极低出生体质量儿坏死性小肠结肠炎危险因素分析

Analysis of risk factors of very low birth weight infants with necrotizing enterocolitis

摘要:

目的： 探讨极低出生体质量儿（very low birth weight infants，VLBWI）发生坏死性小肠结肠炎（necrotizing enterocolitis，NEC）的危险因素。方法： 回顾性分析2011年1月至2019年10月在重庆医科大学附属儿童医院收治的VLBWI临床病例资料，分为NEC组（BellⅡ期及以上）和非NEC组，采用t检验、Kruskal-Wallis检验、卡方检验或Fisher精确概率法进行组间比较，多因素logistic回归分析NEC独立危险因素。结果： 共497名VLBWI纳入研究，其中NEC组30人，非NEC组467人，2组患儿在性别、胎龄、出身体质量、入院年龄上无显著性差异，NEC组患儿试管婴儿比例（P=0.025）、合并宫内生长迟缓（P=0.015）、房间隔缺损（P=0.014）、心功能损伤（P=0.041）、肾功能损伤（P=0.012）、肝功能损伤（P=0.003）、低蛋白血症（P=0.002）、电解质紊乱（P=0.041）、败血症（P=0.000）比例均高于非NEC组患儿。多因素logistic回归分析显示，败血症（OR=13.24，95%CI=4.04～43.36，P=0.000）、低白蛋白血症（OR=4.22，95%CI=1.14～15.58，P=0.031）、宫内生长迟缓（OR=3.46，95%CI=1.18～10.14，P=0.024）、试管婴儿（OR=4.85，95%CI=1.50～15.68，P=0.008）是VLBWI发生NEC的危险因素。结论： 败血症、宫内生长迟缓、低白蛋白血症、试管婴儿是极低出生体质量儿发生NEC的危险因素。

Abstract:

Objective: To investigate the risk factors of necrotizing enterocolitis (NEC) in very low birth weight infants (VLBWI). Methods: A retrospective study of VLBWI admitted to the Children's Hospital of Chongqing Medical University from January 2011 to October 2019 was conducted. Infants were assigned into two groups: NEC group (Bell stage≥Ⅱ) and non-NEC group. The data were measured with the Student's t-test, Kruskal-Wallis test, chi-square or the Fisher's exact test. Logistic regression analysis was used to identify independent risk factors associated with NEC. Results: Of 497 VLBWI enrolled, 30 infants developed NEC. There were no significant differences in gender, gestational age, birth weight, and admitted age between the two groups. Higher incidences of in vitro fertilization and embryo transfer (IVF-ET) (P=0.025), intrauterine growth retardation (IUGR) (P=0.015), atrial septal defect (P=0.014), cardiac dysfunction (P=0.041), renal dysfunction (P=0.012), liver dysfunction (P=0.003), hypoalbuminemia (P=0.002), electrolyte disorder (P=0.041), and sepsis (P=0.000) were found in infants with NEC compared with those without NEC. Logistic regression analysis revealed sepsis (OR=13.24, 95%CI=4.04-43.36, P=0.000), hypoalbuminemia (OR=4.22, 95%CI=1.14-15.58, P=0.031), IUGR (OR=3.46, 95%CI=1.18-10.14, P=0.024) and IVF-ET (OR=4.85, 95%CI=1.50-15.68, P=0.008) were the risk factors of VLBWI with NEC. Conclusion: We should keep an eye on sepsis, hypoalbuminemia, IUGR and in IVF-ET among VLBWI, which are the risk factors of NEC.