Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops.
Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops.
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DOI：
10.1542/peds.97.2.210
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发表时间：
1996-02
期刊：
影响因子：
8
通讯作者：
K. Watterberg;L. Demers;S. Scott;S. Murphy
中科院分区：
文献类型：
--
作者：
K. Watterberg;L. Demers;S. Scott;S. Murphy
目的 支气管肺发育不良 (BPD) 的发生通常归因于机械通气和补充氧气造成的损伤。 BPD 婴儿的早期肺部炎症被认为是这些因素继发的。本研究的目的是评估先前存在的（产前）炎症是否可能是 BPD 发展的主要致病因素。方法 前瞻性招募出生体重小于 2,000 g 的插管新生儿。记录是否存在绒毛膜羊膜炎。通过测定气管灌洗液中白细胞介素 1 β (IL-1 β)、血栓素 B2、白三烯 B4 和前列腺素 E2 的浓度，在插管第 1、2 和 4 天评估肺部炎症。将患有边缘性人格障碍的婴儿与未使用这些措施的婴儿进行比较。结果 53 名婴儿被纳入研究； 41人幸存。 38 人患有呼吸窘迫综合征； 15 人因其他诊断而接受插管。产前接触过绒毛膜羊膜炎的婴儿出现呼吸窘迫综合征的可能性较小；然而，绒毛膜羊膜炎与插管第一天起 IL-1β 的存在以及 BPD 的发生显着相关。患有 BPD 的婴儿气管灌洗液中 IL-1β 的浓度较高。在发生 BPD 的婴儿中，第 1 天的血栓素 B2 浓度相似，但第 2 天和第 4 天的浓度较高。结论 在这项研究中，患有 BPD 的出生时体重低于 2,000 克的插管婴儿在产前接触炎症（绒毛膜羊膜炎）的机会增加，并且有证据表明从出生后第一天起肺部炎症就增加。我们推测绒毛膜羊膜炎可能会加速肺部成熟，但它也会导致插管婴儿肺部炎症和随后的肺损伤，从而促进 BPD 的发展。
OBJECTIVE The development of bronchopulmonary dysplasia (BPD) often has been attributed to injury from mechanical ventilation and supplemental oxygen. Early lung inflammation in infants with BPD has been thought to be secondary to these factors. The purpose of this study was to evaluate whether preexisting (prenatal) inflammation may be a primary causative factor in the development of BPD. METHODS Intubated newborns of less than 2,000 g birth weight were prospectively enrolled. The presence or absence of chorioamnionitis was documented. Lung inflammation was evaluated on days 1, 2, and 4 of intubation by assaying concentrations of interleukin 1 beta (IL-1 beta), thromboxane B2, leukotriene B4, and prostaglandin E2 in tracheal lavages. Infants in whom BPD developed were compared with those in whom it did not using these measures. RESULTS Fifty-three infants were enrolled; 41 survived. Thirty-eight had respiratory distress syndrome; 15 were intubated for other diagnoses. Infants prenatally exposed to chorioamnionitis were less likely to present with respiratory distress syndrome; however, chorioamnionitis was significantly associated with both the presence of IL-1 beta from the first day of intubation and the development of BPD. Tracheal lavage concentrations of IL-1 beta were higher in infants in whom BPD developed. Thromboxane B2 concentrations were similar on day 1 but were higher on days 2 and 4 in infants in whom BPD developed. CONCLUSIONS In this study, intubated infants weighing less than 2,000 g at birth in whom BPD developed had increased exposure to inflammation prenatally (chorioamnionitis) and evidence of increased lung inflammation from the first postnatal day. We speculate that chorioamnionitis may accelerate lung maturation but that it also causes lung inflammation and subsequent lung injury in intubated infants, fostering the development of BPD.