支气管肺发育不良患儿暴露于有血流动力学意义的动脉导管未闭与发生肺动脉高压的相关性研究  

Correlation between exposure to hemodynamically significant patent ductus arteriosus and pulmonary hypertension in children with bronchopulmonary dysplasia

作　　者：欧阳芊寒 颜崇兵 翁博雯 蔡成 Ouyang Qianhan;Yan Chongbing;Weng Bowen;Cai Cheng(Department of Neonatology,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Neonatology,Jiading District Maternal and Child Health Hospital,Shanghai 201821,China)

机构地区：[1]上海交通大学医学院附属儿童医院,上海市儿童医院新生儿科,上海200062 [2]上海市嘉定区妇幼保健院新生儿科,上海201812

出　　处：《中华实用儿科临床杂志》2025年第4期277-282,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：“科技兴蒙”上海交通大学行动计划专项项目(2023XYJG0001-01-09);上海市儿童医院院级临床研究培育专项(2023YLY02)。

摘　　要：目的探讨支气管肺发育不良(BPD)患儿暴露于有血流动力学意义的动脉导管未闭(hsPDA)合并肺动脉高压(PH)发生的风险及其相关性。方法回顾性病例对照研究。选择2018年1月至2022年12月上海市儿童医院新生儿科收治的极早产儿(胎龄<32周)的临床资料进行回顾性分析。由2名专业超声科团队医师对所有需要呼吸机支持且纠正胎龄≥36周、符合BPD诊断的极早产儿行超声心动图评估,依据是否合并PH,分为非PH组和PH组。采用单因素和多因素分析等方法,对BPD患儿合并PH的发生危险因素进行分析,通过Logistic模型分析hsPDA对BPD患儿合并PH发生结局的影响,使用受试者工作特征(ROC)曲线对该模型性能进行评价。结果(1)共纳入147例BPD患儿,非PH组74例,PH组73例,2组胎龄[(204.5±11.8)d比(201.6±11.5)d]、出生体重[(1222±273)g比(1153±237)g]比较差异均无统计学意义(均P>0.05)。(2)单因素方差分析显示出生后正压通气复苏(P=0.036)、有创呼吸机支持(P=0.002)、产前使用糖皮质激素(P=0.043)、静脉激素(P=0.003)、液体限制(P<0.001)、高碳酸血症(P=0.004)、PDA(P=0.010)、hsPDA(P<0.001)与BPD患儿合并PH有关,其差异均有统计学意义。(3)Logistic回归分析提示hsPDA暴露(OR=5.414,95%CI:1.852~15.824,P=0.002)是BPD患儿合并PH的独立危险因素。通过该模型预测概率绘制ROC曲线,该模型最佳截断值为42.9%(敏感度、特异度分别为83.6%、63.5%,曲线下面积=0.794,约登指数=0.471)。结论BPD患儿hsPDA的暴露会增加其合并PH的发病风险,hsPDA暴露是BPD患儿合并PH的独立危险因素。Objective:To investigate the risk of developing pulmonary hypertension(PH)in children with bronchopulmonary dysplasia(BPD)exposed to hemodynamically significant patent ductus arteriosus(hsPDA)and the correlation between PH and exposure to hsPDA.Methods:Retrospective case-control study.The clinical data of extremely premature infants(gestational age<32 weeks)admitted to the Department of Neonatology,Shanghai Children′s Hospital from January 2018 to December 2022 were retrospectively analyzed.All the very premature infants had a corrected gestational age≥36 weeks,required respiratory support,and were diagnosed with BPD.Their echocardiograms were evaluated by a team of physicians specialized in ultrasound.The patients were divided into a non-PH group and a PH group based on whether they were complicated by PH.The risk factors of PH in infant with BPD were analyzed by univariate and multivariate analyses.The influence of hsPDA on the outcome of PH in infant with BPD was analyzed by a Logistic model,whose performance was evaluated by the receiver-operating characteristic(ROC)curve.Results:(1)A total of 147 infants with BPD were included,with 74 cases in the non-PH group and 73 cases in the PH group.There was no significant difference in gestational age[(204.5±11.8)days vs.(201.6±11.5)days]and birth weight[(1222±273)g vs.(1153±237)g]between the non-PH and PH groups(all P>0.05).(2)Univariate ANOVA showed the development of PH in children with BPD was significantly related to postnatal positive pressure ventilation resuscitation(P=0.036),invasive respiratory support(P=0.002),prenatal glucocorticoids(P=0.043),intravenous hormones(P=0.003),liquid restriction(P<0.001),hypercapnia(P=0.004),PDA(P=0.010),and hsPDA(P<0.001).(3)The Logistic regression analysis suggested that exposure to hsPDA(OR=5.414,95%CI:1.852-15.824,P=0.002)was an independent risk factor for PH development in children with BPD.The ROC curve is plotted through the prediction probability of the model,which has an optimal cut-off value of 42.9%(sensitiv

关 键 词：支气管肺发育不良 肺动脉高压 动脉导管未闭 极早产儿 

分 类 号：R722.6[医药卫生—儿科]