新生儿胆汁淤积的临床特征和病因分析  

Clinical features and etiology of cholestasis in neonates

作　　者：王瑾[1] 张蓉[1] 安宁[1] 袁琳[1] 陈超[1] 

机构地区：[1]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华医学杂志》2012年第18期1259-1263,共5页National Medical Journal of China

摘　　要：目的总结新生儿胆汁淤积病例临床特征和病因，并分析早产儿和足月儿的差异。方法对2004年1月至2010年12月复旦大学儿科医院住院的176例新生儿胆汁淤积病例进行回顾性分析。淤胆病因分为胃肠外营养相关胆汁淤积（PNAC）、感染、胆道疾病、先天畸形或染色体疾病、遗传代谢性疾病、其他和原因不明7大类。将所有患儿按出生孕周分为足月儿组35例，早产儿组141例，观察两组喂养、静脉营养使用、感染史、缺氧史等胆汁淤积相关因素，以及发病时间、总胆红素和结合胆红素水平、肝脏受损情况、相关实验室指标等，并分析两组引起淤胆的病因和预后差异。结果早产儿组禁食、开奶、达到全量喂养、使用胃肠外营养的时间均明显长于足月儿组（均P〈0．01），使用全胃肠外及有感染史的比例均高于足月儿组（均P〈0．05）；而足月儿发生淤胆、出现肝损伤的时间却明显早于早产儿（均P〈0．05）。足月儿组胆汁淤积治愈和好转率62．9％（22／35），明显低于早产儿组[82．3％（116／141），P=0．014]。足月儿淤胆病因中感染11例（31．4％）、胆道闭锁4例（11．4％）、先天畸形或染色体异常7例（20．0％）、遗传代谢性疾病3例（8．6％）、其他原因7例（20．0％）、不明原因3例（8．6％）。早产儿中达到PNAC诊断标准97例（68．8％），其平均出生孕周30＋4（25＋3～36＋2）周；另44例（31．2％）早产儿不符合PNAC诊断，平均孕周33＋3（27—36＋5）周。其中感染21例、胆道疾病3例、遗传代谢性疾病2例、其他病因5例、原因不明13例。结论新生儿胆汁淤积病因繁多，相对而言足月儿和早产儿非PNAC胆汁淤积的病因更为复杂。有必要对住院新生儿进行常规筛查发现淤胆，对明确淤胆患儿应尽早病因诊断，并长期随访。Objective To explore the clinical features and etiology of cholestasis in neonates, and elucidate the difference between preterm and term infants. Methods A retrospective study was conducted for 176 cases of cholestasis during neonatal periods from January 2004 to December 2010 of Children＇s Hospital of Fudan University. Their etiologies included parenteral nutrition-associated cholestasis （PNAC）, infection, biliary tract disorders, congenital abnormalities and chromosomal disorders, metabolic diseases, others （prenatal hypoxia, post unconjugated hyperbilirubinemia, neonatal lupus and congenital chylothorax） and unknown reasons. They were also divided into term and preterm groups according to gestational age, the relative factors, such as feeding patterns, use of parenteral nutrition （ PN）, infection and hypoxic history, and the clinical features, such as cholestasis onset age, bilirubin level, liver function and outcome were compared between two groups. Results The time of fasting, age of starting feeding, age of reaching to full feeding and the time of overall PN time were all longer in the preterm group than those in the term group （ all P 〈 0.01 ）. The preterm group had more PN and infection cases （ all P 〈 0. 05）. The term group presented earlier with cholestasis and liver function damage versus the preterm group （ both P 〈 0.05 ）. The rate of recovery in term group is lower than in preterm group which is （62. 9% （22/35） vs 82. 3% （ 116/141 ）, P=0. 014）. The etiologies of 35 term infants were infection （n = 11, 31.4% ）, biliary tract disorders （n =4, 11.4% ）, congenital abnormalities and chromosomal disorders （ n = 7, 20.0% ）, metabolic diseases （n = 3, 8.6% ）, others （n = 7, 20. 0% ） and unknown reasons （n = 3, 8.6% ）. There were 97 cases （68. 8% ） of PNAC in preterm infants and the average gestational age was 30 ＋4 （25 ＋3 _ 36 ＋2） weeks. And the etiologies of the remaining 44 （ 31.2% ） preterm cases without PNAC were infe

关 键 词：胆汁淤积 高胆红素血症 婴儿 新生 婴儿 早产 

分 类 号：R722.1[医药卫生—儿科]