中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2015年
8期
606-609
,共4页
绒毛膜羊膜炎%早产%胎膜早破
絨毛膜羊膜炎%早產%胎膜早破
융모막양막염%조산%태막조파
Chorioamnionitis%Premature birth%Fetal membranes,premature rupture
目的 分析早产与胎盘组织学绒毛膜羊膜炎(histological chorioamnionitis,HCA)的关系,探讨早产原因及发生机制. 方法 2009年12月1日至2012年12月1日,在北京大学第一医院分娩的早产病例中,纳入327例胎盘行病理检查的病例.根据早产的临床类型,分为医源性组106例、自发宫缩组56例、胎膜早破组165例.每组进一步根据分娩孕周分为3个亚组:早期组(≥28～＜32周)、中期组(≥32～＜34周)、晚期组(≥34～＜37周).分娩后取胎盘组织标本,HE染色,高倍镜下观察,绒毛膜板及羊膜上出现≥5个中性粒细胞浸润考虑HCA.采用回顾性分析的方法,比较不同临床类型及不同分娩孕周早产的HCA发生率,以及临床绒毛膜羊膜炎与HCA的一致性.胎膜早破组中,比较不同破膜潜伏期的HCA发生率.采用X2检验进行统计学分析.结果 医源性组、自发宫缩组、胎膜早破组HCA发生率分别为25.5％(27/106)、66.1％(37/56)和33.3％(55/165).自发宫缩组高于医源性组和胎膜早破组(X2值分别为25.27和18.44,P值均＜0.01),医源性组与胎膜早破组比较,差异无统计学意义(P＞0.05).早期、中期、晚期早产3个亚组的HCA发生率,医源性组分别为24.0％(6/25)、33.3％(8/24)和22.8％(13/57),自发宫缩组分别为13/17、5/7和59.4％(19/32),差异均无统计学意义(P值均＞0.05);胎膜早破组分别为70.0％(20/29)、41.2％ (14/34)和20.6％(21/102),早期组高于中期组和晚期组(X2值分别为4.87和24.58,P值均＜0.05),中期组高于晚期组(X2=5.66,P＜0.05).胎膜早破组中,破膜潜伏期≥72 h者HCA发生率[68.6％(24/35)]高于＜72h者[23.8％(31/130)],差异有统计学意义(X2=24.82,P＜0.01).327例早产病例中,52例(1 5.9％)诊断为临床绒毛膜羊膜炎,其中31例[59.6％(31/52)]为HCA. 结论 自发宫缩性早产与HCA关系密切,部分医源性早产也可发生HCA;早产发生越早,HCA的发生率越高;胎膜早破性早产的破膜潜伏期越长,HCA的发生率越高;临床绒毛膜羊膜炎与HCA的符合性存在差异,应进行鉴别诊断.
目的 分析早產與胎盤組織學絨毛膜羊膜炎(histological chorioamnionitis,HCA)的關繫,探討早產原因及髮生機製. 方法 2009年12月1日至2012年12月1日,在北京大學第一醫院分娩的早產病例中,納入327例胎盤行病理檢查的病例.根據早產的臨床類型,分為醫源性組106例、自髮宮縮組56例、胎膜早破組165例.每組進一步根據分娩孕週分為3箇亞組:早期組(≥28～＜32週)、中期組(≥32～＜34週)、晚期組(≥34～＜37週).分娩後取胎盤組織標本,HE染色,高倍鏡下觀察,絨毛膜闆及羊膜上齣現≥5箇中性粒細胞浸潤攷慮HCA.採用迴顧性分析的方法,比較不同臨床類型及不同分娩孕週早產的HCA髮生率,以及臨床絨毛膜羊膜炎與HCA的一緻性.胎膜早破組中,比較不同破膜潛伏期的HCA髮生率.採用X2檢驗進行統計學分析.結果 醫源性組、自髮宮縮組、胎膜早破組HCA髮生率分彆為25.5％(27/106)、66.1％(37/56)和33.3％(55/165).自髮宮縮組高于醫源性組和胎膜早破組(X2值分彆為25.27和18.44,P值均＜0.01),醫源性組與胎膜早破組比較,差異無統計學意義(P＞0.05).早期、中期、晚期早產3箇亞組的HCA髮生率,醫源性組分彆為24.0％(6/25)、33.3％(8/24)和22.8％(13/57),自髮宮縮組分彆為13/17、5/7和59.4％(19/32),差異均無統計學意義(P值均＞0.05);胎膜早破組分彆為70.0％(20/29)、41.2％ (14/34)和20.6％(21/102),早期組高于中期組和晚期組(X2值分彆為4.87和24.58,P值均＜0.05),中期組高于晚期組(X2=5.66,P＜0.05).胎膜早破組中,破膜潛伏期≥72 h者HCA髮生率[68.6％(24/35)]高于＜72h者[23.8％(31/130)],差異有統計學意義(X2=24.82,P＜0.01).327例早產病例中,52例(1 5.9％)診斷為臨床絨毛膜羊膜炎,其中31例[59.6％(31/52)]為HCA. 結論 自髮宮縮性早產與HCA關繫密切,部分醫源性早產也可髮生HCA;早產髮生越早,HCA的髮生率越高;胎膜早破性早產的破膜潛伏期越長,HCA的髮生率越高;臨床絨毛膜羊膜炎與HCA的符閤性存在差異,應進行鑒彆診斷.
