目的：探讨产前使用阿奇霉素（azithromycin,AZ）治疗母亲解脲脲原体（ureaplasma urealyticum,UU）定植与极低出生体重儿（very low birth weight infants,VLBWIs）并发症发生风险的相关性。方法：采用单中心回顾性研究,纳入2018年1月至2023年5月在长沙市妇幼保健院进行规律产检和分娩的孕妇,以及她们所分娩的极低出生体重儿作为研究对象,根据孕妇孕期宫颈分泌物UU-DNA的检测结果,将孕妇分娩的极低出生体重儿分为三组：A组 （UU-DNA阳性,产前接受AZ治疗）、 B组（UU-DNA阳性,产前未接受AZ治疗）和C组（UU-DNA阴性）。比较三组的一般资料、孕妇的围生期因素、早产儿并发症情况。结果：共纳入253例极低出生体重儿作为研究对象,A组132例,B组39例,C组82例。三组中,C组UU感染率显著低于A组、B组,孕妇辅助生殖率显著高于A组、B两组。三组间有血流动力学意义的动脉导管开放（hemodynamically significant patent ductus arteriosus,hsPDA）、新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome,NRDS）、坏死性小肠结肠炎（necrotizing enterocolitis,NEC）发生率及正压通气<7d的比例存在显著性差异。具体而言,B组NEC发生率较C组显著升高,而A组NEC发生率低于B组;B组hsPDA发生率显著降低,A组正压通气<7d的比例显著升高。与B组相比,A组NRDS发生率显著降低,差异有统计学意义。结论：阿奇霉素治疗孕期解脲脲原体定植,可能降低极低出生体重儿的NEC、NRDS发病率,缩短极低出生体重儿正压通气时间。
Abstract
Objective To investigate the correlation between the prenatal treatment of Azithromycin for maternal ureaplasma urealyticum (UU) colonization and the rate of the very low birth weight infants' (VLBWIs) complications. Methods This was a retrospective single center analysis which involves the gravidas who underwent prenatal examination and delivery in Changsha Hospital for Maternal & Child Healthcare, and their VLBWIs who was hospitalized in the NICU (Neonatal Intensive Care Unit) from January 2018 to May 2023 were employed as the study subjects. According to the results of UU-DNA of maternal cervical secretion, all the VLBWIs were divided into three groups: Group A: UU-DNA was positive (+), and the VLBWIs' mothers were received the prenatal treatment of Azithromycin (AZ); Group B: UU-DNA was positive (+), while the VLBWIs' mothers didn't receive AZ treatment; Group C: UU-PCR was negative. The general data of VLBWIs and their mothers' perinatal data, the situation of the respiratory systems and the complications of the VLBWIs were compared between the three groups. Results 253 VLBWIs were included in this study (group A: 132, group B: 39, group C: 82). The UU infection rate of group C was significantly lower than other two groups, whereas the ratio of IVF-ET was significantly higher than other two groups. Among them, compared with group C, the incidence of NEC in group B was significantly higher, whereas the incidence of NEC in group A was lower than that in group B. The incidence of hsPDA in group B was significantly decreased, and the rate of positive pressure ventilation <7d in group A was significantly increased, with statistical significance. Compared to group B, the incidence of NRDS in group A was significantly decreased, and the difference was statistically significant. Conclusion AZ treatment of maternal UU colonization during pregnancy may reduce the incidence of NEC and NRDS in VLBWIs and shorten the positive pressure ventilation time of VLBWIs.
关键词
解脲脲原体 /
阿奇霉素 /
极低出生体重儿
Key words
ureaplasma urealyticum /
azithromycin /
very low birth weight infants
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基金
湖南省科技创新计划“孕期解脲支原体感染对新生儿支气管肺发育不良的影响”（2021SK53208）; 湖南省教育厅科学研究项目“口腔运动干预对极低出生体重儿脑白质损伤的神经系统发育研究”（22C0033）
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