极低出生体质量儿胃肠外营养相关性胆汁淤积临床分析

Clinical characteristics of parenteral nutrition associated cholestasis in very low birth weight infants

目的:对60例极低出生体质量儿胃肠外营养相关性胆汁淤积(PNAC)的临床资料进行回顾性分析,探讨极低出生体质量儿PNAC肝损害的相关因素和近期预后。方法:对我院新生儿监护室2014年7月至2018年6月60例接受≥14 d胃肠外营养的体质量≤1500 g且胎龄≤32周的胆汁淤积患儿进行分析,肝功能损害38例为观察组,剩余22例为对照组。分析PNAC肝损害的相关因素,检测两组患儿胆汁淤积发生时间、持续时间、胆汁淤积程度及肝功能等情况,分析近期预后。结果:PNAC肝损害相关因素包括患儿到达全胃肠内营养的时间(P<0.01)、母孕期糖尿病(P=0.048)和高血压(P=0.036)。观察组胆汁淤积持续时间比对照组长[(88.79±7.57)d vs(35.09±1.30)d,P<0.01],肝功能损害出现在胆汁淤积后约3周,胆汁淤积消退后4周肝功能恢复正常。观察组直接胆红素峰值为(101.30±7.38)μmol/L,明显高于对照组(22.88±0.46)μmol/L(P<0.01)。结论:全胃肠内营养是极低出生体质量儿PNAC肝损害的保护因素,母孕期糖尿病和高血压是危险因素。PNAC肝损害患儿胆汁淤积程度重,持续时间长。PNAC近期预后良好。

Objective:To analyze the clinical characteristics of 60 patients with parenteral nutrition associated cholestasis(PNAC)and to explore the related factors and short-term prognosis of PNAC in very low birth weight infants retrospectively.Methods:A total of 60 infants with birth weight≤1500 g and gestational age≤32 weeks were exposed to parenteral nutrition for≥14 days in NICU during the period from July 2014 to June 2018.Of these infants,38 cases who had liver damage were assigned into the observation group,and the other 22 cases without liver damage were assigned into the control group.The onset time,degree,duration of PNAC and liver damage were observed,and the shorttime prognosis was analyzed.Results:Time to reach total gastro-intestinal nutrition,gestational diabetes mellitus and pregnancy associated hypertension were the related factors of PNAC-induced liver damage.Infants with PNAC-induced liver damage had longer cholestasis time than those without liver damage as(88.79±7.57)d vs(35.09±1.30)d(P<0.01).Liver injury usually occurred about 3 weeks after cholestasis,and lasted for about 4 weeks after cholestasis relieved.The direct bilirubin(DB)peak in the observation group was significantly higher than that in the control group as(101.30±7.38)μmol/L vs(22.88±0.46)μmol/L(P<0.01).Conclusion:Total gastro-intestinal nutrition was a protective factor,but GDM and pregnancy associated hypertension were the risk factors for PNAC-induced liver damage.Infants with PNAC-induced liver damage had a high degree of cholestasis with a long duration.Moreover,infants with PNAC had a good prognosis in the near future.