목적 분석조산여태반조직학융모막양막염(histological chorioamnionitis,HCA)적관계,탐토조산원인급발생궤제. 방법 2009년12월1일지2012년12월1일,재북경대학제일의원분면적조산병례중,납입327례태반행병리검사적병례.근거조산적림상류형,분위의원성조106례、자발궁축조56례、태막조파조165례.매조진일보근거분면잉주분위3개아조:조기조(≥28～＜32주)、중기조(≥32～＜34주)、만기조(≥34～＜37주).분면후취태반조직표본,HE염색,고배경하관찰,융모막판급양막상출현≥5개중성립세포침윤고필HCA.채용회고성분석적방법,비교불동림상류형급불동분면잉주조산적HCA발생솔,이급림상융모막양막염여HCA적일치성.태막조파조중,비교불동파막잠복기적HCA발생솔.채용X2검험진행통계학분석.결과 의원성조、자발궁축조、태막조파조HCA발생솔분별위25.5％(27/106)、66.1％(37/56)화33.3％(55/165).자발궁축조고우의원성조화태막조파조(X2치분별위25.27화18.44,P치균＜0.01),의원성조여태막조파조비교,차이무통계학의의(P＞0.05).조기、중기、만기조산3개아조적HCA발생솔,의원성조분별위24.0％(6/25)、33.3％(8/24)화22.8％(13/57),자발궁축조분별위13/17、5/7화59.4％(19/32),차이균무통계학의의(P치균＞0.05);태막조파조분별위70.0％(20/29)、41.2％ (14/34)화20.6％(21/102),조기조고우중기조화만기조(X2치분별위4.87화24.58,P치균＜0.05),중기조고우만기조(X2=5.66,P＜0.05).태막조파조중,파막잠복기≥72 h자HCA발생솔[68.6％(24/35)]고우＜72h자[23.8％(31/130)],차이유통계학의의(X2=24.82,P＜0.01).327례조산병례중,52례(1 5.9％)진단위림상융모막양막염,기중31례[59.6％(31/52)]위HCA. 결론 자발궁축성조산여HCA관계밀절,부분의원성조산야가발생HCA;조산발생월조,HCA적발생솔월고;태막조파성조산적파막잠복기월장,HCA적발생솔월고;림상융모막양막염여HCA적부합성존재차이,응진행감별진단.
Objective To investigate the causes and mechanism of preterm birth through analysis of the relationship between histological chorioamnionitis (HCA) in placental tissue and preterm birth.Methods Totally,327 preterm birth cases with report of placental pathologic examination were retrospectively collected from those women who delivered from December 1,2009 to December 1,2012 in Peking University First Hospital.According to the etiology of preterm birth,three groups were assigned:iatrogenic group (n=106),spontaneous contraction group (n=56) and premature rupture of membranes (PROM) group (n=165).According to the gestational age at delivery,three subgroups were further divided:early-preterm group (≥ 28-＜ 32 weeks),mid-preterm group(≥ 32-＜ 34 weeks) and late-preterm group (≥ 34-＜ 37 weeks).HCA was confirmed when ≥ 5 neutrophil infiltration identified on the chorionic plate and amniotic membrane under high power light microscope after HE staining.The relationship between HCA and the different types of preterm birth and the different delivery gestational age were analyzed.Besides,the consistency between clinical chorioamnionitis and HCA was also analyzed.Chi-square test was applied for statistics.Results The incidence of HCA in the spontaneous contraction group was significantly higher than in the iatrogenic group and PROM group [66.1％ (37/56) vs 25.5％ (27/106) and 33.3％ (55/165),x2=25.27 and 18.44,both P ＜ 0.01],but no significant difference was found between the latter two groups (P ＞ 0.05).Among the three subgroups,the early-,midand late-preterm subgroup,the incidence of HCA in the iatrogenic group was 24.0％ (6/25),33.3％ (8/24) and 22.8％ (13/57) (P ＞ 0.05),and 13/17,5/7 and 59.4％ (19/32) in the spontaneous contraction group (P ＞ 0.05).However,significantly higher incidence of HCA was shown in the early-preterm subgroup than in the mid-and late-preterm subgroup [70.0％ (20/29) vs 41.2％ (14/34) and 20.6％ (21/102),X2=4.87 and 24.58,both P ＜ 0.05] in the PROM group.Among the subjects in PROM group,those with the latency ≥ 72 h after the rupture of membranes had a higher incidence of HCA than those with the latency less than 72 h [68.6％ (24/35) vs 23.8％ (31/130),x2=24.82,P ＜ 0.01].For all 327 cases in this study,the incidence of clinical chorioamnionitis was 15.9％ (52/327),among which 31 cases [59.6％ (31/52)] were diagnosed as HCA.Conclusions The occurrence of HCA is closely associated with spontaneous contraction preterm.Some iatrogenic preterm birth might cause HCA.The earlier the preterm birth and the longer the latency after PROM,the higher the incidence of HCA.Differential diagnosis is necessary as the inconsistency between clinical chorioamnionitis and HCA.
