极低出生体重儿中性粒细胞减少症的危险因素

摘要

目的：研究极低出生体重儿中性粒细胞减少症的危险因素。方法回顾性纳入2011年1月至2013年12月在北京协和医院新生儿重症监护室住院治疗的极低出生体重儿。根据生后第一周内有无中性粒细胞减少症，分为早发中性粒细胞减少症和无早发中性粒细胞减少症病例；同时根据第一周后有无中性粒细胞减少症，分为晚发中性粒细胞减少症和无晚发中性粒细胞减少症病例。分别对其临床情况进行比较，对中性粒细胞减少症的危险因素进行分析。结果共108例患儿纳入本研究，平均胎龄（30.1±2.2）周，平均出生体重（1188±216） g。其中32例发生早发中性粒细胞减少症，53例发生晚发中性粒细胞减少症。早发中性粒细胞减少症患儿孕母妊娠期患高血压疾病发生率高于未发生早发中性粒细胞减少症患儿（59.4％比31.6％， P＝0.007）。晚发中性粒细胞减少症患儿胎龄小于未发生晚发中性粒细胞减少症患儿[（29.5±2.3）周比（30.6±2.0）周， P＝0.009]；出生体重低于未发生晚发中性粒细胞减少症患儿[（1123±212） g比（1251±201） g， P＝0.002]；早发感染、晚发感染的发生率均高于未发生晚发中性粒细胞减少症患儿（50.9％比30.9％， P＝0.034；100％比43.6％， P＜0.001）。早发感染患儿中血小板减少症发生率高于中性粒细胞减少症发生率（45.5％比25.0％， P＝0.045）。结论早发中性粒细胞减少症与晚发中性粒细胞减少症的危险因素不同。孕母妊娠期高血压疾病可能是早发中性粒细胞减少症的危险因素；小胎龄、低出生体重、早发感染和晚发感染可能是晚发中性粒细胞减少症的危险因素。%Objective To investigate the risk factors for neutropenia in extremely low birth weight ( EL-BW) infants.Methods We retrospectively studied the clinical data of ELBW infants treated in Neonatal In-tensive Care Unit of Peking Union Medical College Hospital between January 2011 and December 2013.They were divided into two groups according to the presence or absence of neutropenia within the first postnatal week ( early-onset or non-early-onset neutropenia ) , also divided into two groups according to the presence or absence of neutropenia after a week ( late-onset or non-late-onset neutropenia ) .The clinical characteristics were com-pared between groups to identify possible risk factors for neutropenia .Results One hundred and eight infants were included.Their mean gestational age was (30.1 ±2.2) weeks, and mean birth weight was (1188 ± 216) g.Among them, 32 had early-onset neutropenia, and 53 had late-onset neutropenia.The incidence of gestational hypertension was significantly higher in mothers of the infants with early-onset neutropenia than in those of the infants with non-early-onset neutropenia ( 59.4% vs.31.6%, P=0.007 ) .Compared with in-fants with non-late-onset neutropenia , the gestational age was smaller and birth weight was lower in infants with late-onset neutropenia [(29.5 ±2.3) weeks vs.(30.6 ±2.0) weeks, P=0.009; (1123 ±212) g vs. (1251 ±201) g, P=0.002], while the incidences of early-onset infection and late-onset infection were high-er in infants with late-onset neutropenia (50.9%vs.30.9%, P=0.034;100%vs.43.6%, P<0.001). Among the infants with early-onset infection , the incidence of thrombocytopenia was higher than that of neutro-penia (45.5%vs.25.0%, P=0.045).Conclusions The risk factors for early-onset neutropenia and late-onset neutropenia are different , of which the former may include gestational hypertension , while the latter may include small gestational age, low birth weight, early-onset infection, and late-onset infection.