目的 探讨解脲脲原体(UU)感染与支气管肺发育不良(BPD)发生的相关性,对比分析UU感染相关的BPD的临床特点及其预后.方法 2004年1月至2011年6月,在浙江大学医学院附属儿童医院新生儿监护病房住院的561例出生时胎龄≤32周、于生后48 h内入住且最终存活的早产儿,入院时即取咽部或气道分泌物,行UU-DNA测定的结果为阳性、排除其他病原菌感染且出生早期的胸部X线检查结果提示肺部有炎症性改变者(UU感染组)共168例,UU-DNA测定的结果为阴性者(非UU感染组)393例；回顾性对比两组患儿的基本临床特点,探讨UU感染与BPD发生的相关性,对比分析UU感染相关与非UU感染相关的BPD的临床特点及其预后.结果 两组患儿的基本临床特点进行比较,UU感染组中母亲羊膜早破率＞24 h的发生率和自然分娩率显著高于非UU感染组(65.5％vs 37.7％,83.9％ vs 55.7％),而新生儿呼吸窘迫综合征的发生率和肺表面活性物质的应用率显著低于非UU感染组(23.8％ vs 62.6％,17.3％ vs 46.8％),差异有统计学意义(P=0.000,0.000,0.000,0.000)；其他基本临床特点,如出生体重、孕周等均无显著差别.两组患儿所致的BPD的发生率(42.9％vs 29.5％)进行比较,差异有统计学意义(x2=9.400,P=0.002).两组患儿中的中、重度BPD的发生率(38.9％ vs 25％,19.4％ vs 8.6％)进行比较,均有显著差异(P=0.044,0.031),表明UU感染者所致的BPD较无UU感染者严重.对两组患儿进行随访至生后1年,其中UU感染组2例失访,非UU感染组6例失访.将两组中的中、重度BPD患儿于生后1年内发生反复肺部感染、喘息发作的比率、因发生肺部感染和(或)喘息发作再次入院的比率、因发生肺部感染和(或)喘息发作再入院≥2次的比率及因肺部感染的死亡率相比较(52.5％ vs 39.4％,42.5％ vs 33.3％,70.0％ vs 54.5％,37.5％ vs 21.2％,7.5％ vs 6.1％),差异均无统计学意义(P=0.264,0.422,0.173,0.131,0.823).结论 UU感染者BPD的发生率较无UU感染者高,UU感染相关的BPD严重程度较非UU感染者高,UU感染相关的BPD与非UU感染相关的BPD预后相仿.%Objective To investigate the association of Ureaplasma urealyticum (UU) infection with the incidence of bronchopulmonary dysplasia (BPD),to compare the clinical manifestations and prognosis of BPD infants with or without Ureaplasma urealyticum infection.Method Data were retrospectively collected between January 2004 and June 2011.All infants whose gestational age was ≤32 w and survived at 36 w were included in this study.Endotracheal aspirates were collected for UU polymerase chain reaction (PCR) within the first 48 hr of life.Statistical analyses were performed by using SPSS 11.5 software.The clinical characteristics of infants in the two groups were compared.The association of UU infection and BPD was analyzed and the clinical manifestations and prognosis of BPD in the two groups were compared.Result The results of PCR for UU were positive while that for other pathogens were negative in 168 infants whose chest X rays confirmed pulmonary inflammatory changes (UU group).The results of PCR for UU were negative in 393 infants (non-UU group).Except for premature rupture of membranes ＞ 24 hr,the rates of vaginal delivery,neonatal respiratory distress syndrome (NRDS) and surfactant use,there was no significant difference in the demographics and other baseline clinical characteristics of the two groups.The incidence of BPD was higher in UU group than in non-UU group and there was statistically significant difference in severity of BPD (P =0.044,0.031).The infants had been followed up until they were 1 year old.Compared to infants in non-UU group,infants in UU group showed no significant differences in the rate of death of pulmonary infection in moderate and severe BPD infants,the same as the rates of BPD infants hospitalized again or hospitalized more than 2 times because of pulmonary infection or/and wheezing episode in the first year after birth.Conclusion Preterm infants infected with UU were more likely to have BPD than non-UU infants.BPD infants associated with UU infection were more severe than that in non-UU infants.Prognosis of BPD infants associated with UU infection was similar to that of the infants whose BPD was not associated with UU infection.
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