabolism of Schwann cells linked to axon stability[J]. Dev Cell, 2021, 56(21): 2980-2994.

[20] Dunne E A, O'Donnell C P F, Nakstad B, et al. Thermoregulation for very preterm infants in the delivery room:a narrative review[J]. Pediatr Res, 2024, 95(6): 1448-1454.

[21] Mohamed S O O, Ahmed S M I, Khidir R J Y, et al. Outcomes of neonatal hypothermia among very low birth weight infants:a meta-analysis[J]. Matern Health Neonatol Perinatol, 2021, 7(1): 14.

[22] 杨春燕, 申青华, 李丛, 等. 通过质量提升项目改善NICU极低出生体重早产儿入院低体温的临床分析[J]. 中国儿童保健杂志, 2020, 28(11): 1263-1266.

基金资助

潍坊医学院附属医院科技发展项目(2023FYM110)

聊城市重点研发计划政策引导类项目(2022YDSF19)