Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
J Pediatr. 2013 Feb;162(2):236-42.e2. doi: 10.1016/j.jpeds.2012.07.012. Epub 2012 Aug 21.
To accumulate available evidence regarding the association between antenatal inflammation and necrotizing enterocolitis (NEC).
A systematic literature search was performed using Medline, Embase, Cochrane Library, ISI Web of Knowledge, and reference hand searches. Human studies published in English that reported associations between chorioamnionitis or other indicators of antenatal inflammation and NEC were eligible. Relevant associations were extracted and reported. Studies reporting associations between histological chorioamnionitis (HC) and NEC, HC with fetal involvement and NEC, and clinical chorioamnionitis and NEC were pooled in separate meta-analyses.
A total of 33 relevant studies were identified. Clinical chorioamnionitis was significantly associated with NEC (12 studies; n = 22 601; OR, 1.24; 95% CI, 1.01-1.52; P = .04; I(2) = 12%), but the association between HC and NEC was not statistically significant (13 studies; n = 5889; OR, 1.39; 95% CI, 0.95-2.04; P = .09; I(2) = 49%). However, HC with fetal involvement was highly associated with NEC (3 studies; n = 1640; OR, 3.29; 95% CI, 1.87-5.78; P ≤ .0001; I(2) = 10%). Selection based on study quality did not affect the results. No indications of publication bias were apparent. Multivariate analyses in single studies generally attenuated the reported associations. Several associations between other markers of antenatal inflammation and NEC are reported.
Currently available evidence supports a role for antenatal inflammation in NEC pathophysiology. This finding emphasizes the need to further study the underlying mechanisms and evaluate potential interventions to improve postnatal intestinal outcomes.
积累关于产前炎症与坏死性小肠结肠炎（NEC）之间关联的现有证据。
使用 Medline、Embase、Cochrane 图书馆、ISI Web of Knowledge 和参考文献手工检索进行系统文献检索。符合条件的研究为发表于英文文献、报告绒毛膜羊膜炎或其他产前炎症指标与 NEC 之间关联的人类研究。提取并报告相关关联。分别对报告绒毛膜羊膜炎（HC）与 NEC、HC 伴有胎儿受累与 NEC 以及临床绒毛膜羊膜炎与 NEC 之间关联的研究进行荟萃分析。
共确定了 33 项相关研究。临床绒毛膜羊膜炎与 NEC 显著相关（12 项研究；n = 22601；OR，1.24；95%CI，1.01-1.52；P =.04；I² = 12%），但 HC 与 NEC 之间的关联无统计学意义（13 项研究；n = 5889；OR，1.39；95%CI，0.95-2.04；P =.09；I² = 49%）。然而，HC 伴有胎儿受累与 NEC 高度相关（3 项研究；n = 1640；OR，3.29；95%CI，1.87-5.78；P ≤.0001；I² = 10%）。基于研究质量进行选择并未影响结果。未发现发表偏倚的迹象。单研究中的多变量分析通常会减弱报告的关联。还报告了其他产前炎症标志物与 NEC 之间的一些关联。
目前的证据支持产前炎症在 NEC 病理生理学中的作用。这一发现强调了需要进一步研究潜在机制，并评估潜在的干预措施以改善出生后肠道结局。
