组织学绒毛膜羊膜炎与早产儿脑损伤相关性分析

摘要

Objective To explore the correlation between histological chorioamnionitis (HC) and brain injury in preterm infants. Methods Three hundred and forty-seven cases of infants at the gestational age of 28-31 weeks who were admitted to the neonatology department of our hospital were analyzed retrospectively. They were divided into the HC group and the control group according to the pathological examination. Moreover, HC group was divided into FV group and non-FV group according to the pathological findings of fetal vasculitis (FV). Based on the findings of periodical ultrasonography, the incidences of periventricular leukomalacia (PVL), periventricular-intraventricular hemorrhage (PVH-IVH), and the PVL+PVH-IVH were compared among groups. Results The incidences of PVL in the HC group and the control group were 17.9% and 10.3%respectively. The incidences of PVL+PVH-IVH in the two groups were 5.5%and 1.48%respectively, and the difference between two groups was signiifcant (P<0.05). The incidences of PVH-IVH in the two groups were 28.9%and 26.2%respectively, and the difference between two groups was not signiifcant (P>0.05). In the HC group, the incidences of PVL in FV group and non-FV group were 28.1%and 9.87%respectively, and the difference between two groups was signiifcant (P<0.05). The incidences of PVH-IVH in FV group and non-FV group were 34.3%and 24.7%respectively, and the difference between two groups was not signiifcant (P>0.05). The incidences of PVL+PVH-IVH in FV group and non-FV group were 7.81%and 3.70%respectively, and the difference between the two groups was not have signiifcant (P>0.05). Conclusions HC may increase the ncidences of PVL and PVL+PVH-IVH in the preterm infants, while its effect is minimal on PVH-IVH. FV could increase the incidence of brain injury in preterm infants.%目的：探讨组织学绒毛膜羊膜炎(HC)及合并胎儿血管炎(FV)时与早产儿脑损伤的相关性。方法回顾性分析347例住院的出生胎龄28~32周早产儿的临床资料。根据病理检查结果将早产儿分为HC组和对照组，HC组再根据是否合并胎儿血管炎分FV组及无FV组。早产儿定期行头颅B超检查，比较早产儿脑室周围白质软化(PVL)、脑室周围-脑室内出血(PVH-IVH)和脑室周围白质软化并脑室周围-脑室内出血的发生情况。结果 HC组、对照组PVL发生率分别为17.9%、10.4%，PVL合并PVH-IVH发生率分别为5.5%、1.5%，差异均有统计学意义(P<0.05)；而PVH-IVH的发生率分别为29.0%、26.2%，差异无统计学意义(P>0.05)。在HC组中，FV组、无FV组的PVL发生率则分别28.1%、9.9%，差异有统计学意义(P<0.05)；PVH-IVH的发生率为34.3%、24.7%，PVL合并PVH-IVH发生率分别为7.8%、3.7%，差异均无统计学意义(P>0.05)。结论 HC可使早产儿PVL、PVL合并PVH-IVH的发生率增加，而对PVH-IVH的影响不大，合并FV会增加早产儿脑损伤发生率。