128例新生儿胆汁淤积症临床病例特征回顾性分析  

Restrospective analysis of clinicopathological features of 128 cases of neonatal cholestasis

作　　者：赵阳[1] 王建华[2] 胡晓明[1] 王晓颖[1] 康利民[1] 贾盛华 杨盛男 李莉[1] Yang;Wang Jianhua;Hu Xiaoming;Wang Xiaoying;Kang Limin;Jia Shenghua;Yang Shengnan;Li Li(Department of Neonatology,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Beijing Key Laboratory of Child Development and Nutriomics,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院新生儿科,北京100020 [2]首都儿科研究所儿童发育营养组学北京市重点实验室,北京100020

出　　处：《中华临床医师杂志（电子版）》2019年第5期321-325,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家自然科学基金资助项目(81571443);北京市自然科学基金资助项目(7172038)

摘　　要：目的总结新生儿胆汁淤积病例的临床资料,并分析早产儿和足月儿的差异。方法对2017年2月至2019年2月首都儿科研究所附属儿童医院新生儿科住院的128例新生儿胆汁淤积病例进行回顾性分析。将所有患儿按出生孕龄分为足月儿组(孕龄38~<42周)66例,早产儿组(孕龄28~<38周)62例,观察2组一般临床资料、生化指标及确诊胆道闭锁比例结果。采用成组t检验,对2组患儿年龄、黄疸持续时间及天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、白蛋白、球蛋白、血清Ca2+、胆汁酸、血氨、乳酸和碱性磷酸酶(ALP)水平等进行统计学比较。采用Mann-Whitney U秩和检验,对2组患儿γ-谷氨酰转肽酶(GGT)、丙氨酸氨基转移酶(ALT)水平等进行统计学比较。采用χ2检验,对2组患儿性别构成比、白陶土样便发生率及肝大、脾大、GGT水平≥300 U/L、TBil浓度≥150.0μmol/L和DBil浓度≥100.0μmol/L所占比例进行统计学比较。结果 (1)2组患儿年龄、黄疸持续时间、肝大和脾大所占比例分别比较,差异均无统计学意义(P>0.05),黄疸开始时间比较,差异有统计学意义(P <0.05)。(2)足月儿组患儿白陶土样便发生率及GGT水平≥300 U/L、TBil浓度≥150.0μmol/L、DBil浓度≥100.0μmol/L与胆道闭锁所占比例,均显著高于早产儿组,差异均有统计学意义(χ2=17.266、34.613、26.848、18.657、35.186,P <0.05)。足月儿组患儿GGT水平和DBil浓度分别为389.9(316.0,1127.3)U/L和(118.3±35.2)μmol/L,显著高于早产儿组的128.9(110.3,361.8)U/L和(86.3±35.8)μmol/L,2组分别比较,差异均有统计学意义(Z=2.845,P=0.003;t=3.314,P <0.05)。结论足月儿与早产儿胆汁淤积症在临床上存在差异性,足月儿胆道闭锁发生率更高,应积极行胆道造影检查以排除胆道闭锁。Objective To summarize the clinical data of neonatal cholestasis and analyze its difference between premature and full-term infants. Methods A total of 128 cases of neonatal cholestasis were retrospectively analyzed from February 2017 to February 2019 at the Department of Neonatology of the Children′s Hospital Affiliated to the Capital Institute of Pediatrics. The patients were divided into a fullterm infant group(66 cases) and premature infant group(62 cases) according to their gestational weeks. The general clinical data, biochemical indicators, and ultrasonographic results of the two groups were compared. The age, duration of jaundice, and the levels of aspartate aminotransferase(AST), total bilirubin(TBil), direct bilirubin(DBil), albumin, globulin, serum Ca2+, bile acid, blood ammonia, lactic acid, and alkaline phosphatase(ALP) were compared by the t-test. The levels of gamma-glutamyl transpeptidase(GGT) and alanine aminotransferase(ALT) in the two groups were compared by the Mann-Whitney U rank sum test. The Chi-square test was used to compare the sex ratio, the incidence of clay stool, hepatomegaly, and splenomegaly, and the percentages of patients with GGT level > 300 U/L, TBil concentration > 150.0 mol/L, and DBil concentration > 100.0 mol/L in the two groups. Results There was no significant difference in age, the duration time of jaundice or the incidence of hepatomegaly and splenomegaly between the two groups(P > 0.05), but there was a significant difference in the onset time of jaundice(P < 0.05). The incidence of clay stool and the percentages of patients with GGT > 300 U/L, TBil > 150.0 mol/L, DBil > 100.0 mol/L, and biliary atresia were significantly higher in the full-term infant group than in the preterm group(χ2=17.266, 34.613, 26.848, 18.657, and 35.186, P < 0.05). The GGT level and DBIL concentration of full-term infants were 389.9 U/L(316.0-1127.3) and(118.3±35.2) mol/L, respectively, which were significantly higher than those of preterm infants [128.9(110.3-361.8) and(86.3±35.8) mol/L;

关 键 词：早产儿 足月儿 新生儿 胆汁淤积 胆道闭锁 

分 类 号：R722.1[医药卫生—儿科]