两种支气管肺发育不良诊断标准下早产儿临床特征及近远期结局  

Clinical characteristics and short-term and long-term outcomes of preterm infants under two diagnostic criteria of bronchopulmonary dysplasia

作　　者：谢露露 李增清[1] 杨洋[2] 王柱[2] 高薇薇[2] Xie Lulu;Li Zengqing;Yang Yang;Wang Zhu;Gao Weiwei(Department of Pediatrics,Guangdong Women and Children's Hospital,Guangzhou 511442,China;Department of Neonatology,Guangdong Women and Children's Hospital,Guangzhou 511442,China)

机构地区：[1]广东省妇幼保健院儿科,广州511442 [2]广东省妇幼保健院新生儿科,广州511442

出　　处：《中华新生儿科杂志（中英文）》2023年第10期609-614,共6页Chinese Journal of Neonatology

基　　金：广东省医学科研基金(A2020224)。

摘　　要：目的:探讨两种支气管肺发育不良(bronchopulmonary dysplasia,BPD)诊断标准下早产儿的临床特征及近远期结局。方法:采用回顾性观察性队列研究,选择2019年1月至2021年6月广东省妇幼保健院新生儿科收治的胎龄<32周、符合2001年美国国立儿童健康与人类发育研究所BPD诊断标准的早产儿为研究对象,并根据2019年Jensen BPD诊断标准重新分度,采用独立样本t检验、非参数检验或χ2检验比较两种BPD标准及分度下BPD早产儿的临床特征、新生儿期并发症、婴儿期呼吸系统疾病发生率和生长发育情况。结果:共纳入392例患儿,按照2001年标准分为轻度组129例、中度组134例和重度组114例,15例无法分度;按照2019年标准分为Ⅰ级组134例、Ⅱ级组89例、Ⅲ级组25例,非BPD 144例。2019年标准的Ⅰ级组、Ⅱ级组BPD患儿出院后家庭氧疗率、出院年龄和住院时间均明显大于2001年标准的轻度组、中度组BPD患儿(P<0.05)。在两种标准中,随着BPD严重程度的增加,病死率增加。2019年标准的Ⅲ级组BPD患儿病死率为48.0%,明显高于2001年标准重度组BPD患儿的病死率14.0%(P<0.01)。138例获得完整的校正12月龄的随访资料,2001年轻度组与2019年Ⅰ级组、2001年中度组与2019年Ⅱ级组、2001年重度组与2019年Ⅲ级组呼吸道疾病发生率、再次住院率、严重神经系统损伤率及大部分体格发育指标比较差异均无统计学意义(P>0.05)。结论:2001年BPD标准的诊断率和重度BPD发生率明显高于2019年标准的诊断率和Ⅲ级BPD发生率,但重度BPD病死率却远低于2019年标准的Ⅲ级BPD。与2001年标准相比,2019年标准的诊断要求更加严格,分类更合理,便于临床应用,能更大程度识别不良结局患儿。Objective To investigate the clinical characteristics and short-term and long-term outcomes of preterm infants under two diagnostic criteria of bronchopulmonary dysplasia(BPD).Methods A retrospective observational cohort study was conducted of infants admitted to the Department of Neonatology of Guangdong Women and Children's Hospital from January 2019 to June 2021.Infants who were born at<32 weeks gestational age and met the 2001 National Institute of Child Health and Human Development(NICHD)BPD definition were included.The 2019 Jenson BPD diagnostic criteria was then used to re-grade the enrolled population.Comparisons of clinical characteristics,neonatal morbidities,respiratory morbidities and growth status at follow-up between the two definition groups were conducted with t-test,nonparametric test,or Chi‐square test.Results A total of 392 patients were included.The number of patients with BPD classified as mild,moderate,severe,and unclassifiable according to the 2001 definition was 129,134,114,and 15,respectively.According to the 2019 definition,there were 134 cases in the ClassⅠgroup,89 cases in the ClassⅡgroup,25 cases in the ClassⅢgroup,and 144 cases of non BPD.Patients with gradeⅠandⅡBPD from the 2019 definition had an higher incidence of post-discharge home oxygen therapy,older age at discharge,and longer length of stay,compared to those with mild and moderate BPD from the 2001 definition(all P<0.05).Under both criteria,mortality increased as severity of BPD increased.Patients with gradeⅢBPD from the 2019 definition had higher mortality than those with severe BPD from the 2001 definition,the difference was statistically significant(48.0%vs.14.0%,P<0.01).A total of 138 infants were followed up at 12 months of corrected age.There were no significant differences in the majority of physical development indicators and the rates of respiratory disease,readmission,and severe neurological injury,between the two definition groups at follow-up.Conclusions The 2001 definition leads to higher BPD diagn

关 键 词：支气管肺发育不良 诊断标准 早产儿 临床特征 预后 

分 类 号：R722.6[医药卫生—儿科]