呼吸道解脲脲原体定植与早产儿支气管肺发育不良回顾性队列研究

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摘要目的：研究呼吸道解脲脲原体（UU）定植与早产儿支气管肺发育不良（BPD）发生的关系。方法：回顾性队列研究。以住院早产儿行呼吸道分泌物UU检测者为对象，UU阳性为定植组、UU阴性为非定植组，出院时为队列终点，观察UU定植与早产儿呼吸系统结局的关系；并基于UU-DNA拷贝数、初始治疗时机与BPD关系ROC曲线的最佳切点值将UU定植早产儿分为不同亚组，观察不同DNA拷贝数及初始治疗时间与呼吸系统结局的关系。结果：共纳入399例早产儿，UU定植组105例（26.3%），非定植组294例。定植组早产儿胎龄、出生体重均明显低于非定植组，胎膜早破和中重度BPD比例显著高于UU非定植组；校正协变量后，多因素Logistic回归分析发现，UU定植与BPD的发生风险差异无统计学意义，OR=0.72 (95%CI: 0.34~1.54)。但UU定植可能增加生后1周内需较高氧浓度（＞40%）呼吸支持的风险，OR=4.22 (95%CI:1.34~13.26)。高UU-DNA拷贝数（≥4.47×105·mL-1）及晚治疗（初始治疗开始时间≥8 d）早产儿的BPD发生率更高。结论：UU定植与BPD发生无显著关系，但高UU-DNA拷贝数及较晚开始药物治疗可能增加BPD的发生风险。

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Abstract：Objective：To study the relationship between respiratory tract Ureaplasma urealyticum (UU) colonization and bronchopulmonary dysplasia (BPD) in preterm infants. Methods：This is a retrospective cohort study. We enrolled hospitalized premature infants who received respiratory secretions test for UU. UU positives (colonization) and negatives were assigned to the exposure and non-exposure group, respectively. Discharge from NICU was taken as the end of the cohort. We observed the relationship between UU colonization in preterm infants and BPD. Preterm infants with UU colonization were divided into different subgroups according to the cut-off value of ROC curve between UU-DNA copies and the start time of antibiotic therapy. Results：A total of 399 preterm infants were included in the analyses with 105 cases (26.3%) of UU colonization and 294 cases of non-UU colonization. The gestational age and birth weight of infants with UU colonization were lower than those of infants in the control group. But the proportion of premature rupture of membranes and moderate or severe BPD were higher. After adjusting for several covariates, no significant relation was found in BPD between infants with UU colonization and infants without colonization. But UU-colonization might be related to higher oxygen demand (OR=4.22, 95%CI: 1.34-13.26). UU colonization with higher copies(≥4.47×105·mL-1), and treatment starting later than 8 days after birth were related to a higher incidence of BPD. Conclusion：Respiratory tract UU colonization is not significantly related to the risk of BPD in preterm infants. Late drug treatment and higher DNA copies may be risk factors for BPD.

收稿日期: 2020-06-28 出版日期: 2020-12-25

通讯作者: 曹云 E-mail: yuncao@fudan.edu.cn

引用本文:

吴永芳韩俊彦蒋思远曹云. 呼吸道解脲脲原体定植与早产儿支气管肺发育不良回顾性队列研究[J]. 中国循证儿科杂志, 2020, 15(6): 426-430. WU Yongfang, HAN Junyan, JIANG Siyuan, CAO Yun. Respiratory tract Ureaplasma urealyticum colonization and bronchopulmonary dysplasia in reterm infants: A retrospective cohort study. Chinese Journal of Evidence -Based Pediatric, 2020, 15(6): 426-430.

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