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发育医学电子杂志  2024, Vol. 12 Issue (4): 271-277    DOI: 10.3969/j.issn.2095-5340.2024.04.005
  围产医学   论著 |新生儿 |
超/ 极低出生体重儿嗜酸性粒细胞增多症与支气管肺发育不良的临床相关性分析
朱晶文 何玺玉 郭明 李玉蕊 张雪峰
解放军总医院第五医学中心 儿科,北京100039)
Clinical correlation analysis of eosinophilia and bronchopulmonary dysplasia in extremely/ very low birth weight infants
Zhu Jingwen, He Xiyu, Guo Ming, et al
(Department of Pediatrics, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China)
 
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摘要 【摘要】 目的  探讨发生不同程度嗜酸性粒细胞增多症的超低出生体重儿(extremely low birth weight
infants,ELBW)和极低出生体重儿(very low birth weight infants,VLBW)的临床特点,以及嗜酸性粒
细胞增多症与支气管肺发育不良(bronchopulmonary dysplasia,BPD)的相关性。 方法 回顾性分析
2019 年1 月至2022 年12 月解放军总医院第五医学中心儿科收治的147 例ELBW 及VLBW 患儿的临床资料。根据嗜酸性粒细胞计数升高程度进行分组:正常组(嗜酸性粒细胞计数<0.7×109/L,n=43),轻度升高组[ 嗜酸性粒细胞计数为(0.7~0.9)×109/L,n=39]、中重度升高组(嗜酸性粒细胞计数≥ 1.0×109/L,n=65),比较各组围产期资料以及出生后相关疾病的发生率。根据患儿是否患有BPD 以及BPD 的严重
程度分为无BPD 组(n=81),轻度BPD 组(n=46),中重度BPD 组(n=20),比较3 组患儿之间嗜酸性粒细胞计数的差异。统计学方法包括t 检验、方差分析、秩和检验、χ2 检验、Fisher 确切概率法,以及单因素和多因素Logistic 回归分析、受试者工作特征(receiver operating characteristic,ROC)曲线。 结果  嗜酸性粒细胞增多症的发病率为70.7%(104/147),其中轻度升高26.5%(39/147),中重度升44.2%(65/147)。中重度升高组和轻度升高组胎龄均小于正常组,差异均有统计学意义(P 值均<0.05)。嗜酸性粒细胞计数轻度、中重度升高组中败血症、Ⅱ度以上呼吸窘迫综合征(respiratory distress syndrome,RDS)、BPD、血液输注的发生率明显高于正常组;中重度升高组患儿的BPD 发生率高于轻度升高组;轻度、中重度升高组无创呼吸机应用时间均长于正常组,差异均有统计学意义(P 值均<0.05)。无BPD 组和BPD 组患儿的胎龄、败血症的发生率以及嗜酸性粒细胞增多症、呼吸机应用天数、血液输注比较,差异均有统计学意义(P 值均<0.05)。多因素Logistic 回归分析结果显示,胎龄、嗜酸性粒细胞增多症、呼吸机应用天数、血液输注、败血症与BPD 的发生具有独立相关性(P 值均<0.05)。出生后第3 周嗜酸性粒细胞计数的曲线下面积(area under the curve,AUC)最大(0.772),灵敏度及特异度均较高(70.1%、76.2%),提示对BPD的预测价值较好。出生后第3、4 周轻度BPD 组患儿嗜酸性粒细胞计数高于无BPD 组(Z=-3.178、-2.475,P=0.001、0.013)。出生后第3、4 周中重度BPD 组患儿嗜酸性粒细胞计数高于无BPD 组(Z=-2.601、2.460,P=0.009、0.014)。出生后第3 周中重度BPD 组患儿嗜酸性粒细胞计数高于轻度BPD 组(Z=-2.422,P=0.015)。 结论 ELBW 及VLBW 新生儿嗜酸性粒细胞增多症发生率较高,并且嗜酸性粒细胞增多症与BPD 的发生存在一定的相关性。出生后第3 周嗜酸性粒细胞计数预测BPD 的灵敏度及特异度最高,临床上应加以重视。
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关键词:  超低出生体重儿  极低出生体重儿  嗜酸粒细胞增多症  支气管肺发育不良  败血症    
Abstract: 【Abstract】 Objective To investigate the clinical characteristics of extremely low birth weight infants
(ELBW) and very low birth weight infants (VLBW) with different degrees of eosinophilia, and analyze the
correlation between eosinophilia and bronchopulmonary dysplasia (BPD). Method The clinical data of
147 ELBW and VLBW infants admitted to the Department of Pediatrics, the Fifth Medical Center of Chinese
PLA General Hospital from January 2019 to December 2022 were retrospectively analyzed. The infants weredivided into normal group (eosinophils <0.7×109/L, n=43), mild elevation group [eosinophils was (0.7-0.9)×109/L, n=39] and moderate to severe elevation group (eosinophils ≥1.0×109/L, n=65) accordingto the degree of elevation in eosinophils. Perinatal data and incidence of postnatal related diseases werecompared among all groups. According to whether the infants had BPD and the severity of BPD, they weredivided into non-BPD group (n=81), mild BPD group (n=46) and moderate to severe BPD group (n=20),and the differences in eosinophils among the three groups were compared. Statistical methods performed byt-test, analysis of variance, rank sum test, χ2 test, Fisher exact probability method, univariate and multivariateLogistic regression analysis and receiver operating characteristic (ROC) curve.  