新生儿重症监护病房早产儿解脲脲原体感染的临床特征及危险因素分析

doi:10.11958/20253350

摘要/Abstract

摘要：

目的探讨新生儿重症监护病房（NICU）早产儿解脲脲原体（UU）感染的临床特征及危险因素。方法纳入2023年1月—2025年1月于南阳市中心医院新生儿重症科治疗的462例早产儿，根据其出生后48 h内进行的下呼吸道分泌物UU检测结果分为UU阳性组（130例）和UU阴性组（332例）。比较2组早产儿的一般资料、实验室检查指标、治疗情况以及母亲围产期相关指标差异，多因素Logistic回归分析UU感染的影响因素，建立联合诊断模型并绘制受试者工作特征（ROC）曲线。结果与UU阴性组相比，UU阳性组早产儿的胎龄、出生体质量、1 min Apgar评分、5 min Apgar评分、血小板计数（PLT）降低，合并有急性呼吸窘迫综合征、支气管肺发育不良（BPD）、败血症及颅内出血的患儿比例增加，白细胞计数（WBC）、中性粒细胞计数（NEUT）、C反应蛋白（CRP）水平增加，抗生素使用时间、机械通气时间及氧疗时间增加（P<0.05）。与UU阴性组相比，UU阳性组早产儿母亲的UU感染史和孕期并发绒毛膜羊膜炎、胎膜早破、产前发热、阴道分娩及羊水Ⅲ度污染比例增加，产程较长（P<0.05），2组母亲年龄、孕次、产次、受孕方式、孕期并发妊娠期高血压、妊娠期糖尿病比例差异无统计学意义。多因素Logistic回归分析显示，并发败血症、并发颅内出血、母亲UU感染史、孕期并发绒毛膜羊膜炎、阴道分娩是新生儿UU阳性的独立危险因素，较高出生体质量、5 min Apgar评分以及较长抗生素使用时间是新生儿UU阳性的独立保护因素。联合诊断模型ROC曲线下面积（AUC）为0.949（95%CI：0.925~0.968）。结论筛查早产儿呼吸道UU阳性的危险因素，可早期识别并降低NICU早产儿UU感染风险。

关键词: 婴儿, 早产, 疾病, 解脲支原体, 影响因素分析, ROC曲线

Abstract:

Objective To analyze the clinical characteristics and risk factors of ureaplasma urealyticum (UU) infection in preterm infants. Methods A total of 462 preterm infants admitted to the Neonatal Intensive Care Unit (NICU) of Nanyang Central Hospital from January 2023 to January 2025 were enrolled. According to the test results of UU testing of lower respiratory tract secretions was performed within 48 hours after birth, and these infants were divided into the UU positive group of 130 cases and the UU negative group of 332 cases. The general data, laboratory examination indicators, and treatment conditions of the two groups of preterm infants, as well as the pregnancy and perinatal related indicators of their mothers were compared. Multivariate Logistic regression was used to analyze the influencing factors of UU infection, and a combined diagnostic model was established and the receiver operating characteristic (ROC) curve was drawn. Results Compared with the UU-negative group, the UU-positive group of preterm infants had lower gestational age, birth weight, 1-minute Apgar score, 5-minute Apgar score, and platelet (PLT), and higher proportions of infants with acute respiratory distress syndrome, bronchopulmonary dysplasia (BPD), sepsis and intracranial hemorrhage, as well as increased levels of white blood cell (WBC), neutrophil (NEUT), and C-reactive protein (CRP), and longer durations of antibiotic use, mechanical ventilation, and oxygen therapy (P<0.05). Compared with the UU-negative group, the mothers of the UU-positive group had a higher proportion of UU infection history, concurrent chorioamnionitis, premature rupture of membranes, antepartum fever, vaginal delivery, and amniotic fluid grade Ⅲ contamination during pregnancy, and longer duration of labor (P<0.05). There were no statistically significant differences in maternal age, parity, gravidity, conception method, concurrent gestational hypertension and gestational diabetes between the two groups. Multivariate Logistic regression analysis showed that concurrent sepsis, concurrent intracranial hemorrhage, maternal UU infection history, concurrent chorioamnionitis during pregnancy and vaginal delivery were independent risk factors for UU positivity in neonates, while higher birth weight, 5-minute Apgar score and longer duration of antibiotic use were independent protective factors. The area under the receiver operating characteristic (ROC) curve of the combined diagnostic model was 0.949 (95%CI: 0.925-0.968). Conclusion Screening for risk factors of UU positivity in the respiratory tract of preterm infants can enable early identification and reduce the risk of UU infection in preterm infants in the NICU.

