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发育医学电子杂志  2025, Vol. 13 Issue (2): 114-119    DOI: 10.3969/j.issn.2095-5340.2025.02.006
  围产医学   论著 |新生儿 |
支气管肺发育不良患儿发生肺动脉高压的影响因素分析
牛慧霞 司丽英 常志霞 邵毅 赵晓英 郭志梅
(河北省中医院 儿科,河北 石家庄 050001)
Influencing factors of pulmonary hypertension in infants with bronchopulmonary dysplasia
Niu Huixia, Si Liying, Chang Zhixia, et al
(Department of Pediatrics, Hebei Hospital of Traditional Chinese Medicine, Heibei, Shijiazhuang 050001, China)
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摘要 【摘要】 目的  探讨支气管肺发育不良(bronchopulmonary dysplasia,BPD)患儿发生肺动脉高压
(pulmonary hypertension,PH)的相关影响因素。 方法 采用回顾性研究方法,选取2021 年2 月至2024 年1 月于河北省中医院住院的62 例BPD 患儿为研究对象,其中BPD 未合并PH 组24 例,BPD 合并PH 组38 例。比较两组的一般资料、孕母资料和临床特征,分析肺泡- 动脉血氧分压差(alveolar artery
oxygen partial pressure gradient,PA-aO2)、氧合指数(oxygenation index,OI)、B 型利钠肽(B-type natriureticpeptide,BNP)、D- 二聚体(D-Dimer,DD)、主肺动脉/降主动脉内径(main pulmonary artery/descending aorta diameter,rPDA)、右心房内径(right atrial diameter,RA)、右心室内径(right ventricular diameter,RV)、左心房内径(left atrial diameter,LA)、左心室内径(left ventricular diameter,LV)等指标对BPD 患儿是否合并PH 的预测能力。统计学方法采用独立样本t 检验、Mann-Whitney U 检验、χ2 检验、多因素 Logistic 回归分析和受试者操作特征曲线分析。 结果  BPD 合并PH 组胎龄低于BPD 未合并PH 组[(27.89±1.13)周与(29.49±1.81)周,t=-3.760,P<0.001)]、孕母妊娠期高血压疾病比例低于BPD 未合并 PH组[34.21%( 13/38)与62.50%( 15/24),χ2=4.354,P=0.042)]、机械通气时间长于BPD未合并PH组[276(123,462) h 与69(12,175) h,Z=-3.573,P<0.001]。BPD 合并PH 组PA-aO2、BNP、DD、rPDA、LV、RA 均高于BPD 未合并PH 组,OI 低于BPD 未合并PH 组。多因素Logistic 回归分析表明,PA-aO2(OR=0.988,95% CI :0.979~0.997)、rPDA(OR=0.000,95% CI :0.000~0.577)、RA(OR=0.366,95% CI :0.167~0.803)能够预测患儿BPD 合并PH 的发生(P 值均<0.05)。rPDA ≥ 1.105、P(A-a)O2 >225.000 mmHg、RA ≥ 20.550 mm 时,可以预测BPD 患儿发生PH,曲线下面积分别为0.760、0.747、0.747。 结论 PA-aO2、rPDA、RA 对预测BPD 患儿合并PH 有意义,临床中需要密切关注BPD 患儿这些指标,并及早进行干预治疗以减少或减轻BPD 患儿并发症的发生,改善预后。
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关键词:  肺泡动脉血氧分压差  主肺动脉/降主动脉内径  右心房内径  肺动脉高压  预测    
Abstract: 【Abstract】 Objective To explore the related influencing factors of pulmonary hypertension (PH) in
infants with bronchopuldysplasia (BPD). Method A retrospective study was conducted to select 62
infants with BPD who were admitted to Hebei Hospital of Traditional Chinese Medicine from February 2021
to January 2024 as the study objects, of whom 24 infants were in the BPD group without PH and 38 infants were in the BPD group with PH. The general data, maternal data and clinical characteristics of the two groups were compared. Alveolar-artery oxygen partial pressure gradient (PA-aO2), oxygenation index (OI), B-type natriuretic peptide (BNP), D-Dimer (DD), main pulmonary artery/descending aorta diameter (rPDA), right atrial diameter (RA), right ventricular diameter (RV), left atrial diameter (LA), left ventricular diameter (LV) and other indicators to predict whether infants with BPD combined PH were analyzed. Statistical methods performed by t-test, Mann-Whitney U test, χ2 test, multiple Logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Result The gestational age of the BPD group with PH was lower than that of the BPD group without PH [(27.89±1.13) weeks and (29.49±1.81) weeks, t=-3.760, P<0.001)], and the proportion of hypertensive diseases during pregnancy was lower than that of the BPD group without PH [34.21% (13/38) vs 62.50% (15/24), χ2=4.354, P=0.042], mechanical ventilation time was longer than that in BPD group without PH [276 (123, 462) h vs 69 (12, 175) h, Z=-3.573, P<0.001]. PA-aO2 O2, BNP, DD, rPDA, LV and RA in BPD group with PH were higher than those in BPD group without PH, and OI values were lower than those in PH group without BPD. Multivariate Logistic regression analysis showed that PAaO2 (OR=0.988, 95% CI: 0.979-0.997), rPDA (OR=0.000, 95% CI: 0.000-0.577), RA (OR=0.366, 95% CI:0.167-0.803) could predict the occurrence of PH in children with BPD (all P<0.05). When rPDA≥1.105, PAaO2 >225.000 mmHg, RA≥20.550 mm, the PH of BPD children could be predicted, and the area under theROC curve was 0.760, 0.747, 0.747, respectively. Conclusion PA-aO2, rPDA, and RA are significant in predicting PH in infants with BPD. Clinically, it is essential to closely monitor these indicators in BPD infants and to intervene early to reduce or mitigate the occurrence of complications, thereby improving the prognosis
Key words:  Alveolar-artery oxygen partial pressure gradient    Main pulmonary artery/descending aortadiameter    Right atrial diameter    Pulmonary hypertension    Forecast
收稿日期:  2024-07-19                     发布日期:  2025-03-31     
通讯作者:  郭志梅    E-mail:  506854687@qq.com
引用本文:    
牛慧霞 司丽英 常志霞 邵毅 赵晓英 郭志梅. 支气管肺发育不良患儿发生肺动脉高压的影响因素分析[J]. 发育医学电子杂志, 2025, 13(2): 114-119.
Niu Huixia, Si Liying, Chang Zhixia, et al. Influencing factors of pulmonary hypertension in infants with bronchopulmonary dysplasia. Journal of Developmental Medicine(Electronic Version), 2025, 13(2): 114-119.
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http://www.fyyxzz.com/CN/10.3969/j.issn.2095-5340.2025.02.006  或          http://www.fyyxzz.com/CN/Y2025/V13/I2/114
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