新生儿胆汁淤积症46例临床特征分析  

Restrospective analysis of clinicopathological features of 46 cases of neonatal cholestasis

作　　者：刘银芝[1] 杨慧[1] 廖镇宇[1] 占彩霞[1] 杨志明[1] 叶红球[1] 黄瑞文[1] LIU Yin-zhi;YANG Hui;LIAO Zhen-yu;ZHAN Cai-xia;YANG Zhi-ming;YE Hong-qiu;HUANG Rui-wen(Neonatal Department,Hunan Children’s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院新生儿科,长沙410007

出　　处：《肝脏》2022年第7期800-802,813,共4页Chinese Hepatology

摘　　要：目的分析新生儿胆汁淤积症的不同起病时间及其临床特征。方法对2016年1月至2020年12月湖南省儿童医院新生儿科住院的46例新生儿胆汁淤积症临床特征进行分析。将患儿按胆汁淤积症的起病时间分为早起病组(生后2周以内起病)和晚起病组(生后2周以后起病)。观察两组一般临床资料、实验室指标及预后特点。采用独立样本t检验对两组之间起病日龄、胎龄、出生体重、痊愈月龄、总胆红素、结合胆红素、总胆汁酸、ALT、碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(GGT)等进行比较。采用卡方检验对两组患儿足月儿、性别、治愈率、不同病因、肝脏肿大及白陶土样大便所占比例进行比较。结果2组患儿性别构成、痊愈时间、感染性胆汁淤积占比、总胆红素、结合胆红素、总胆汁酸、AKP、GGT比较差异无统计学意义(P>0.05)。早起病组起病日龄(5.91±4.61)d,晚起病组起病日龄(36.8±14.1)d;早起病组胎龄(35.4±2.8)周,高于晚起病组(31.6±2.5)周;早起病组出生体重(2001.8±522.2)g,高于晚起病组(1477.3±356.4)g,差异有统计学意义(t=11.21,4.325,3.111,P<0.05)。早起病组足月儿占(36.4%),晚起病组全为早产儿;早起病组治愈率(72.3%),低于晚起病组(100%);早起病组静脉营养相关性胆汁淤积0例,明显低于晚起病组(48.6%);早起病组不明原因胆汁淤积占比(63.4%),高于晚起病组(28.6%);早起病组白陶土样大便占比(36.4%),高于晚起病组(8.6%),差异有统计学意义(χ2=13.939、10.21、8.475、4.417、5.011,P<0.05)。早起病组ALT为(142.3±122.8)U/L,高于晚起病组的(77.5±46.4)U/L,差异有统计学意义(t=2.625,P=0.012)。所有痊愈患儿平均治愈月龄3.4个月。结论早起病组与晚起病组胆汁淤积在临床特征上存在差异,早起病组胎龄、出生体重及ALT水平高于晚起病组,不明原因性胆汁淤积、白陶土样大便、足月儿占比高,预后较差。晚起病组静脉营养相关性Objective To analyze the clinical data of neonatal cholestasis and analyze its difference between different onset time.Methods A total of 46 cases of neonatal cholestasis were retrospectively analyzed from January 2016 to December 2020 at the Department of Neonatology of Hunan Children’s Hospital.According to the onset time of cholestasis,all children were divided into early onset group(onset within 2 weeks after birth)and late onset group(onset after 2 weeks after birth).The general clinical data,biochemical indexes and prognosis of the two groups were observed.The age of onset,gestational age,birth weight,months of recovery,total bilirubin,conjugated bilirubin,total bile acid,alanine aminotransferase(ALT),γ-glutamyl transpeptidase(GGT)and alkaline phosphatase(AKP)were statistically compared between the two groups by independent sample t-test.Chi-square test was used to statistically compare the sex composition ratio,the proportion of full-term infants,the cure rate,the composition ratio of different etiologies,the incidence of clay colored stool and the proportion of hepatomegaly between the two groups.Results 1.There were no significant differences in sex composition,cure time,proportion of infectious cholestasis,total bilirubin,direct bilirubin,total bile acid,GGT and AKP between two groups(P>0.05).The average disease onset age of early onset group was(5.91±4.61)d and that of late onset group was(36.8±14.1d).The average gestational age of early onset group was higher than that of late onset group[(35.4±2.8)w vs(31.6±2.5)w].The average birth weight of early onset group was(2001.8±522.2)g,higher than that of late onset group[(1477.3±356.4)g],the difference was statistically significant(t=11.21,4.325,3.111,P<0.05).Full term infants accounted for 36.4%in early onset group,and there were all premature infants in late onset group.The cure rate of early onset group(72.3%)was lower than that of late onset group(100%).There were 0 case of venous nutrition-related cholestasis in early onset group,which was sig

关 键 词：胆汁淤积 新生儿 早产儿 

分 类 号：R722.1[医药卫生—儿科]