支气管肺发育不良患儿发生肺动脉高压的影响因素分析  

Influencing factors of pulmonary hypertension in infants with bronchopulmonary dysplasia

作　　者：牛慧霞 司丽英 常志霞 邵毅 赵晓英 郭志梅 Niu Huixia;Si Liying;Chang Zhixia;Shao Yi;Zhao Xiaoying;Guo Zhimei(Department of Pediatrics,Hebei Hospital of Traditional Chinese Medicine,Heibei,Shijiazhuang 050001,China)

机构地区：[1]河北省中医院儿科,河北石家庄050001

出　　处：《发育医学电子杂志》2025年第2期114-119,共6页Journal of Developmental Medicine (Electronic Version)

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,P_(A-a)O_(2))、氧合指数(oxygenation index,OI)、B型利钠肽(B-type natriuretic peptide,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、χ^(2)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),χ^(2)=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P_(A-a)O_(2)、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,P_(A-a)O_(2)(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P_(A-a)O_(2)、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。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(P_(A-a)O_(2)),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,χ^(2)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),χ^(2)=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].P_(A-a)O_(2) 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 the ROC curve was 0.760,0.747,0.747,respectively.Conclusi

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 

分 类 号：R72[医药卫生—儿科]