早产儿成年后肺部长期预后的前瞻性波兰队列研究：PREMATURITAS 20 研究
Long-term pulmonary outcomes of young adults born prematurely: a Polish prospective cohort study PREMATURITAS 20.
机构信息
Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.
Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland.
出版信息
BMC Pulm Med. 2024 Mar 12;24(1):126. doi: 10.1186/s12890-024-02939-5.
BACKGROUND
The long-term consequences of prematurity are often not sufficiently recognized. To address this gap, a prospective cohort study, which is a continuation of the multicenter Polish study PREMATURITAS, was conducted, utilizing unique clinical data from 20 years ago.
OBJECTIVE
The main goal was to evaluate lung function, detect any structural abnormalities using lung ultrasound, and assess psychological well-being in young adults born between 24 and 34 weeks of gestational age (GA). Additionally, the study aimed to investigate potential associations between perinatal risk factors and abnormalities observed in pulmonary function tests (PFTs) during adulthood.
METHODS
The young survivors underwent a comprehensive set of PFTs, a lung ultrasound, along with the quality of life assessment. Information regarding the neonatal period and respiratory complications was obtained from the baseline data collected in the PREMATURITAS study.
RESULTS
A total of 52 young adults, with a mean age of 21.6 years, underwent PFTs. They were divided into two groups based on GA: 24-28 weeks (n = 12) and 29-34 weeks (n = 40). The subgroup born more prematurely had significantly higher lung clearance index (LCI), compared to the other subgroup (p = 0.013). LCI ≥ 6.99 was more frequently observed in the more premature group (50% vs. 12.5%, p = 0.005), those who did not receive prenatal steroids (p = 0.020), with a diagnosis of Respiratory Distress Syndrome (p = 0.034), those who received surfactant (p = 0.026), and mechanically ventilated ≥ 7 days (p = 0.005). Additionally, elevated LCI was associated with the diagnosis of asthma (p = 0.010).
CONCLUSIONS
The findings suggest pulmonary effects due to prematurity persist into adulthood and their insult on small airway function. Regular follow-up evaluations of young survivors born preterm should include assessments of PFTs. Specifically, the use of LCI can provide valuable insights into long-term pulmonary impairment.
背景
早产儿的长期后果往往没有得到充分认识。为了解决这一差距，进行了一项前瞻性队列研究，该研究是波兰多中心 PREMATURITAS 研究的延续，利用了 20 年前独特的临床数据。
目的
主要目标是评估肺功能，使用肺部超声检测任何结构异常，并评估胎龄为 24 至 34 周之间的年轻成年人的心理健康。此外，该研究旨在调查围产期危险因素与成年期肺功能检查（PFT）中观察到的异常之间的潜在关联。
方法
年轻幸存者接受了一系列全面的 PFT、肺部超声以及生活质量评估。新生儿期和呼吸道并发症的信息是从 PREMATURITAS 研究中收集的基线数据中获得的。
结果
共有 52 名年轻成年人接受了 PFT，平均年龄为 21.6 岁。他们根据胎龄分为两组：24-28 周（n=12）和 29-34 周（n=40）。出生更早的亚组的肺清除指数（LCI）显著更高，与另一亚组相比（p=0.013）。出生更早的组（50%比 12.5%，p=0.005）、未接受产前类固醇治疗的组（p=0.020）、诊断为呼吸窘迫综合征的组（p=0.034）、接受表面活性剂治疗的组（p=0.026）和机械通气时间超过 7 天的组（p=0.005）中更频繁地观察到 LCI≥6.99。此外，升高的 LCI 与哮喘的诊断相关（p=0.010）。
结论
这些发现表明，早产儿的肺部影响持续到成年期，并对小气道功能造成损害。对早产儿出生的年轻幸存者进行定期随访评估应包括 PFT 评估。具体来说，使用 LCI 可以提供对长期肺部损伤的有价值的见解。
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