早产儿代谢性骨病的临床高危因素分析  

Clinical high-risk factors of metabolic bone disease in very low birth weight infants

作　　者：徐佳鑫 李向红[1] 王小虎[1] 尹向云[1] 锡洪敏[1] 袁芮 杨丽娟[1] Xu Jiaxin;Li Xianghong;Wang Xiaohu;Yin Xiangyun;Xi Hongmin;Yuan Rui;Yang Lijuan(Neonatal Intensive Care Unit,The Affiliated Hospital of Qingdao University,Qingdao 266555,Shandong,China)

机构地区：[1]青岛大学附属医院新生儿科,266555

出　　处：《中华临床营养杂志》2019年第6期374-380,共7页Chinese Journal of Clinical Nutrition

摘　　要：目的回顾性分析早产儿代谢性骨病(MBD)的临床资料,分析早产儿MBD的高危因素,为临床规范诊治提供依据。方法回顾性分析2016年1月至2017年12月于青岛大学附属医院新生儿监护病房住院的出生体重<1500 g的早产儿资料。将生后血清碱性磷酸酶(ALP)>500 IU/L且同期血磷<1.5 mmol/L,出生体重<1500 g的早产儿纳入研究组,随机选取未发生MBD的出生体重<1500 g的早产儿作为对照组。记录并比较两组一般资料、肺表面活性物质、持续气道正压、机械通气、开始肠内营养时间、肠外营养时间、母乳喂养时间及母乳强化剂添加情况、药物使用、住院时间、并发症等信息。结果研究期间共收治出生体重<1500 g的早产儿440例。研究组患儿58例,发病率13.2%(58/440),其中出生体重<1000 g有33例,占研究组的56.9%(33/58)。出生体重是早产儿MBD的独立保护因素(OR=0.62;95%CI:0.389~0.990),出生体重越重,发生早产儿MBD的风险越低;母乳喂养时间越长(OR=2.191;95%CI=1.628~2.950)、开始肠内喂养时间越晚(OR=2.695;95%CI=1.710~4.248)、肠外营养时间越长(OR=6.205;95%CI=3.359~11.463)、呼吸支持时间越长(OR=1.046;95%CI=1.026~1.067)、住院时间越长(OR=1.703;95%CI=1.109~2.615)以及小于胎龄儿(SGA)(OR=2.965;95%CI=1.163~5.658),发生早产儿MBD的风险越高,均是早产儿MBD的独立危险因素。其中肠外营养维持时间是最重要的独立危险因素(OR=6.205;95%CI=(3.359~11.463))。结论多种因素导致早产儿发生MBD,出生体重是早产儿MBD的独立保护因素,肠外营养时间是MBD的最危险因素。Objective To explore the high-risk factors of metabolic bone disease(MBD)in premature infants by retrospective analysis of the clinical data so as to provide evidence for optimal clinical management.Methods Clinical data of premature infants with birth weight<1500 g admitted in our hospital from January 2016 to December 2017 were retrospectively analyzed.Infants with serum alkaline phosphatase(ALP)>500 IU/L and blood phosphorus<1.5 mmol/L were selected as MBD group and premature infants with birth weight<1500 g were selected randomly as non-MBD group.General data,pulmonary surfactant,continuous positive airway pressure,mechanical ventilation,start time of enteral nutrition,parenteral nutrition(PN)time,breast feeding time and breast milk fortifier adding,drug usage,hospitalization time and complications were recorded and compared between the two groups.Results A total of 440 premature infants with birth weight<1500 g were admitted to the hospital during the study period.58[13.2%(58/440)]infants were enrolled in the MBD group,among which infants with birth weight<1000 g accounting for 56.9%(33/58).High birth weight(OR=0.62,95%CI:0.389-0.990)was an independent protective factor of MBD in premature infants.The higher the birth weight,the lower the risk of MBD in premature infants.The longer duration of breast feeding time(OR=2.191,95%CI:1.628-2.950),later initial time of enteral feeding(OR=2.695,95%CI:1.710-4.248),longer duration of PN(OR=6.205,95%CI:3.359-11.463)time,longer duration of respiratory supporting time(OR=1.046,95%CI:1.026-.067),longer hospital stay time(OR=1.703,95%CI:1.109-2.615)and small for gestational age(OR=2.965,95%CI:1.163-5.658)were independent risk factors of MBD in premature infants.The duration of PN was the most important independent risk factor of MBD in premature infants(OR=6.205,95%CI:3.359-11.463).Conclusion Multiple factors can lead to MBD of premature infants.The high birth weight is an independent protective factor of MBD and the duration of PN is the most important independent risk fa

关 键 词：早产儿 代谢性骨病 高危因素 

分 类 号：R722[医药卫生—儿科]