摘要
目的分析胎儿炎症反应综合征(FIRS)的影响因素分析及其早产儿脑损伤(BIPI)情况。方法选取2022年10月至2024年2月在赣州市妇幼保健院分娩的126例早产儿作为研究对象,所有产妇均接受产检且有孕期高危因素。收集早产儿临床资料,所有早产儿均于断脐后抽取脐血检测白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子α(TNF-α)水平,同时胎盘送病理检查。且所有早产儿在出生后定期行头颅彩超检查、振幅整合脑电图监测及头颅MRI检查。根据FIRS诊断标准、胎盘组织学绒毛膜羊膜炎(HCA)情况、BIPI诊断标准将研究对象分为FIRS组(包括HCA+FIRS-组、HCA+FIRS+组)、无FIRS组(HCA-FIRS-)。分析FIRS的影响因素、与脐血细胞因子水平的关系及BIPI的发生情况。结果HCA+FIRS+组IL-6、IL-1β、TNF-α水平均高于HCA+FIRS-组和无FIRS组,且HCA+FIRS-组IL-6、IL-1β、TNF-α水平高于无FIRS组,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,生殖道感染、绒毛膜羊膜炎、胎膜早破>18 h、羊水异常、出生窒息、IL-6、IL-1β、TNF-α均为早产儿发生FIRS的独立危险因素(P<0.05)。HCA+FIRS+组BIPI发生率均高于HCA+FIRS-组及无FIRS组,且HCA+FIRS-组BIPI发生率高于无FIRS组,差异有统计学意义(P<0.05)。结论FIRS的患儿的脐血炎症因子水平显著升高,且FIRS程度越重,脑损伤的发生率越高。对此,应加强产前保健、降低不良影响因素,对新生儿应早诊断、早治疗以改善预后,降低FIRS和BIPI的发生率。
Objective The analyzed factors influencing the occurrence of FIRS and their possible relationship with BIPI.Methods A total of 126 preterm infants delivered in Ganzhou Maternal and Child Health Hospital from October 2022 to February 2024 were selected as the study subjects.All the pregnant women received prenatal examination and had high risk factors during pregnancy.Clinical data of preterm infants were collected,and the levels of interleukin-6(IL-6),interleukin-1β(IL-1β)and tumor necrosis factorα(TNF-α)were detected in the umbilical blood of all preterm infants after umbilical rupture,and the placenta was examined by pathology.In addition,all premature infants underwent skull color ultrasound examination,amplitude integrated electroencephalogram monitoring and head MRI examination regularly after birth.According to the diagnostic criteria for fetal inflammatory response syndrome(FIRS)and preterm brain injury(BIPI),the study subjects were divided into FIRS group(including HCA+FIRS-group,HCA+FIRS+group),no FIRS group(HCA-FIRS-),brain injury group and no brain injury group.The influencing factors of FIRS,the relationship between FIRS and the level of cord blood cytokines and the occurrence of BIPI were analyzed.Results The levels of IL-6,IL-1β,and TNF-αin HCA+FIRS+group were higher than those in HCA+FIRS-and HCA-FIRS-groups,Moreover,the levels of IL-6,IL-1β,and TNF-αwere higher in the HCA+FIRS-group than those in the HCA-FIRS-group,the differences were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that reproductive tract infection,chorioamnitis,premature rupture of membranes>18 h,abnormal amniotic fluid,birth asphyxia,IL-6,IL-1βand TNF-αwere all independent risk factors for FIRS in preterm infants(P<0.05).The incidence of BIPI in HCA+FIRS+group was higher than that in HCA+FIRS-group and no FIRS group,and the incidence of BIPI in HCA+FIRS-group was higher than that in no FIRS group,the differences were statistically significant(P<0.05).Conclusion Children with FIRS had significantly higher levels of umbilical cord blood inflammatory factors,and the heavier the FIRS degree,the higher the incidence of brain injury.In this regard,antenatal care should be strengthened to reduce adverse factors,diagnosis and treatment should be done early to improve prognosis,and reduce the incidence of FIRS and BIPI.
作者
黄桂兰
王燕
廖欢
罗孝华
HUANG Guilan;WANG Yan;LIAO Huan;LUO Xiaohua(Department of Neonatology,Ganzhou Maternal and Child Health Hospital,Jiangxi Province,Ganzhou 341000,China)
出处
《中国当代医药》
CAS
2024年第32期61-65,共5页
China Modern Medicine
基金
江西省卫生健康委科技计划项目(202410825)。
关键词
胎儿炎症
胎儿炎症反应综合征
脑损伤
危险因素
脐血因子
Fetal inflammation
Fetal inflammatory response syndrome
Brain injury
Risk factors
Cord factor
作者简介
黄桂兰(1985-),女,汉族,江西赣州人,硕士,研究方向:新生儿科学。
