肠外补充多种微量元素对早产低出生体重儿微量元素水平的影响  

Effects of trace elements supplementation for parenteral nutrition on serum trace element levels in preterm low birth weight infants

作　　者：顾莹芬 付欢欢 贾雪琦 潘莉雅 GU Ying-fen;FU Huan-huan;JIA Xue-qi;PAN Li-ya(Department of Clinical Nutrition,Shanghai Children s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心临床营养科,上海200127

出　　处：《中国新药杂志》2025年第4期401-406,共6页Chinese Journal of New Drugs

基　　金：国家重点研发计划“生育健康及妇女儿童健康保障”重点专项(2023YFC2706505);国家重点研发计划“食品营养与安全关键技术研发”重点专项(2023YFF1104301);福建省卫生健康重大科研专项资助计划(2022ZD01007)。

摘　　要：目的:研究肠外补充多种微量元素注射液(I)对早产低出生体重儿血清微量元素水平的影响和安全性。方法:选择2020年3月—2020年8月出生后24 h内入我院新生儿重症监护室且需要肠外营养(parenteral nutrition,PN)支持的胎龄<37周、出生体重<2500 g的早产低出生体重儿,每日肠外补充多种微量元素注射液(I)1 mL·kg^(-1),采用电感耦合等离子体质谱法(inductively coupled plasma mass spectrometry,ICP-MS)检测补充前后血清微量元素(Zn,Cu,Se,Mn)水平,收集患儿基本情况,记录住院期间每日体重、身长、头围,监测前白蛋白、白蛋白、C反应蛋白、降钙素原(procalcitonin,PCT)、血常规、肝肾功能及药物不良反应情况。结果:共纳入43例早产儿,其中男婴22例(51.2%)、女婴21例(48.8%),胎龄(31.4±2.4)周,出生体重1430(1200,1830)g,肠外补充多种微量元素起始日龄2(1,2)d,补充时间11(9,17)d。补充后,血清Cu和血清Se水平均显著升高(P<0.05),血清Mn水平显著降低(P<0.05),血清Zn水平无显著性差异(P>0.05);血清Zn水平与住院期间体重增长速率呈正相关(r=0.319,P<0.05);血清Se水平和出院体重(r=0.303,P<0.05)、出院体重Z值(r=0.533,P<0.05)均呈正相关;前白蛋白显著升高(P<0.05),PCT显著降低(P<0.05),碱性磷酸酶(alkaline phosphatase,ALP)、直接胆红素(direct bilirubin,DB)、肌酐(creatinine,Cr)显著升高(P<0.05),谷草转氨酶(aspartate transaminase,AST)、γ-谷氨酰转移酶(gamma glutamyltransferase,GGT)、总胆红素(total bilirubin,TB)、血尿素氮(blood urea nitrogen,BUN)显著降低(P<0.05);除1例患儿发生肠外营养相关性胆汁淤积(parenteral nutrition-associated cholestasis,PNAC)外,未见明显药物不良反应。结论:早产低出生体重儿每日肠外补充多种微量元素注射液(I)1 mL·kg^(-1)是安全的,并可有效提高血清Cu水平,维持早产低出生体重儿体内血清Zn和Se水平,改善血清Mn水平。Objective:To evaluate the efficacy and safety of multi-trace element injection I[MTEI-(I)]for parenteral nutrition in preterm low birth weight(LBW)infants.Methods:From March 2020 to August 2020,infants with GA<37 weeks and BW<2500 g admitted to NICU within 24 hours after birth were included.PN with MTEI-(I)at 1 mL·kg^(-1)·d^(-1)was administered to the infants.The serum trace element levels were detected by ICP-MS pre-and post-supplementation.The body weight was daily measured.The body length,head circumference,pre-albumin(pre-ALB),albumin(ALB),C-reactive protein(CRP),procalcitonin(PCT),routine blood tests,liver and kidney functions and adverse drug reactions(ADR)were monitored.Results:A total of 43 preterm infants were enrolled,including 22 male infants(51.2%)and 21 female infants(48.8%)with GA of(31.4±2.4)weeks and BW of 1430(1200,1830)g.Administration of MTEI-(I)in parenteral nutrition was initiated 2(1,2)days after birth,and continued for 11(9,17)days.Serum Cu and Se levels were significantly higher than those pre-parenteral nutrition(P<0.05),whereas serum Mn levels were significantly lower than those before(P<0.05).No significant differences were observed in serum Zn levels(P>0.05).A significant positive correlation between serum Zn levels after supplementation and weight growth velocity in hospitalized preterm LBW infants was found(P<0.05).Serum Se levels were positively correlated with weight and weight-for-age z scores at discharge(P<0.05).After MTEI-(I)was administered,PCT,aspartate transaminase(AST),gamma glutamyltransferase(GGT),total bilirubin(TB),and blood urea nitrogen(BUN)were significantly lower(P<0.05),while pre-ALB,alkaline phosphatase(ALP),direct bilirubin(DB),and creatinine(Cr)were significantly higher(P<0.05).No significant ADR were observed except for one infant with parenteral nutrition-associated cholestasis(PNAC).Conclusion:Parenteral supplementation of MTEI-(I)at 1 mL·kg^(-1)·d^(-1)is safe for preterm LBW infants and might increase serum Cu levels,maintain the levels of serum Zn and

关 键 词：微量元素 低出生体重 早产儿 疗效 安全性 

分 类 号：R977.2[医药卫生—药品]