胃肠外营养相关胆汁淤积症患儿预后不良的相关因素分析  

Analysis of related factors of poor prognosis in children with parenteral nutrition-associated cholestasis

作　　者：易巍 于雪 余雷[3] 熊小丽[3] 江治霞[3] 周俪姗[3] 丘燕燕 鄢素琪[3,4] Yi Wei;Yu Xue;Yu Lei;Xiong Xiaoli;Jiang Zhixia;Zhou Lishan;Qiu Yanyan;Yan Suqi(Clinical College of Traditional Chinese Medicine,Hubei University of Chinese Medicine,Wuhan 430065,Hubei,China;Jianghan University,Wuhan 430058,Hubei,China;Department of Integrated Traditional Chinese Medicine and Western Medicine,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,Hubei,China;Hubei University of Chinese Medicine,Wuhan 430065,Hubei,China)

机构地区：[1]湖北中医药大学中医临床学院,武汉430065 [2]江汉大学,湖北武汉430058 [3]华中科技大学同济医学院附属武汉儿童医院中西医结合科,湖北武汉430016 [4]湖北中医药大学,武汉430065

出　　处：《中华危重病急救医学》2021年第6期731-735,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金面上项目(81574024);湖北省武汉市医药卫生临床医学科研项目(WZ17A07);湖北省医药卫生中医药中西医结合科研项目(2017HZ-Y35)。

摘　　要：目的探讨影响胃肠外营养相关胆汁淤积症(PNAC)患儿预后的相关因素。方法采用回顾性研究方法,选择华中科技大学同济医学院附属武汉儿童医院2014年1月至2020年12月收治的20例PNAC患儿作为研究对象。将患儿按预后分为预后良好组(15例)和预后不良组(5例)。收集两组患儿一般情况、静脉营养时间、相关生化检查指标、主要治疗方法等临床资料;采用Spearman相关性分析法量化丙氨酸转氨酶(ALT)与预后不良的相关性;采用单因素分析影响PNAC患儿预后的危险因素,并绘制受试者工作特征曲线(ROC曲线),评价ALT对患儿预后的预测价值。结果两组患儿性别、体质量、胎龄、年龄、喂养方式、静脉营养持续时间、直接胆红素(DBil)、丙氨酸转氨酶(AST)、γ-谷氨酰转移酶(GGT)、总蛋白(TP)、血清白蛋白(Alb)、球蛋白(GLB)、碱性磷酸酶(ALP)、血小板计数(PLT)、白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、淋巴细胞计数(LYM)、尿培养、AST/PLT比值(APRI)及主要治疗方法比较差异均无统计学意义。预后良好组总胆红素(TBil)、ALT、中性粒细胞计数(NEU)、单核细胞计数(MONO)均明显低于预后不良组〔TBil(μmol/L):120.00±48.63比175.26±29.14,ALT(U/L):73.25±44.29比145.30±74.33,NEU(×10^(9)/L):2.55±1.29比5.08±4.10,MONO(×10^(9)/L):1.23±0.87比2.13±0.60,均P<0.05〕。二分类Logistic回归分析显示,ALT是影响PNAC患儿预后的危险因素,ALT每升高1 U/L,预后不良发生的概率就升高3.6%〔优势比(OR)=1.04,95%可信区间(95%CI)为1.00-1.07,P=0.04〕。Spearman相关性分析显示,预后不良发生率与ALT呈正相关(r=0.49,P=0.03)。ROC曲线分析显示,ALT对PNAC患儿预后有一定的预测价值〔ROC曲线下面积(AUC)=0.83,95%CI为0.00-1.00,P=0.03〕;当截断值为121.50 U/L时,其敏感度为80%,特异度为93%,提示ALT可作为临床预测PNAC患儿预后不良的主要指标。结论ALT为影响PNAC患儿预后不良的Objective To explore the related factors affecting the prognosis of children with parenteral nutrition-associated cholestasis(PNAC).Methods Twenty children with PNAC admitted to Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2014 to December 2020 were selected as research objects by retrospective study.According to prognosis,children were divided into good(15 cases)and poor prognosis group(5 cases).Clinical data such as general condition,intravenous nutrition duration,related biochemical examination indexes and main treatment methods of children in the two groups were collected.Spearman correlation analysis was used to quantify the correlation between alanine aminotransferase(ALT)and poor prognosis.Univariate analysis was used to analyze the risk factors affecting the prognosis of children with PNAC,and receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of ALT on the prognosis of children.Results There were no significant differences in gender,body weight,gestational age,age,feeding mode,duration of intravenous nutrition,direct bilirubin(DBil),aspartate aminotransferase(AST),γ-glutamyltranspeptidase(GGT),total protein(TP),serum albumin(Alb),globulin(GLB),alkaline phosphatase(ALP),platelet count(PLT),white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),lymphocyte count(LYM),urine culture,AST/PLT ratio(APRI)and main treatment methods between the two groups.Total bilirubin(TBil),ALT,neutrophil count(NEU)and monocyte count(MONO)in the good prognosis group were significantly lower than those in the poor prognosis group[TBil(μmol/L):120.00±48.63 vs.175.26±29.14,ALT(U/L):73.25±44.29 vs.145.30±74.33,NEU(×10^(9)/L):2.55±1.29 vs.5.08±4.10,MONO(×10^(9)/L):1.23±0.87 vs.2.13±0.60,all P<0.05].Logistic regression analysis showed that ALT was the risk factor affecting the prognosis of children with PNAC,when ALT increased by 1 U/L,the probability of poor prognosis increased by 3.6%[odds ratio(OR)=1.0

关 键 词：胃肠外营养相关胆汁淤积症 预后不良 丙氨酸转氨酶 危险因素 

分 类 号：R725.7[医药卫生—儿科]