新生儿胃肠外营养相关性胆汁淤积的发生及危险因素评估  

Incidence of and risk factors for parenteral nutrition associated cholestasis in neonates

作　　者：云翔[1] 罗彬[2] 漆光紫[3] 唐清[1] 单庆文[1] 陈秀奇[1] 陈玉君[1] 王琳琳[1] 

机构地区：[1]广西医科大学一附院儿科,广西壮族自治区南宁市530021 [2]广西医科大学基础医学院,广西壮族自治区南宁市530021 [3]广西医科大学公共卫生学院,广西壮族自治区南宁市530021

出　　处：《世界华人消化杂志》2014年第19期2789-2794,共6页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81360374~~

摘　　要：目的:研究新生儿胃肠外营养相关性胆汁淤积(parenteral nutrition associated cholestasis,PNAC)的发生及相关危险因素,为临床上PNAC的预防和诊疗奠定基础.方法:对接受胃肠外营养(parenteral nutrition,PN)超过14 d的97例新生儿进行回顾分析,研究PNAC的发病率及与出生胎龄、出生体质量和PN持续时间等指标的关系;按是否发生PNAC进行分组,统计比较PNAC组和非PNAC组间各相关影响因素有无差异并寻找危险因素.结果:PNAC发病率为18.56%(18/97);新生儿出生体质量越低、PN持续时间越长,其PNAC发病率越高.PNAC组与非PNAC组相比,出生体质量(1.53 kg±0.41 kg vs 1.79 kg±0.55kg,P<0.05)、PN持续时间(32.28 d±16.31 d vs22.78 d±7.60 d,P<0.05)、完全肠外营养持续时间[7(3.75-9.75)vs 3(0-7),P<0.01]、氨基酸累积用量(67.82 g/kg±48.35 g/kg vs 48.58 g/kg±22.17 g/kg,P<0.05)、氨基酸使用时间(32.28d±16.31 d vs 22.61 d±7.57 d,P<0.05)、脂肪乳使用时间(28.17 d±10.61 d vs 21.38 d±7.42 d,P<0.01)、有否感染(83.33%vs 34.18%,P<0.01)的差异具有统计学意义;L o g i s t i c回归分析显示感染(OR=6.818,95%CI:1.599-29.07,P<0.01)和氨基酸使用时间(OR=1.228,95%CI:1.057-1.426,P<0.01)是PNAC发生的独立危险因素.结论:PNAC的发生可能与新生儿出生体质量、PN和完全胃肠外营养持续时间、氨基酸累积用量、氨基酸和脂肪乳使用时间、有否感染有关,其中感染和氨基酸使用时间可能是PNAC发生的独立危险因素.AIM： To investigate the incidence of and risk fac-tors for parenteral nutrition associated cholesta-sis（PNAC） in neonates.METHODS： A retrospective review of 97 neo-nates who had received parenteral nutrition（PN） for more than 14 d was performed. Theincidence of PNAC and the possible relationship among birth weight, gestational age, duration of PN and PNAC frequency were analyzed. Subjects were divided into either a PNAC group or a non-PNAC group. Statistical analysis was done to compare several parameters relevant to PNAC between the two groups. The risk factors for PNAC were also assessed. RESULTS： The incidence of PNAC was 18.6%（18/97）. The neonates with lower birth weight or longer duration of PN had a higher incidence of PNAC. There were significant differences be-tween the PNAC group and non-PNAC group with respect to birth weight（1.53 kg ± 0.41 kg vs 1.79 kg ± 0.55 kg, P〈0.05）, duration of PN（32.28 d ± 16.31 d vs 22.78 d ± 7.60 d, P〈0.05）, dura-tion of total parenteral nutrition [7（3.75-9.75） vs 3（0-7）, P〈0.01], cumulative amount of amino acids（67.82 g/kg ± 48.35 g/kg vs 48.58 g/kg ± 22.17 g/kg, P〈0.05）, duration of amino acid intake（32.28 d ± 16.31 d vs 22.61 d ± 7.57 d, P〈0.05）, duration of lipid emulsion intake（28.17 d ± 10.61 d vs 21.38 d ± 7.42 d, P〈0.01）, and infection（83.33% vs 34.18%, P〈0.01）. Logistic regression analysis revealed that infection（OR = 6.818, 95%CI： 1.599-29.07, P〈0.01） and dura-tion of amino acid intake（OR = 1.228, 95%CI： 1.057-1.426, P〈0.01） were independent risk fac-tors for PNAC. CONCLUSION： PNAC may be associated with birth weight, duration of PN and TPN, cumula-tive amount of amino acids, duration of amino acid and lipid emulsion intake, and infection. Infection and duration of amino acid intake are independent risk factors for PNAC.

关 键 词：胃肠外营养 胃肠外营养相关性胆汁淤积 危险因素 

分 类 号：R722.1[医药卫生—儿科]