呼吸窘迫综合征极低出生体重儿解脲脲原体感染与支气管肺发育不良的关系

Association of Ureaplasma urealyticum infection with bronchopulmonary dysplasia in very low birth weight infants with respiratory distress syndrome

摘要:

目的 探讨并发新生儿呼吸窘迫综合症（RDS）的极低出生体重儿下呼吸道分泌物解脲脲原体（UU）感染与支气管肺发育不良（BPD）的关系。方法 选取73例诊断为RDS、早期使用机械通气治疗且至少应用1剂肺表面活性物质的极低出生体重儿，采用荧光定量聚合酶链反应法检测气管内吸出物UU核酸，分为UU感染组（n=21）和非感染组（n=52），比较两组临床特点及BPD的发生率。结果 UU感染组阴道产百分率及反复院内肺部感染、胎膜早破发生率均高于非感染组；胎膜早破持续时间长于非UU感染组；且吸氧时间及住院时间均长于非UU感染组。UU感染组生后3 h内血浆免疫球蛋白IgM、白细胞计数、中性粒细胞绝对值显著高于非UU感染组。73例患儿中，发生BPD 45例，其中UU感染组BPD发生率（90%，19/21）显著高于非UU感染组（50%，26/52），差异有统计学意义（P<0.01）。结论 下呼吸道UU感染可增加RDS 极低出生体重儿BPD的发生率。

Abstract:

Objective To study the relationship between Ureaplasma urealyticum (UU) infection in the lower respiratory tract and the incidence of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS). Methods Seventy-three VLBW infants diagnosed with neonatal RDS, who had received at least one dose of pulmonary surfactant, as well as mechanical ventilation, and were hospitalized for over 28 days, were recruited. Endotracheal aspirates were obtained from the lower respiratory tract and examined by real-time PCR to detect UU DNA. The infants were divided into UU infection and non-UU infection groups according to examination results. Clinical characteristics and the incidence of BPD were compared between the two groups. Results Compared with the non-UU infection group, the UU infection group had a higher rate of maternal vaginal delivery, higher incidence of recurrent nosocomial pulmonary infection and premature rupture of membranes (PROM), and longer durations of PROM, oxygen supplementation, and hospital stay; in addition, the UU infection group had higher plasma IgM level, leukocyte count, and neutrophil count within 3 hours after birth. Among 73 VLBW infants, 45 developed BPD; the incidence of BPD in the UU infection group was 90% (19/21), versus 50% (26/52) in the non-UU infection group (P<0.01). Conclusions UU infection in the lower respiratory tract increases the incidence of BPD in VLBW infants with RDS.