出生时胎龄<28 周且伴有急性肾损伤的早产儿支气管肺发育不良发生率增加。
Premature infants born <28 weeks with acute kidney injury have increased bronchopulmonary dysplasia rates.
机构信息
Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN, USA.
出版信息
Pediatr Res. 2023 Aug;94(2):676-682. doi: 10.1038/s41390-023-02514-4. Epub 2023 Feb 9.
BACKGROUND
Despite a growing understanding of bronchopulmonary dysplasia (BPD) and advances in management, BPD rates remain stable. There is mounting evidence that BPD may be due to a systemic insult, such as acute kidney injury (AKI). Our hypothesis was that severe AKI would be associated with BPD.
METHODS
We conducted a secondary analysis of premature infants [24-27 weeks gestation] in the Recombinant Erythropoietin for Protection of Infant Renal Disease cohort (N = 885). We evaluated the composite outcome of Grade 2/3 BPD or death using generalized estimating equations. In an exploratory analysis, urinary biomarkers of angiogenesis (ANG1, ANG2, EPO, PIGF, TIE2, FGF, and VEGFA/D) were analyzed.
RESULTS
594 (67.1%) of infants had the primary composite outcome of Grade 2/3 BPD or death. Infants with AKI (aOR: 1.69, 95% CI: 1.16-2.46) and severe AKI (aOR: 2.05, 95% CI: 1.19-3.54). had increased risk of the composite outcome after multivariable adjustment Among 106 infants with urinary biomarkers assessed, three biomarkers (VEGFA, VEGFD, and TIE2) had AUC > 0.60 to predict BPD.
CONCLUSIONS
Infants with AKI had a higher likelihood of developing BPD/death, with the strongest relationship seen in those with more severe AKI. Three urinary biomarkers of angiogenesis may have potential to predict BPD development.
IMPACT
AKI is associated with lung disease in extremely premature infants, and urinary biomarkers may predict this relationship. Infants with AKI and severe AKI have higher odds of BPD or death. Three urinary angiogenesis biomarkers are altered in infants that develop BPD. These findings have the potential to drive future work to better understand the mechanistic pathways of BPD, setting the framework for future interventions to decrease BPD rates. A better understanding of the mechanisms of BPD development and the role of AKI would have clinical care, cost, and quality of life implications given the long-term effects of BPD.
背景
尽管对支气管肺发育不良（BPD）的认识不断加深，管理水平也有所提高，但 BPD 的发病率仍保持稳定。越来越多的证据表明，BPD 可能是由全身性损伤引起的，例如急性肾损伤（AKI）。我们的假设是严重 AKI 与 BPD 有关。
方法
我们对早产儿[胎龄 24-27 周]进行了重组促红细胞生成素保护婴儿肾脏疾病队列的二次分析（N=885）。我们使用广义估计方程评估 2/3 级 BPD 或死亡的复合结局。在探索性分析中，分析了血管生成的尿生物标志物（ANG1、ANG2、EPO、PIGF、TIE2、FGF 和 VEGFA/D）。
结果
594 名（67.1%）婴儿发生 2/3 级 BPD 或死亡的主要复合结局。AKI（优势比：1.69，95%可信区间：1.16-2.46）和严重 AKI（优势比：2.05，95%可信区间：1.19-3.54）婴儿在多变量调整后，复合结局的风险增加。在评估的 106 名具有尿生物标志物的婴儿中，有 3 种生物标志物（VEGFA、VEGFD 和 TIE2）的 AUC > 0.60 可预测 BPD。
结论
AKI 的婴儿发生 BPD/死亡的可能性更高，在 AKI 更严重的婴儿中，这种关系最强。血管生成的 3 种尿生物标志物可能具有预测 BPD 发展的潜力。
影响
AKI 与极早产儿的肺部疾病有关，尿生物标志物可能预测这种关系。AKI 和严重 AKI 的婴儿发生 BPD 或死亡的几率更高。发生 BPD 的婴儿的三种尿血管生成生物标志物发生改变。这些发现有可能推动未来的工作，以更好地了解 BPD 发展的机制途径，为降低 BPD 发病率制定未来的干预措施。鉴于 BPD 的长期影响，更好地了解 BPD 发展的机制和 AKI 的作用将对临床护理、成本和生活质量产生影响。
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