摘要目的 探讨组织学绒毛膜羊膜炎(HCA)的病理改变与新生儿感染的关系.方法 收集2012年6月至2014年12月在西北妇女儿童医院产科分娩且胎盘、胎膜及脐带完整送病理检查的病例共5 810例,其中胎盘病理检查诊断为HCA的898例,总体阳性率为18.3％.回顾所有病例的新生儿临床资料,将临床资料完整的新生儿分组,其中病例组(感染新生儿)308例、对照组(非感染新生儿)120例,将新生儿的出生方式、性别、胎龄、临床感染情况和实验室检查结果与其胎盘病理结果进行比较,采用相关性分析的方法进行统计学分析.结果 两组428例新生儿中早产儿39例(39/428,9.1％),小于胎龄儿21例(21/428,4.9％),剖宫产111例(111/428,25.9％).308例感染新生儿中败血症104例、化脓性脑膜炎16例、感染性肺炎78例、感染性肠炎34例、尿路感染18例、皮肤感染58例.胎盘病理检查诊断早期HCA 40例(病例组18例,对照组22例),中期HCA 104例(病例组88例,对照组16例),晚期HCA 183例(病例组172例,对照组11例).中-晚期HCA易见于早产儿,其孕晚期B族链菌筛查阳性率及出生后血培养阳性率明显更高(均P ＜0.05);中-晚期HCA患儿具有相对高的血清C反应蛋白浓度和白细胞计数(均P＜0.05);中-晚期HCA、脐带炎与合体细胞结节增生与新生儿感染明显相关(P＜0.05),而局灶绒毛炎、绒毛小叶血栓形成以及绒毛纤维素沉着与新生儿感染无明显相关(P＞0.05).结论 HCA患者临床无症状或症状轻微,仅靠胎盘病理检查发现,易漏诊,与胎儿感染以及新生儿感染密切相关.因此,准确详细的胎盘病理检查对于诊断围产儿感染意义重大.

abstractsObjective To investigate the pathologic features of histologic chorioamnionitis (HCA) and its impact on newborns.Methods From Jun.2012 to Dec.2014,5 810 placentas delivered in our hospital were collected.There were 898 HCA cases and positive rate was 18.3％.Cases with complete clinical data were collected,including 308 cases of infected newbon infants (case group),and 120 cases of non-infected infants(control group).The correlation between pathologic results and neonatal outcome was analyzed.Results Thirty nine cases were premature delivery(39/428,9.1％).Twenty one cases were small for gestational age (21/428,4.9％).One hundred and eleven cases were delivered by caesarean section (111/428,25.9％).Three hundred and eight cases of neonatal infection included 104 cases of hematosepsis,16 cases of purulent meningitis,78 cases of infectious pneumonia,34 cases of infective enteritis,18 cases of urinary tract infection and 58 cases of skin infection.Placental pathological examination found out 40 cases showed mild HCA (18 cases of neonatal infection,and 22 non-neonatal infection cases),104 cases showed moderate HCA (88 cases of neonatal infection,and 16 non-neonatal infection cases),and 183 cases showed severe HCA (172 cases of neonatal infection and 11 non-neonatal infection cases).Moderate to severe HCA were easily found in premature infants,with higher positive rate of both late pregnancy group B streptococcus (P ＜ 0.05) and afterbirth blood culture (P ＜ 0.05).Significantly higher serum C reaction protein(P ＜ 0.05) and white-cell count(P ＜ 0.05) were also found within moderate to severe HCA patients.Moderate to severe HCA,funisitis and syncytial nodular hyperplasia were associated with neonatal infections (P ＜ 0.05),while infarction,intervillous thrombosis and villi thrombus were not observed in the inflammation group (P ＞ 0.05).Conclusions HCA is often of few clinical symptoms and easily misdiagnosed by placental pathological assessment only.HCA is found associated with intrauterine infection and neonatal infection.Pathological assessment of placenta is valuable in diagnosis and treatment of intrauterine infection.