年龄别体质量Z评分法动态评估早产儿宫外生长发育迟缓  

Variation of weight for age Z scores in preterm infants with extrauterine growth restriction

作　　者：徐文英[1] 胡金绘[2] 岳虹霓[1] 张丽[1] 王玉美[1] 武荣[2] 

机构地区：[1]扬州大学医学院附属淮安市妇幼保健院儿童保健科,江苏淮安223002 [2]扬州大学医学院附属淮安市妇幼保健院新生儿医学中心,江苏淮安223002

出　　处：《中华实用儿科临床杂志》2016年第2期108-111,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的了解宫外生长发育迟缓（EUGR）早产儿的年龄别体质量z（WZ）评分变化规律，探讨WZ评分法对早产儿发生EUGR的动态评估优势。方法回顾性分析2011年1月至2013年12月在淮安市妇幼保健院新生儿医学中心收治的出生4h内住院、住院4周以上、小胎龄（胎龄〈32周，VLGA）早产儿资料。根据出院时体质量是否低于校正年龄体质量的第10百分位来诊断EUGR，分为非EUGR组和EUGR组。分别计算早产儿出生后每周的WZ评分值，观察2组早产儿的WZ评分变化趋势，比较2组问的差异。作WZ评分诊断EUGR的受试者操作特征曲线（ROC），比较每周的ROC下面积，分析其敏感度和特异度等诊断试验评价指标。结果共177例VLGA早产儿人选，其中EUGR早产儿104例，EUGR发生率为58．8％。EUGR组的WZ评分曲线在全部早产儿之下，非EUGR组在全部早产儿之上；全部早产儿和EUGR组早产儿每周WZ评分随住院时间延长整体呈下降趋势；而非EUGR组早产儿每周WZ评分除了第1周下降外，其他时间点变化不明显。2组的WZ评分均为负值，EUGR组在出生时（-0．84±0．39比-0．31±0．41）、出生第1周（-1．19±0．36比-0．74±0．40）、出生第2周（-1．17±0．36比-0．68±0．40）、出生第3周（-1．23±0．34比-0．64±0．39）、出生第4周（-1．35±0．41比-0．65±0．42）、出生第5周（-1．45±0．41比-0．56±0．38）、出生第6周（-1．54±0．49比-0．70±0．36）、出院时（-1．72±0．38比-0．67±0．42）WZ评分均低于非EUGR组，差异有统计学意义（P均=0．000）。早产儿开始胃肠喂养时间（r=-0．271）、胃肠营养达418k．1／（kg·d）的时间（r=-0．388）、达全胃肠喂养时间（r=-0．332）、氨基酸累积使用剂量（r=-0．298）、脂肪乳累积使用剂量（r=-2．221）与出院时WZ评分均呈负相关（P均〈0．05）。每周的WZ评分预测EUGR的曲线下面积随着出生后时间的Objective To understand variation of weight for age Z scores in premature infants with extrauterine growth restriction（ EUGR）. Methods Retrospective analysis was adopted with the data of very - low - gestational age （VLGA） preterm infants who met with the following criteria：admitted to Neonatal Medical Center of Huai＇an Maternity and Child Healthcare Hospital from January 2011 to December 2013, gestational age 〈 32 weeks, more than 4 weeks of hospital stay and survived when discharged. All VLGA premature infants were divided into non - EUGR group and EUGR group according to whether the standard weight on hospital discharge was below the 10^th percentile of body weight at corrected age. The weight for age Z scores of preterm infants were calculated at each time point. The differences and trends between 2 groups were compared. The receiver operating characteristic （ ROC ） curve in diagnosing EUGR by weight for age Z scores was drawn. Results A total of 177 VLGA premature infants were enrolled, and among them there were was 104 cases of EUGR and the incidence amounted to 58.8%. The weight for age Z scores curve of EUGR group was under that of all preterm infants, and the curve of non - EUGR group was above that of all preterm infants. The weight for age Z scores of all preterm infants and EUGR group showed overall downward trend along with prolonged hospitalization. However, the weight for age Z scores of non - EUGR group did not change significantly at each week point except for the first week. The weight for age Z scores of EUGR group was lower than that of non - EUGR group at birth （ -0.84±0.39vs -0.31±0.41）,the first week after birth （ -1.19±0.36 vs -0.74±0.40）,the second week after birth （ - 1.17 ± 0.36 vs - 0. 68 ± 0.40）, the third week after birth （ - 1.23 ± 0. 34 vs -0. 64 ± 0.39 ）, the fourth week after birth （ - 1.35 ± 0.41 vs - 0. 65 ± 0.42 ） , the fifth week after birth （ - 1.45 ± 0.41 vs - 0. 56 ± 0. 38 ） , the sixth week （ - 1.54± 0.49 vs - 0. 70

关 键 词：宫外生长发育迟缓 年龄别体质量Z评分 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]