CAJ | 학술논문

目的：探讨宫内感染对早产儿脑损伤的影响及感染后脑损伤发病的可能机制。方法收集肇庆市第二人民医院产科2012年6月至2014年1月出生的早产儿80例,按照母亲产前有无宫内感染(是否有绒毛膜羊膜炎)分为感染组(38例)和非感染组(42例),对两组行胎膜胎盘病理、患儿头颅彩超以及脐带血细胞因子检测。结果感染组脑损伤率为47.4%,非感染组脑损伤率为7.1%,差异具有统计学意义(χ2=16.675,P<0.05)。感染组中脑损伤儿脐带血细胞因子指标白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均明显的高于非脑损伤儿,白细胞介素-10(IL-10)水平低于非脑损伤儿(t值分别为7.455、8.231、6.548、3.342,均P<0.05)；非感染组中脑损伤与非脑损伤儿IL-1β、IL-6、TNF-α、IL-10之间差异均具有统计学意义(t值分别为3.452、4.435、2.789、2.756,均P<0.05)。感染组新生儿行为神经测定(NANB)评分低于非感染组(t=2.897,P<0.05)；感染组NANB评分小于35分的比例为50.0%,高于非感染组(χ2=18.379,P<0.05)。感染组住院时间和治疗费用明显的高于非感染组,两组间差异具有显著统计学意义(t值分别为6.679、8.890,均P<0.05)。结论宫内感染可以导致早产儿脑损伤的发病率明显增高,并且促使炎症指标发生改变,可能机制由于宫内感染引起导致炎症反应,炎症因子释放异常,从而造成早产儿脑损伤。
목적：탐토궁내감염대조산인뇌손상적영향급감염후뇌손상발병적가능궤제。방법수집조경시제이인민의원산과2012년6월지2014년1월출생적조산인80례,안조모친산전유무궁내감염(시부유융모막양막염)분위감염조(38례)화비감염조(42례),대량조행태막태반병리、환인두로채초이급제대혈세포인자검측。결과감염조뇌손상솔위47.4%,비감염조뇌손상솔위7.1%,차이구유통계학의의(χ2=16.675,P<0.05)。감염조중뇌손상인제대혈세포인자지표백세포개소-1β(IL-1β)、백세포개소-6(IL-6)、종류배사인자-α(TNF-α)수평균명현적고우비뇌손상인,백세포개소-10(IL-10)수평저우비뇌손상인(t치분별위7.455、8.231、6.548、3.342,균P<0.05)；비감염조중뇌손상여비뇌손상인IL-1β、IL-6、TNF-α、IL-10지간차이균구유통계학의의(t치분별위3.452、4.435、2.789、2.756,균P<0.05)。감염조신생인행위신경측정(NANB)평분저우비감염조(t=2.897,P<0.05)；감염조NANB평분소우35분적비례위50.0%,고우비감염조(χ2=18.379,P<0.05)。감염조주원시간화치료비용명현적고우비감염조,량조간차이구유현저통계학의의(t치분별위6.679、8.890,균P<0.05)。결론궁내감염가이도치조산인뇌손상적발병솔명현증고,병차촉사염증지표발생개변,가능궤제유우궁내감염인기도치염증반응,염증인자석방이상,종이조성조산인뇌손상。
Objective To investigate the influence of intrauterine infection on brain injury in preterm infants and the possible pathogenesis of brain injury after infection. Methods During the period of June 2012 to January 2014 80 preterm infants born in Second People ’ s Hospital of Zhaoqing were collected and divided into infection group (38 cases) and non-infection group (42 cases) according to whether mothers suffering prenatal intrauterine infection ( chorioamnionitis ) . Fetal membrane and placenta pathological examination, color ultrasonography on head and cord blood cytokines detection were done for two groups. Results The rate of brain injury in the infection group and the non-infection group was 47. 4% and 7. 1%, respectively, with significant difference (χ2 =16. 675,P<0. 05). In the infection group cord blood cytokine IL-1β, IL-6 and TNF-α levels were obviously higher in infants with brain injury than in those without brain injury, and IL-10 level was lower in infants with brain injury (t value was 7. 455, 8. 231, 6. 548 and 3. 342, respectively, all P<0. 05). In the non-infection group there was significant differences in IL-1β, IL-6, TNF-α and IL-10 levels between infants with or without brain injury (t value was 3. 452, 4. 435, 2. 789 and 2. 756, respectively, all P<0. 05). There were 50. 0% cases with less than 35 in NANB score in the infection group, which was higher than in the non-infection group (χ2 =18. 379,P<0. 05). The hospitalization length and cost of the infection group were significantly higher than the non-infection group (t value was 6. 679 and 8. 890, respectively, both P<0. 05). Conclusion Intrauterine infection can increase the incidence of brain injury in preterm infants significantly, and promote changes in inflammation indexes. The possible mechanism is that intrauterine infection causes inflammation, which releases inflammatory cytokines abnormally and thus leads to brain injury of preterm infants.