Ghezzi F, Gomez R, Romero R, Yoon B H, Edwin S S, David C, Janisse J, Mazor M
Perinatology Research Branch, National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
Eur J Obstet Gynecol Reprod Biol. 1998 May;78(1):5-10. doi: 10.1016/s0301-2115(97)00236-4.
To determine if an intrauterine sub-clinical inflammatory process is a risk factor for the development of bronchopulmonary dysplasia.
A cohort study was conducted in patients who met the following criteria: (1) Singleton gestation; (2) preterm labor or preterm premature rupture of the membranes; (3) amniocentesis for microbiologic studies of the amniotic fluid and (4) delivery between 24 and 28 weeks of gestation. Bronchopulmonary dysplasia was defined as the need for supplemental oxygen for 28 days or longer after birth, associated with compatible chest radiographic findings. Amniotic fluid interleukin-8, was measured using a specific immunoassay. Logistic regression analysis and bootstrap procedure were used for statistical purposes.
Forty-seven patients met the inclusion criteria for this study. Among these patients, the prevalence of bronchopulmonary dysplasia was 23.4% (11/47). Amniotic fluid culture was positive in 21 out of 47 (44.7%) patients. Median (range) amniotic fluid interleukin-8 concentration was higher in patients whose neonates subsequently developed bronchopulmonary dysplasia than in those who did not (17 [9.8-583.7] ng ml(-1) versus 9.6 [0.91-744] ng ml(-1), P=0.057). An amniotic fluid IL-8 level greater than 11.5 ng ml(-1) was far more common in mothers whose fetuses went on to develop bronchopulmonary dysplasia than in those who did not (10/11 [90.9%] versus 17/36 [47%]; P=0.01). This relationship remained significant even after correcting for the effect of gestational age and birthweight (Odds ratio: 11.9; P<0.05).
Sub-clinical intrauterine inflammation is a risk factor for the subsequent development of bronchopulmonary dysplasia. We propose that in utero aspiration of fluid with high concentration of pro-inflammatory mediators may contribute to the lung injury responsible for the development of bronchopulmonary dysplasia.
确定子宫内亚临床炎症过程是否为支气管肺发育不良发生的危险因素。
对符合以下标准的患者进行队列研究：（1）单胎妊娠；（2）早产或胎膜早破；（3）行羊膜腔穿刺术进行羊水微生物学研究；（4）妊娠24至28周之间分娩。支气管肺发育不良定义为出生后需补充氧气28天或更长时间，并伴有符合的胸部X线表现。使用特定免疫测定法测量羊水白细胞介素-8。采用逻辑回归分析和自助法进行统计分析。
47例患者符合本研究的纳入标准。在这些患者中，支气管肺发育不良的患病率为23.4%（11/47）。47例患者中有21例（44.7%）羊水培养呈阳性。新生儿随后发生支气管肺发育不良的患者羊水白细胞介素-8浓度中位数（范围）高于未发生者（17 [9.8 - 583.7] ng/ml对9.6 [0.91 - 744] ng/ml，P = 0.057）。胎儿发生支气管肺发育不良的母亲中，羊水白细胞介素-8水平大于11.5 ng/ml的情况远比未发生者常见（10/11 [90.9%]对17/36 [47%]；P = 0.01）。即使在校正胎龄和出生体重的影响后，这种关系仍然显著（比值比：11.9；P < 0.05）。
亚临床子宫内炎症是随后发生支气管肺发育不良的危险因素。我们认为，子宫内吸入高浓度促炎介质的液体可能导致造成支气管肺发育不良的肺损伤。
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