围产期母体下生殖道解脲脲原体定植对婴儿不安运动阶段神经发育的影响

关键词：围产期  解脲脲原体  下生殖道  不安运动  神经发育

Keywords:perinatal period  ureaplasma urealyticum  lower genital tract  fidget movements  neurodevelopment

摘要：

      摘要 目的：探究围产期母体下生殖道解脲脲原体（ureaplasma urealyticum， UU）定植对婴儿不安运动（fidget movements phase， FMs）阶段神经发育的影响。 方法：本研究为回顾性队列研究，以围产期下生殖道进行UU检测的母体、FMs阶段进行全身运动评估（general movements assessment， GMs）和头颅磁共振成像（magnetic resonance imaging， MRI）检查的婴儿作为研究对象，婴儿最后一次GMs为队列终点。本研究母婴各纳入140例，其中围产期母体下生殖道UU定植组71例，UU非定植组69例。采用χ2检验比较UU定植与婴儿FMs阶段神经发育的相关性，采用Logistic回归分析其危险/保护因素，根据ROC曲线最佳切入点进一步将UU定植组归类成高/低UU-DNA copy数亚组，观察亚组间以及UU-DNA copy数与婴儿FMs阶段神经发育的关系。 结果：UU定植组母体在胎膜早破、阴道分娩、是否有流产史方面同UU非定植组比较差异有显著性（P＜0.05），婴儿在胎龄、出生体重、新生儿窒息、新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy， HIE）、脑室内出血方面同UU非定植组比较差异有显著性（P＜0.05）；χ2检验结果显示围产期母体下生殖道UU定植将对婴儿FMs阶段神经发育产生不良影响（P＜0.05）；Logistic分析结果显示新生儿窒息、HIE是导致FMs阶段异常神经发育的独立性危险因素（P＜0.05），而UU定植对婴儿FMs阶段神经发育的影响并不显著（OR=0.251，95%CI=1.913—5.786）。随着围产期母体下生殖道UU-DNA copy数增加（UU≥3.15×104 copy/ml）婴儿FMs阶段异常神经发育的风险增加。 结论：围产期母体下生殖道UU定植并非导致婴儿不安运动阶段异常神经发育的独立性危险因素，但UU定植可对神经发育造成不良影响，且UU-DNA高copy数值与婴儿不安运动阶段异常神经发育呈正相关关联。

Abstract:

      Abstract Objective： Investigating the effect of perinatal maternal lower genital tract ureaplasma urealyticum （UU） colonization on neurodevelopment in infants at the fidget movements phase （FMs）. Method： This study is a retrospective cohort with moms who were conducted UU testing in the prenatal lower genital tract，and infants who underwent general movements assessment （GMs） and cranial magnetic resonance imaging （MRI） throughout the FMs phase. In addition, the last GMs was served as the cohort endpoint. 71 cases of perinatal maternal lower vaginal tract UU colonization and 69 cases of UU non-colonization were included in this study. The relationship between subgroups and the relationship between UU-DNA copy number and neurodevelopment of infants at the FMs stage were observed. χ2 test was used to compare the correlation between UU colonization and neurodevelopment of infants at the FMs phase， and logistic regression was used to analyze the risk/protective factors. The UU colonization group was further divided into high or low UU-DNA copy number subgroups according to the best cut-off point of the ROC curve. Neurodevelopment was observed in infants at the FMs phase. Result： There were significant differences in maternal UU fixation group in terms of premature rupture of membranes （PROM）， vaginal delivery， and history of miscarriages compared with the UU non-fixation group （P<0.05）， and significant differences in infant’s age， birth weight， neonatal asphyxia， neonatal hypoxic-ischemic encephalopathy （HIE）， and intraventricular hemorrhage compared with the UU non-fixation group （P<0.05）. χ2 test results showed that perinatal maternal lower genital tract UU colonization would adversely affect the neurodevelopment of infants at the FMs phase （P<0.05）. Binary ordered logistic multifactorial analysis showed that neonatal asphyxia and HIE were independent risk factors for abnormal neurodevelopment at the FMs phase （P<0.05）， while the effect of UU colonization on the neurodevelopment of infants at the FMs phase was not significant （OR=0.251，95%CI 1.913—5.786）. With an increase in the number of UU-DNA copies in the maternal lower genital tract during the perinatal period （UU≥3.15×104 copy/ml） the risk of abnormal neurodevelopment in infants at the FMs phase increased. Conclusion： Perinatal maternal lower genital tract UU colonization is not an independent risk factor for abnormal neurodevelopment during the restless motor phase， but UU colonization can adversely affect neurodevelopment， and high UU-DNA copy values are positively associated with abnormal neurodevelopment during the fidget movements phase of infants.