小于胎龄儿坏死性小肠结肠炎发病危险因素分析

doi:10.12372/jcp.2022.22e0213

摘要/Abstract

摘要：

目的探究小于胎龄（SGA）儿发生坏死性小肠结肠炎（NEC）的危险因素。方法选择2008年1月至2021年12月住院患NEC的SGA新生儿为研究对象;选择同期住院的未患NEC的SGA新生儿为对照组,按照孕周相差<3 d、出生体重相差<200 g、入院日期相差<3 月的条件进行1:2匹配。采用条件logistic回归分析SGA新生儿发生NEC的影响因素。结果研究期间共收治5 365例SGA新生儿,其中符合NECⅡ期及以上诊断标准的147例,发生率为2.70%,经筛选排除后最终纳入140例;对照组按1:2匹配共选取280例。与对照组相比,NEC组贫血、新生儿败血症、病死或放弃治疗比例较高,住院时间较长,产前使用糖皮质激素、口服益生菌比例较低,差异有统计学意义（P<0.05）。条件logistic回归分析结果发现,败血症、贫血为SGA新生儿患NEC的独立危险因素（P<0.05）,而产前糖皮质激素暴露、口服益生菌则是其独立保护因素（P<0.05）。结论 SGA新生儿存在贫血、败血症更容易发生NEC,而口服益生菌、产前使用糖皮质激素可降低NEC发生的风险。

关键词: 败血症, 贫血, 小于胎龄儿, 坏死性小肠结肠炎

Abstract:

Objective To explore the risk factors of necrotizing enterocolitis (NEC) in small for gestational age (SGA) neonates. Methods The SGA patients suffering from NEC from January 2008 to December 2021 were selected as the research subjects. The SGA patients without NEC in the same period were selected as the control group, and 1∶2 matching was performed according to gestational age difference <3 d, birth weight difference <200 g, and date of admission difference <3 months. The influencing factors of NEC occurrence in SGA neonates were analyzed by conditional logistic regression. Results A total of 5 365 SGA neonates were admitted during the study period, among whom 147 SGA neonates met the diagnostic criteria of NEC stage Ⅱ or above, and the incidence rate was 2.70%. After screening and exclusion, 140 patients were finally included. A total of 280 SGA neonates were involved in the control group by 1∶2 matching. Compared with the control group, the NEC group had higher rates of anemia, neonatal sepsis, death or treatment abandonment, longer hospital stay, and lower rates of prenatal exposure to glucocorticoids and oral probiotics, and the differences were statistically significant (P<0.05). Conditional logistic regression analysis showed that sepsis and anemia were independent risk factors for NEC in SGA (P<0.05), while prenatal glucocorticoids exposure and oral probiotics were independent protective factors (P<0.05). Conclusions The SGA neonates with anemia and sepsis are more likely to develop NEC, while oral probiotics and prenatal exposure to glucocorticoids can reduce the risk of NEC..

Key words: sepsis, anemia, small for gestational age, necrotizing enterocolitis

黄丹, 蒋亚君, 张忠垚, 李禄全. 小于胎龄儿坏死性小肠结肠炎发病危险因素分析[J]. 临床儿科杂志, 2022, 40(9): 661-665.

HUANG Dan, JIANG Yajun, ZHANG Zhongyao, LI Luquan. Risk factors of necrotizing enterocolitis in small for gestational age neonates[J]. Journal of Clinical Pediatrics, 2022, 40(9): 661-665.

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参考文献 32

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项目	NEC组(n=140)	对照组(n=280)	统计量	P
一般临床资料
男性[n(%)]	81(57.9)	155(53.4)	χ²=0.24	0.626
胎龄[M(P₂₅~P₇₅)]/周	37.4(35.5~39.1)	37.3(35.8~39.0)	Z=0.02	0.983
早产儿[n(%)]	57(40.7)	118(42.1)	χ²=0.08	0.780
出生体重[M(P₂₅~P₇₅)]/g	2 200.0(1 752.5~2 597.5)	2 200.0(1 800.0~2 600.0)	Z=0.59	0.556
剖宫产率[n(%)]	100(71.4)	195(69.6)	χ²=0.14	0.706
母乳喂养率[n(%)]	52(37.1)	100(35.7)	χ²=0.08	0.774
母亲年龄[M(P₂₅~P₇₅)]/岁	28.0(24.0~32.0)	28.0(24.0~32.0)	Z=0.66	0.511
母孕期情况[n(%)]
妊娠期高血压	22(15.7)	51(18.2)	χ²=0.41	0.524
妊娠期贫血	24(17.1)	43(15.4)	χ²=0.22	0.638
妊娠期胆汁淤积症	4(2.9)	6(2.1)	χ²=0.01	0.910
妊娠期糖尿病	12(8.6)	35(12.5)	χ²=1.45	0.229
胎膜早破(≥18 h)	6(4.3)	22(7.9)	χ²=1.91	0.167
产前糖皮质激素暴露	15(10.7)	52(18.6)	χ²=4.30	0.038
母孕期使用抗生素	10(7.1)	13(4.6)	χ²=1.13	0.288
产时情况[n(%)]
宫内窘迫	27(19.3)	39(13.9)	χ²=2.02	0.155
羊水粪染	17(12.1)	32(11.4)	χ²=0.05	0.830
1 min-Apgar评分<7	11(7.9)	25(8.9)	χ²=0.14	0.712
5 min-Apgar评分<7	6(4.3)	9(3.2)	χ²=0.31	0.577
合并症及治疗
贫血[n(%)]	52(37.1)	50(17.9)	χ²=18.88	<0.001
败血症[n(%)]	31(22.1)	27(9.6)	χ²=12.25	<0.001
动脉导管未闭[n(%)]	22(15.7)	47(16.8)	χ²=0.08	0.780
呼吸衰竭[n(%)]	22(15.7)	47(16.8)	χ²=0.08	0.780
呼吸暂停[n(%)]	7(5.0)	5(1.8)	χ²=2.41	0.120
呼吸窘迫综合征[n(%)]	7(5.0)	11(3.9)	χ²=0.26	0.609
红细胞增多症[n(%)]	0(0.0)	2(0.7)	-	0.554¹⁾
口服益生菌[n(%)]	15(10.7)	77(27.5)	χ²=15.37	<0.001
住院时间[M(P₂₅~P₇₅)]/d	16.0(11.0~25.8)	10.0(8.0~16.0)	Z=5.67	<0.001
病死或放弃治疗[n(%)]	36(25.7)	6(2.1)	χ²=57.62	<0.001

变量	偏回归系数	标准误	χ²值	P	OR(95%CI)
产前糖皮质激素暴露	-1.39	0.60	5.34	0.021	0.25(0.08~0.81)
贫血	1.05	0.28	14.32	<0.001	2.85(1.66~4.91)
败血症	1.04	0.37	8.12	0.004	2.83(1.38~5.80)
口服益生菌	-1.06	0.32	10.77	0.001	0.35(0.18~0.65)