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目的探讨组织学绒毛膜羊膜炎(HC)及合并胎儿血管炎(FV)时与早产儿脑损伤的相关性。方法回顾性分析347例住院的出生胎龄28~32周早产儿的临床资料。根据病理检查结果将早产儿分为HC组和对照组,HC组再根据是否合并胎儿血管炎分FV组及无FV组。早产儿定期行头颅B超检查,比较早产儿脑室周围白质软化(PVL)、脑室周围-脑室内出血(PVH-IVH)和脑室周围白质软化并脑室周围-脑室内出血的发生情况。结果 HC组、对照组PVL发生率分别为17.9%、10.4%,PVL合并PVH-IVH发生率分别为5.5%、1.5%,差异均有统计学意义(P<0.05);而PVH-IVH的发生率分别为29.0%、26.2%,差异无统计学意义(P>0.05)。在HC组中,FV组、无FV组的PVL发生率则分别28.1%、9.9%,差异有统计学意义(P<0.05);PVH-IVH的发生率为34.3%、24.7%,PVL合并PVH-IVH发生率分别为7.8%、3.7%,差异均无统计学意义(P>0.05)。结论 HC可使早产儿PVL、PVL合并PVH-IVH的发生率增加,而对PVH-IVH的影响不大,合并FV会增加早产儿脑损伤发生率。
Objective To investigate the relationship between histological chorioamnionitis (HC) and fetal vasculitis (FV) and brain injury in premature infants. Methods The clinical data of 347 hospitalized premature infants with gestational age of 28-32 weeks were retrospectively analyzed. According to the results of pathological examination, preterm infants were divided into HC group and control group, and HC group was divided into FV group and non-FV group according to whether they had fetal vasculitis. Preterm infants were examined by skull B-ultrasound regularly. The incidence of periventricular leukomalacia (PVL), periventricular-intraventricular hemorrhage (PVH-IVH) and periventricular leukomalacia and periventricular-ventricular hemorrhage were compared between preterm infants. Results The incidences of PVL in HC group and control group were 17.9% and 10.4%, respectively. The incidences of PVL and PVH-IVH were 5.5% and 1.5%, respectively, with significant differences (P <0.05) The rates were 29.0% and 26.2% respectively, with no significant difference (P> 0.05). In HC group, the incidence of PVL in FV group and non-FV group was 28.1% and 9.9%, respectively (P <0.05). The incidence of PVH-IVH was 34.3% and 24.7% -IVH were 7.8%, 3.7%, respectively, the difference was not statistically significant (P> 0.05). Conclusions HC can increase the incidence of PVL and PVL combined with PVH-IVH in preterm infants with little effect on PVH-IVH. Combined FV can increase the incidence of brain injury in preterm infants.