摘要
目的:分析超低出生体质量儿肠外营养(PN)相关胆汁淤积(PNAC)发生率及相关因素.方法:回顾性收集305例接受PN支持治疗的超低出生体质量儿的临床资料,统计其PNAC发生率.根据其是否发生PNAC分为观察组(是,n=54)和对照组(否,n=251).收集纳入新生儿的性别、胎龄、分娩方式、出生体质量、出生1 min及5 min时Apgar评分、并发症(新生儿感染、新生儿贫血等)发生情况;住院时间、喂养困难、PN开始时间、PN持续时间;氨基酸累计用量、脂肪乳累计用量;出生第14天血清指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、总胆汁酸(TBA)]水平等信息.分析影响超低出生体质量儿发生PNAC的相关因素.结果:305例接受PN干预的超低出生体质量儿中共有54例发生PNAC,发生率为17.70％.观察组胎龄、出生体质量均低于对照组(P＜0.05),新生儿感染比例、住院时间、喂养困难比例、PN持续时间、ALT、AST、TBil、TBA均高于对照组(P＜0.05);Logistic回归分析显示,出生体质量高为超低出生体质量儿发生PNAC的保护因素,而PN持续时间越长、ALT、AST、TBil、TBA等指标高均是超低出生体质量儿发生PNAC的独立危险因素(P＜0.05).结论:超低出生体质量儿的出生体质量、PN持续时间及ALT、AST、TBil、TBA检测水平对于评估和预测超低出生体质量儿发生PNAC具有一定指导价值.
Abstract
Objective:To analyze the incidence and related factors of parenteral nutrition(PN)-associated cholestasis(PNAC)in extremely low birth weight infants.Methods:The clinical data of 305 extremely low birth weight infants who were received PN sup-portive treatment were collected retrospectively.The incidence of PNAC was calculated.Infants included were divided into the observa-tion group(with PNAC,n=54)and the control group(without PNAC,n=251).Information of the infants was collected,including gender,gestational age,delivery mode,birth weight,1 min and 5 min Apgar scores,complications(neonatal infection,neonatal anemia,etc.),length of hospital stay,feeding difficulties,PN start time,PN duration,cumulative dosage of amino acids,cumulative dosage of fat emulsion,and the levels of serum indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil)and total bile acid(TBA)]on 14 day after birth.Univariate analysis and multivariate analysis were conducted to screen the factors influencing the occurrence of PNAC in extremely low birth weight infants.Results:There were 54 cases of PNAC,with an inci-dence rate of 17.70％.Compared with the control group,gestational age and birth weight of the observation group were lower(P＜0.05).The proportion of neonatal infections,length of hospital stay,the proportion of feeding difficulties,PN duration,and the levels of ALT,AST,TBil and TBA in the observation group were higher and longer(P＜0.05).Logistic regression analysis showed that high birth weight was a protective factor,while PN duration and the levels of ALT,AST,TBil and TBA were independent risk factors for PNAC in extremely low birth weight infants(P＜0.05).Conclusion:Birth weight,PN duration and the levels of ALT,AST,TBil and TBA are helpful for evaluating and predicting the occurrence of PNAC in extremely low birth weight infants.
维普
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