Result The incidence ofeosinophilia was 70.7% (104/147), with a mild elevation of 26.5% (39/147), a moderate to severe elevationof 44.2% (65/147). The gestational age of moderate and severe elevation group and mild elevation groupwas lower than that in the normal group, and the differences were statistically significant (all P<0.05). Theincidence of septicemia, respiratory distress syndrome (RDS) above degree Ⅱ, BPD and blood transfusionin mild elevation group and moderate to severe elevation group were significantly higher than those in thenormal group. The incidence of BPD in the moderate to severe elevation group was higher than that in themild elevation group. The application time of non-invasive ventilator in mild elevation group and moderate tosevere elevation group was longer than that in normal group, and the differences were statistically significant(all P<0.05). There were significant differences in gestational age, septicemia and incidence of eosinophilia,days of ventilator application and blood transfusion between non-BPD group and BPD group (all P<0.05).Multivariate Logistic regression analysis showed that gestational age, eosinophilia, days of ventilatorapplication, blood transfusion and septicemia were independently correlated with the occurrence of BPD (allP<0.05). The area under the curve (AUC) of eosinophils at the third week after birth was the largest (0.772),and the sensitivity and specificity were both higher (70.1% and 76.2%), indicating a good predictive valuefor BPD. The eosinophils in the mild BPD group was higher than that in the non-BPD group at the thirdand fourth week after birth (Z=-3.178, -2.475; P=0.001, 0.013). The eosinophils in the moderate to severeBPD group were higher than those in the non-BPD group at the third and fourth week after birth (Z=-2.601,-2.460; P=0.009, 0.014). The eosinophils in moderate to severe BPD group were higher than those in mildBPD group at the third week after birth (Z=-2.422, P=0.015). Conclusion The incidence of eosinophiliain ELBW and VLBW infants is higher, and eosinophilia is related to the occurrence of BPD. The level ofeosinophils at the third week after birth has the highest sensitivity and specificity in predicting BPD, whichshould be paid attention to clinically.
Key words:  Extremely low birth weight infants    Very low birth weight infants    Eosinophilia    Bronchopulmonary dysplasia    Septicemia
收稿日期:  2023-09-14                     发布日期:  2024-07-31     
通讯作者:  张雪峰    E-mail:  doctor1966@sina.com
引用本文:    
朱晶文 何玺玉 郭明 李玉蕊 张雪峰. 超/ 极低出生体重儿嗜酸性粒细胞增多症与支气管肺发育不良的临床相关性分析[J]. 发育医学电子杂志, 2024, 12(4): 271-277.
Zhu Jingwen, He Xiyu, Guo Ming, et al. Clinical correlation analysis of eosinophilia and bronchopulmonary dysplasia in extremely/ very low birth weight infants. Journal of Developmental Medicine(Electronic Version), 2024, 12(4): 271-277.
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