极低出生体质量儿肠外营养相关性胆汁淤积影响因素及APRI的预测价值分析

Influencing factors of parenteral nutrition-related cholestasis in very low birth weight infants and the predictive value of APRI

目的:探讨极低出生体质量儿(VLBWI)肠外营养相关性胆汁淤积(PNAC)的危险因素及验证天门冬氨酸氨基转移酶(AST)与血小板(PLT)比值指数(APRI)对PNAC的预测价值。方法:对新生儿重症监护室120例肠外营养(PN)时间≥14 d的VLBWI病例资料进行回顾性分析。根据PN期间DB及TB的检测值,分为PNAC组和非PNAC组。应用SPSS 26.0统计学软件,比较两组病儿临床资料及生后不同时间段检验指标和APRI的差异。采用多因素Logistic回归模型,分析VLBWI发生PNAC的独立相关危险因素。绘制受试者工作(ROC)曲线验证APRI的预测价值。结果:纳入120例VLBWI中发生PNAC 19例(15.83%)。两组比较,PNAC组病儿的Apgar评分低,支气管肺发育不良发生率高,达全EN时间长(P<0.05)。多因素Logistic回归模型分析显示,胎龄和PN持续时间是发生PNAC的独立危险因素(P=0.002,P=0.003)。在PN第3周,APRI预测PANC发生的效能最优(AUC=0.669,灵敏度52.6%,特异性86.9%,P=0.048)。结论:胎龄小、PN持续时间长是PNAC发生的独立危险因素;APRI对极低出生体质量儿PNAC的发生具有一定的预测价值。

Objective:The aim of this study was to determine the risk factors of parenteral nutrition associated cholestasis(PNAC)in very low birth weight infants(VLBWI),and evaluate the predictive value of aspartate aminotransferase(AST)to platelet ratio index(APRI)for PNAC.Methods:Medical records of 120 infants with PN≥14 days,birth weight≤1500 g in NICU were reviewed.According to the detected values of DB and TB during PN,they were divided into PNAC group and non-PNAC group.The differences in clinical data,test indexes and APRI at different time periods after birth were compared between the two groups.We analyzed clinical data by using logistic regression.In addition,the accuracy of APRI were evaluated by the receiver operating characteristic(ROC)curve.All statistical analyses were carried out using SPSS 26.0.Results:Among the 120 VLBW infants,19(15.83%)were diagnosed with PNAC.Compared with the two groups,the Apgar score of the children in the PNAC group was lower,the incidence of bronchopulmonary dysplasia was higher,and the time to achieve enteral nutrition was longer(P<0.05).Multivariate logistic regression analysis showed that the gestational age and duration of parenteral were the independent risk factors(P=0.002,P=0.003).The APRI at third week of PN,had the best performance in predicting the occurrence of PANC(AUC=0.669;Sensitivity,52.6%;Specificity,86.9%;P=0.048).Conclusion:This study suggests that the gestational age and duration of parenteral are independent risk factors for PNAC.APRI has a reliable predictive value of PNAC development in VLBW infants.