Key words: infant, premature, diseases, ureaplasma urealyticum, root cause analysis, ROC curve

中图分类号:

R722.139

图/表 6

参考文献 25

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组别			n	男性				胎龄/周
UU阴性组			332	180（54.22）				32.86±2.91
UU阳性组			130	68（52.31）				30.15±2.47
t或χ²				0.137				6.921^＊＊
组别		出生体质量/g				Apgar评分/分
组别		出生体质量/g				1 min			5 min
UU阴性组		1 895.45±412.36				7.68±1.55			8.85±1.07
UU阳性组		1 456.38±345.72				6.45±1.82			8.12±1.34
t		6.715^＊＊				8.377^＊＊			9.124^＊＊
组别	并发症
组别	急性呼吸窘迫综合征				BPD		败血症			颅内出血
UU阴性组	128（38.55）				55（16.57）		30（9.04）			45（13.55）
UU阳性组	85（65.38）				42（32.31）		25（19.23）			30（23.08）
χ²	27.064^＊＊				13.956^＊＊		9.258^＊＊			6.230^＊

组别			n	男性				胎龄/周
UU阴性组			332	180（54.22）				32.86±2.91
UU阳性组			130	68（52.31）				30.15±2.47
t或χ²				0.137				6.921^＊＊
组别		出生体质量/g				Apgar评分/分
组别		出生体质量/g				1 min			5 min
UU阴性组		1 895.45±412.36				7.68±1.55			8.85±1.07
UU阳性组		1 456.38±345.72				6.45±1.82			8.12±1.34
t		6.715^＊＊				8.377^＊＊			9.124^＊＊
组别	并发症
组别	急性呼吸窘迫综合征				BPD		败血症			颅内出血
UU阴性组	128（38.55）				55（16.57）		30（9.04）			45（13.55）
UU阳性组	85（65.38）				42（32.31）		25（19.23）			30（23.08）
χ²	27.064^＊＊				13.956^＊＊		9.258^＊＊			6.230^＊

组别	n		WBC/ （×10⁹/L）	NEUT/ （×10⁹/L）		PLT/ （×10⁹/L）		CRP/ （mg/L）
UU阴性组	332		10.23±2.85	5.32±1.86		220.45±50.12		3.2（1.5，6.8）
UU阳性组	130		12.85±3.62	7.58±2.15		185.62±45.38		8.5（4.2，15.3）
t或Z			8.208^＊＊	11.227^＊＊		5.103^＊＊		10.325^＊＊
组别		抗生素使用时间/d			机械通气时间/d		氧疗时间/d
UU阴性组		7.8（4.5，12.6）			2.5（1.0，5.8）		9.6（5.3，16.8）
UU阳性组		14.5（8.2，22.3）			6.8（3.2，12.5）		18.5（10.2，28.3）
Z		9.876^＊＊			11.234^＊＊		10.567^＊＊

组别	n		WBC/ （×10⁹/L）	NEUT/ （×10⁹/L）		PLT/ （×10⁹/L）		CRP/ （mg/L）
UU阴性组	332		10.23±2.85	5.32±1.86		220.45±50.12		3.2（1.5，6.8）
UU阳性组	130		12.85±3.62	7.58±2.15		185.62±45.38		8.5（4.2，15.3）
t或Z			8.208^＊＊	11.227^＊＊		5.103^＊＊		10.325^＊＊
组别		抗生素使用时间/d			机械通气时间/d		氧疗时间/d
UU阴性组		7.8（4.5，12.6）			2.5（1.0，5.8）		9.6（5.3，16.8）
UU阳性组		14.5（8.2，22.3）			6.8（3.2，12.5）		18.5（10.2，28.3）
Z		9.876^＊＊			11.234^＊＊		10.567^＊＊

组别		n	母亲年龄/岁			孕次/次	产次/次			受孕方式
组别		n	母亲年龄/岁			孕次/次	产次/次			自然受孕			辅助生殖
UU阴性组		332	29.12±3.85			2（1，3）	1（1，2）			305（91.87）			27（8.13）
UU阳性组		130	28.65±4.32			2（1，3）	1（1，2）			118（90.77）			12（9.23）
Z或χ²			1.083			0.587	0.325			0.146
组别	UU 感染史			孕期并发症
组别	UU 感染史			妊娠期高血压				妊娠期糖尿病				绒毛膜羊膜炎
UU阴性组	65（19.58）			68（20.48）				62（18.67）				45（13.55）
UU阳性组	98（75.38）			32（24.62）				28（21.54）				38（29.23）
χ²	127.418^＊＊			0.941				0.488				15.578^＊＊
组别	胎膜早破				产前发热				分娩方式
组别	胎膜早破				产前发热				阴道分娩		剖宫产
UU阴性组	85（25.60）				25（7.53）				120（36.14）		212（63.86）
UU阳性组	72（55.38）				22（16.92）				95（73.08）		35（26.92）
χ²	36.935^＊＊				9.019^＊＊				51.216^＊＊
组别				产程/h						羊水Ⅲ度污染
UU阴性组				8.2（5.5，12.8）						42（12.65）
UU阳性组				12.5（8.3，18.6）						38（29.23）
Z或χ²				8.976^＊＊						17.937^＊＊