背景:绒毛膜羊膜炎(CA)可导致早产儿多器官损伤,尤其是肺部。宫内炎症对新生儿呼吸窘迫综合征(NRDS)和支气管肺发育不良(BPD)的影响存在不同意见。我们旨在系统地回顾早产儿CA或FV与肺损伤之间的关系。
方法:我们电子搜索了PubMed,EMBase,科克伦图书馆,CNKI,和CMB从开始到2023年3月15日的队列研究。两名审稿人独立筛选文献,收集的数据,并进行了纳入研究的NOS量表。使用RevMan5.3进行荟萃分析。
结果:共收集了16项观察性研究,包括68,397例患者。Meta分析显示CA或FV增加肺损伤风险(OR=1.43,95CI:1.06~1.92)。除组织学绒毛膜羊膜炎(HCA)外(OR=0.72,95CI:0.57-0.90),临床绒毛膜羊膜炎(CCA)(OR=1.86,95CI:0.93-3.72),FV(OR=1.23,95CI:0.48-3.15)和HCA伴FV(OR=1.85,95CI:0.15-22.63)在NRDS发生率中均无统计学意义。由于按HCA等级分层,HCA(II)与NRDS发生率降低有显著关联(OR=0.48,95CI:0.35-0.65)。就BPD而言,BPD与CA/FV呈正相关(CA:OR=3.18,95CI:1.68~6.03;FV:OR=6.36,95CI:2.45~16.52)。在CA中,HCA与BPD呈正相关(OR=2.70,95CI:2.38-3.07),而CCA与BPD无关(OR=2.77,95CI:0.68-11.21)。HCA与中重度BPD(OR=25.38,95CI:7.13-90.32)呈正相关,而轻度BPD(OR=2.29,95CI:0.99-5.31)则没有。
结论:目前,有证据表明CA或FV会增加早产儿肺损伤的发生率.对于不同类型的CA和FV,HCA可以增加BPD的发生率,同时降低NRDS的发生率。这种“保护作用”仅适用于32周龄以下的婴儿。关于肺损伤的严重程度,只有中重度BPD病例与CA呈正相关。
BACKGROUND: Chorioamnionitis (CA) can cause multiple organ injuries in premature neonates, particularly to the lungs. Different opinions exist regarding the impact of intrauterine inflammation on neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD). We aim to systematically review the relationship between CA or
Funisitis (FV) and lung injury among preterm infants.
METHODS: We electronically searched PubMed, EMbase, the Cochrane library, CNKI, and CMB for cohort studies from their inception to March 15, 2023. Two reviewers independently screened literature, gathered data, and did NOS scale of included studies. The meta-analysis was performed using RevMan 5.3.
RESULTS: Sixteen observational studies including 68,397 patients were collected. Meta-analysis showed CA or FV increased the lung injury risk (OR = 1.43, 95%CI: 1.06-1.92). Except for histological chorioamnionitis (HCA) (OR = 0.72, 95%CI: 0.57-0.90), neither clinical chorioamnionitis (CCA) (OR = 1.86, 95%CI: 0.93-3.72) nor FV (OR = 1.23, 95%CI: 0.48-3.15) nor HCA with FV (OR = 1.85, 95%CI: 0.15-22.63) had statistical significance in NRDS incidence. As a result of stratification by grade of HCA, HCA (II) has a significant association with decreased incidence of NRDS (OR = 0.48, 95%CI: 0.35-0.65). In terms of BPD, there is a positive correlation between BPD and CA/FV (CA: OR = 3.18, 95%CI: 1.68-6.03; FV: OR = 6.36, 95%CI: 2.45-16.52). Among CA, HCA was positively associated with BPD (OR = 2.70, 95%CI: 2.38-3.07), whereas CCA was not associated with BPD (OR = 2.77, 95%CI: 0.68-11.21). HCA and moderate to severe BPD (OR = 25.38, 95%CI: 7.13-90.32) showed a positive correlation, while mild BPD (OR = 2.29, 95%CI: 0.99-5.31) did not.
CONCLUSIONS: Currently, evidence suggests that CA or FV increases the lung injury incidence in premature infants. For different types of CA and FV, HCA can increase the incidence of BPD while decreasing the incidence of NRDS. And this \"protective effect\" only applies to infants under 32 weeks of age. Regarding lung injury severity, only moderate to severe cases of BPD were positively correlated with CA.