早产儿坏死性小肠结肠炎危险因素的Meta分析

doi:10.7499/j.issn.1008-8830.2202085

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摘要目的系统评价早产儿发生坏死性小肠结肠炎（necrotizing enterocolitis，NEC）的危险因素。方法计算机检索PubMed、Embase、Cochrane Library、中国知网和万方数据库，检索时限均为建库起至2021年12月。收集关于早产儿发生NEC的危险因素的病例对照研究和队列研究，采用RevMan 5.3软件进行Meta分析。结果共纳入38项研究，其中病例对照研究28项，队列研究10项。Meta分析结果显示：母妊娠糖尿病（OR=2.96，P<0.001）、孕期肝内胆汁淤积症（OR=2.53，P<0.001）、子痫前期（OR=1.73，P=0.020），以及新生儿窒息史（OR=2.13，P<0.001）、低胎龄（OR=1.23，P=0.010）、败血症（OR=5.32，P<0.001）、动脉导管未闭（OR=1.57，P=0.001）、先天性心脏病（OR=3.78，P<0.001）、机械通气（OR=2.23，P=0.020）、抗生素应用史（OR=1.07，P<0.001）、使用血管加压药（OR=2.34，P=0.040）、禁食（OR=1.08，P<0.001）是早产儿发生NEC的危险因素；而剖宫产出生（OR=0.73，P=0.004）、使用肺表面活性剂（OR=0.43，P=0.008）、母乳喂养（OR=0.24，P=0.020）是早产儿发生NEC的保护因素。结论母妊娠糖尿病、孕期肝内胆汁淤积症、子痫前期、低胎龄、禁食、败血症、动脉导管未闭、先天性心脏病、窒息史、机械通气史、抗生素应用史、血管加压药应用史可增加早产儿发生NEC的风险；而剖宫产出生、使用肺表面活性剂、母乳喂养可降低早产儿发生NEC的风险。

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关键词 ：坏死性小肠结肠炎, 危险因素, Meta分析, 早产儿

Abstract：Objective To systematically evaluate the risk factors for necrotizing enterocolitis (NEC) in preterm infants. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched for case-control studies and cohort studies on the risk factors for NEC in preterm infants published up to December 2021. RevMan 5.3 software was used to perform the Meta analysis. Results A total of 38 studies were included (28 case-control studies and 10 cohort studies). The Meta analysis showed that maternal gestational diabetes (OR=2.96, P<0.001), intrahepatic cholestasis during pregnancy (OR=2.53, P<0.001), preeclampsia (OR=1.73, P=0.020), history of neonatal asphyxia (OR=2.13, P<0.001), low gestational age (OR=1.23, P=0.010), sepsis (OR=5.32, P<0.001), patent ductus arteriosus (OR=1.57, P=0.001), congenital heart disease (OR=3.78, P<0.001), mechanical ventilation (OR=2.23, P=0.020), history of antibiotic use (OR=1.07, P<0.001), use of vasopressors (OR=2.34, P=0.040), and fasting (OR=1.08, P<0.001) were risk factors for NEC in preterm infants, while cesarean section (OR=0.73, P=0.004), use of pulmonary surfactant (OR=0.43, P=0.008), and breastfeeding (OR=0.24, P=0.020) were protective factors against NEC. Conclusions Maternal gestational diabetes, intrahepatic cholestasis during pregnancy, preeclampsia, low gestational age, fasting, sepsis, patent ductus arteriosus, congenital heart disease, and histories of asphyxia, mechanical ventilation, antibiotic use, and use of vasopressors may increase the risk of NEC in preterm infants, while cesarean section, use of pulmonary surfactant, and breastfeeding may decrease the risk of NEC in preterm infants.

Key words： Necrotizing enterocolitis Risk factor Meta analysis Preterm infant

收稿日期: 2022-02-21

通讯作者: 杜书章，男，主任药师。Email：dushuzhang911@163.com。 E-mail: dushuzhang911@163.com

作者简介: 鲁春云，女，硕士，主管药；

引用本文:

鲁春云,刘克锋,乔高星等. 早产儿坏死性小肠结肠炎危险因素的Meta分析[J]. 中国当代儿科杂志, 2022, 24(8): 908-916.

LU Chun-Yun,LIU Ke-Feng,QIAO Gao-Xing et al. Risk factors for necrotizing enterocolitis in preterm infants: a Meta analysis[J]. CJCP, 2022, 24(8): 908-916.

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