The relationship between infections and adverse pregnancy outcomes: an overview.
The relationship between infections and adverse pregnancy outcomes: an overview.
复制标题
DOI：
10.1902/annals.2001.6.1.153
复制
发表时间：
2001-12-01
期刊：
影响因子：
--
通讯作者：
Gibbs, R S
中科院分区：
文献类型：
--
作者：
Gibbs, R S
早产及其随之而来的发病率和死亡率是美国主要的围产期问题。在妊娠第三十七周之前出生的婴儿约占所有新生儿的6%至9%，但占所有围产期死亡的70%和所有长期神经系统发病率的一半。目前的治疗方法侧重于对症治疗。尽管广泛使用药物来阻止早产(宫缩)，但在过去的20年里，低出生体重或早产儿的数量并没有减少。以预防或治疗根本原因为目的的治疗很可能会更成功。来自许多来源的证据将早产与症状感染联系在一起，例如，尿路或呼吸道感染。在过去的十年里，人们对亚临床感染是早产的重要原因这一假说产生了极大的兴趣。支持这一观点的证据可归类为：组织学上的绒毛膜羊膜炎在早产中增加；早产后临床感染增加；一些下生殖道组织和感染与早产或早产胎膜早破显著相关；一些早产和早产患者羊水或胎膜培养阳性；早产有感染标志；细菌或其产品在动物模型中诱导早产；一些抗生素试验显示早产率较低或已推迟早产。在过去的5年里，更多令人兴奋的信息表明，不仅亚临床感染导致早产，而且许多严重的新生儿后遗症也是如此，包括脑室周围白质软化、脑瘫、呼吸窘迫，甚至支气管肺发育不良和坏死性小肠结肠炎。总之，大量的临床和实验室信息表明，亚临床感染是早产的主要原因，特别是发生在30周前的早产。这一概念承诺，可以开发新的方法来防止早熟。
Preterm birth with its subsequent morbidity and mortality is the leading perinatal problem in the United States. Infants born before the thirty-seventh week of gestation account for approximately 6% to 9% of all births, but 70% of all perinatal deaths and half of all long-term neurologic morbidity. Current approaches focus on symptomatic treatment. Despite widespread use of drugs to arrest preterm labor (tocolytics), there has been no decrease in low birth weight or preterm infants in the last 20 years. It is likely that therapy directed at preventing or treating underlying causes would be more successful. Evidence from many sources links preterm birth to symptomatic infections, for example, of the urinary or respiratory tracts. In the last decade, great interest has been generated to support the hypothesis that subclinical infection is an important cause of preterm labor. Evidence to support this may be categorized as follows: histological chorioamnionitis is increased in preterm births; clinical infection is increased after preterm birth; there is significant association of some lower genital tract organisms and infections with preterm birth or preterm premature rupture of the membranes; there are positive cultures of amniotic fluid or membranes from some patients with preterm labor and preterm birth; there are markers of infections in preterm birth; bacteria or their products induce preterm birth in animal models; and some antibiotic trials have shown a lower rate of preterm birth or have deferred preterm birth. In the last 5 years, additional exciting information has suggested that not only is subclinical infection responsible for preterm birth but also many serious neonatal sequelae including periventricular leukomalacia, cerebral palsy, respiratory distress, and even bronchopulmonary dysplasia and necrotizing enterocolitis. In sum, a large body of clinical and laboratory information suggests that subclinical infection is a major cause of preterm birth, especially those occurring before 30 weeks. This concept holds promise that new approaches can be developed to prevent prematurity.