子痫前期与极低出生体重儿支气管肺发育不良风险：基于人群的研究。
Preeclampsia and the risk of bronchopulmonary dysplasia in VLBW infants: a population based study.
机构信息
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
出版信息
PLoS One. 2013 Sep 20;8(9):e75168. doi: 10.1371/journal.pone.0075168. eCollection 2013.
BACKGROUND
Preeclampsia remains a leading cause of maternal mortality and preterm delivery. Both preeclampsia and bronchopulmonary dysplasia (BPD) of prematurity are associated with impaired angiogenesis. However, the relationship between maternal preeclampsia and BPD remains controversial. This study aims to test whether or not preeclampsia is associated with development of BPD in a cohort of premature infants.
MATERIALS AND METHODS
We conducted a retrospective cohort study assessing the association between preeclampsia and the risk of developing BPD in very-low-birth-weight (VLBW) infants registered in the Premature Baby Foundation of Taiwan from 1997 through 2006. All 21 neonatal departments in Taiwan participated in the data collection. A total of 8,653 VLBW infants were registered in the database. The exclusion criteria included congenital anomalies, chromosome anomalies, infants that died before 36 weeks post-conceptual (PCA), and those whose BPD status were unavailable. BPD was defined as oxygen dependence at 36 weeks postmenstrual age. The association between maternal preeclampsia and BPD was assessed using a multivariate-adjusted logistic regression model.
RESULTS
In the end, a total of 5,753 cases were enrolled in this study. The incidence of preeclampsia was 14.7% (n=847) and the overall incidence of BPD was 34.9%. Infants with maternal preeclampsia had a higher gestational age, higher incidence of cesarean section and being small for their gestational age, lower incidence of respiratory distress syndrome, patent ductus arteriosus, and sepsis. BPD occurred significantly less frequently in the maternal preeclampsia group (24.1% vs. 36.7%; adjusted odds ratio: 0.78; 95% confidence interval, 0.62-0.98). Subgroup analysis showed that the association between preeclampsia and BPD was significant only in those VLBW infants with a gestational age between 31-34 weeks.
CONCLUSION
This data supports the association between fetal exposure to maternal preeclampsia and a reduced risk of BPD in relatively mature VLBW infants.
背景
子痫前期仍然是孕产妇死亡和早产的主要原因。子痫前期和早产儿支气管肺发育不良（BPD）都与血管生成受损有关。然而，母体子痫前期与 BPD 之间的关系仍存在争议。本研究旨在检测子痫前期是否与早产儿队列中 BPD 的发生有关。
材料和方法
我们进行了一项回顾性队列研究，评估了 1997 年至 2006 年期间在台湾早产儿基金会注册的极低出生体重（VLBW）婴儿中，子痫前期与 BPD 风险之间的关联。台湾所有 21 个新生儿科均参与了数据收集。该数据库共登记了 8653 名 VLBW 婴儿。排除标准包括先天性异常、染色体异常、在妊娠后 36 周（PCA）前死亡的婴儿，以及无法确定 BPD 状态的婴儿。BPD 定义为出生后 36 周时需要吸氧。使用多变量调整的逻辑回归模型评估母体子痫前期与 BPD 之间的关联。
结果
最终，共有 5753 例病例纳入本研究。子痫前期的发生率为 14.7%（n=847），BPD 的总发生率为 34.9%。患有母体子痫前期的婴儿胎龄更大，剖宫产率更高，且胎儿小于胎龄的比例更低，呼吸窘迫综合征、动脉导管未闭和败血症的发生率更低。母体子痫前期组的 BPD 发生率明显较低（24.1%比 36.7%；调整后的优势比：0.78；95%置信区间：0.62-0.98）。亚组分析显示，子痫前期与 BPD 之间的关联仅在胎龄为 31-34 周的 VLBW 婴儿中具有统计学意义。
结论
本数据支持胎儿暴露于母体子痫前期与相对成熟的 VLBW 婴儿中 BPD 风险降低之间的关联。
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