血清脂联素在早产儿胃肠外营养相关性胆汁淤积中的预测价值  

Clinical application value analysis of serum adiponectin in preterm infants with parenteral nutrition related cholestasis

作　　者：曾丽娟 姚芳[1] 孙金龙[2] 曾乐辉 Zeng Lijuan;Yao Fang;Sun Jinlong;Zeng Lehui(Department of Neonatology,Yiyang Central Hospital,Yiyang 413000;Department of Pediatrics,Yiyang Central Hospital,Yiyang 413000,China)

机构地区：[1]益阳市中心医院新生儿科,益阳413000 [2]益阳市中心医院儿科,益阳413000

出　　处：《中国医师杂志》2023年第12期1820-1823,共4页Journal of Chinese Physician

基　　金：湖南省科卫联合项目(2020JJ8037)。

摘　　要：目的探讨血清脂联素(APN)在早产儿胃肠外营养相关性胆汁淤积(PNAC)中的预测价值。方法回顾性分析2021年1月至12月益阳市中心医院收治的85例接受PN(肠外营养)治疗的早产儿临床资料,根据患儿住院期间是否发生PNAC分为PNAC组34例、非PNAC组51例。比较PNAC组与非PNAC组,PNAC组不同胎龄患儿血清APN水平,分析早产儿发生PNAC的危险因素,分析血清APN在早产儿PNAC中的预测价值。结果PNAC组第1、3、5周血清APN水平均低于非PNAC组,差异有统计学意义(均P<0.01)。PNAC组胎龄<34周的患儿第1、3、5周血清APN水平均低于≥34周的患儿,差异有统计学意义(均P<0.05)。多因素logistic回归分析显示,胎龄、出生体重、败血症、禁食时间、PN持续时间、脂肪乳累积量、氨基酸起始量、氨基酸累积量均是导致早产儿发生PNAC的影响因素(均P<0.05)。血清APN预测早产儿PNAC的曲线下面积(AUC)为0.814(95%CI:0.722~0.906),灵敏度为0.69、特异度为0.88,截断值为13.28 mg/L。结论血清APN对早产儿发生PNAC具有较高的预测价值,临床上应予以密切关注。Objective To explore the predictive value of serum adiponectin(APN)in parenteral nutrition associated cholestasis(PNAC)in premature infants.Methods A retrospective analysis was conducted on the clinical data of 85 premature infants treated with PN(parenteral nutrition)at the Yiyang Central Hospital from January to December 2021.According to whether PNAC occurred during hospitalization,the infants were divided into 34 PNAC group and 51 non PNAC group.A comparison was made between the PNAC group and the non PNAC group.The serum APN levels in children of different gestational ages in the PNAC group were analyzed,and the risk factors for PNAC in premature infants were analyzed.The predictive value of serum APN in premature PNAC was analyzed.Results The serum APN levels in the PNAC group were lower than those in the non PNAC group at weeks 1,3,and 5,and the difference was statistically significant(all P<0.01).The serum APN levels in children with gestational age<34 weeks in the PNAC group were lower than those in children with gestational age≥34 weeks at 1,3,and 5 weeks,and the differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that gestational age,birth weight,sepsis,fasting time,duration of PN,accumulation of fat emulsion,initial amount of amino acids,and accumulation of amino acids were all risk factors for PNAC in premature infants(all P<0.05).The area under the curve(AUC)of serum APN for predicting PNAC in premature infants was 0.814(95%CI:0.722-0.906),with a sensitivity of 0.69,specificity of 0.88,and a cutoff value of 13.28 mg/L.Conclusions Serum APN has a high predictive value for the occurrence of PNAC in premature infants,and should be closely monitored in clinical practice.

关 键 词：脂联素 婴儿 早产 胃肠外营养 胆汁淤积 

分 类 号：R722.6[医药卫生—儿科]