Wu Yvonne W, Escobar Gabriel J, Grether Judith K, Croen Lisa A, Greene John D, Newman Thomas B
Department of Neurology, University of California, San Francisco 94143, USA.
JAMA. 2003 Nov 26;290(20):2677-84. doi: 10.1001/jama.290.20.2677.
Half of all cases of cerebral palsy (CP) occur in term infants, for whom risk factors have not been clearly defined. Recent studies suggest a possible role of chorioamnionitis.
To determine whether clinical chorioamnionitis increases the risk of CP in term and near-term infants.
DESIGN, SETTING, AND PATIENTS: Case-control study nested within a cohort of 231 582 singleton infants born at 36 or more weeks' gestation between January 1, 1991, and December 31, 1998, in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were identified from electronic records and confirmed by chart review by a child neurologist, and comprised all children with moderate to severe spastic or dyskinetic CP not due to postnatal brain injury or developmental abnormalities (n = 109). Controls (n = 218) were randomly selected from the study population.
Association between clinical chorioamnionitis and increased risk of CP in term and near-term infants.
Most CP cases had hemiparesis (40%) or quadriparesis (38%); 87% had been diagnosed by a neurologist and 83% had undergone neuroimaging. Chorioamnionitis, considered present if a treating physician made a diagnosis of chorioamnionitis or endometritis clinically, was noted in 14% of cases and 4% of controls (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5-10.1; P =.001). Independent risk factors identified in multiple logistic regression included chorioamnionitis (OR, 4.1; 95% CI, 1.6-10.1), intrauterine growth restriction (OR, 4.0; 95% CI, 1.3-12.0), maternal black ethnicity (OR, 3.6; 95% CI, 1.4-9.3), maternal age older than 25 years (OR, 2.6; 95% CI, 1.3-5.2), and nulliparity (OR, 1.8; 95% CI, 1.0-3.0). The population-attributable fraction of chorioamnionitis for CP is 11%.
Our data suggest that chorioamnionitis is an independent risk factor for CP among term and near-term infants.
所有脑瘫（CP）病例中有一半发生在足月儿中，其危险因素尚未明确界定。近期研究提示绒毛膜羊膜炎可能起一定作用。
确定临床绒毛膜羊膜炎是否会增加足月儿和近足月儿患脑瘫的风险。
设计、地点和患者：病例对照研究，纳入1991年1月1日至1998年12月31日在凯撒医疗保健计划中出生的231582名单胎妊娠、孕周36周及以上的婴儿队列。凯撒医疗保健计划是一家为北加利福尼亚州300多万居民提供医疗服务的管理式医疗组织。病例患者通过电子记录识别，并经儿童神经科医生查阅病历确认，包括所有非因产后脑损伤或发育异常导致的中度至重度痉挛型或运动障碍型脑瘫患儿（n = 109）。对照组（n = 218）从研究人群中随机选取。
临床绒毛膜羊膜炎与足月儿和近足月儿患脑瘫风险增加之间的关联。
大多数脑瘫病例为偏瘫（40%）或四肢瘫（38%）；87%由神经科医生诊断，83%接受过神经影像学检查。若治疗医生临床诊断为绒毛膜羊膜炎或子宫内膜炎，则认为存在绒毛膜羊膜炎，病例组中有14%存在该情况，对照组中有4%（优势比[OR]，3.8；95%置信区间[CI]，1.5 - 10.1；P = 0.001）。多因素logistic回归确定的独立危险因素包括绒毛膜羊膜炎（OR，4.1；95% CI，1.6 - 10.1）、宫内生长受限（OR，4.0；95% CI，1.3 - 12.0）、母亲为黑人种族（OR，3.6；95% CI，1.4 - 9.3）、母亲年龄大于25岁（OR，2.6；95% CI，1.3 - 5.2）以及初产（OR，1.8；95% CI，1.0 - 3.0）。绒毛膜羊膜炎导致脑瘫的人群归因分数为11%。
我们的数据表明，绒毛膜羊膜炎是足月儿和近足月儿患脑瘫的独立危险因素。
