早产儿胃肠外营养相关性胆汁淤积症的临床特征

Clinical features of parenteral nutrition associated cholestasis in preterm infants

目的 分析早产儿胃肠外营养相关性胆汁淤积症（PNAC）的临床特点及影响因素,探讨预后.方法 对2007年7月至2009年6月,我院新生儿监护室的159例接受＞14 d胃肠外营养（PN）的体重＜2000 g和（或）胎龄＜34周的早产儿进行分析,以其中发生PNAC的40例作为PNAC组,另将剩余的119例非胆汁淤积患儿作为对照组.观察PNAC组患儿的胆汁淤积发生时间、持续时间、胆汁淤积程度及肝功能损害情况.分析PANC的相关因素.结果 PNAC平均发生在胃肠外营养后（3.3±1.6）周,一般持续（13.3±5.4）周,其直接胆红素峰值为（135.2±65.5）μmol/L;PNAC患儿中73.7%伴有肝功能损害,肝损一般发生于胃肠外营养后（6.6±3.0）周,常持续（9.5±5.4）周,谷丙转氨酶峰值（121.5±48.4）U/L,谷草转氨酶峰值（239.8±122.3）U/L.对可能的PNAC相关因素进行Logistic回归分析提示开始喂养时间、PN持续时间、窒息、SGA、颅内出血与PNAC的发生相关.结论 PNAC的预后良好.在条件允许下,尽早的肠内喂养、缩短PN时间、避免一些并发症如窒息、败血症、颅内出血等可以减少PNAC的发生.

Objective To analyze the clinical features and influential factors of parenteral nutrition associated cholestasis （PNAC） in preterm infants. Method A total of 159 infants with birth weight less than 2000 grams and/or gestational age less than 34 weeks were exposed to parenteral nutrition for longer than 14 days in NICU during the period from July 2007 to June 2009. Of these infants, 40 cases who had PNAC were aligned into the PNAC group, and the other 119 cases without PNAC were aligned into the nonPNAC group. PNAC occurring time, duration, the degree of PNAC and hepatic injury were observed.Logistic regression analysis was performed to evaluate the correlative factors of PNAC. Result PNAC occurred about （3.3 ± 1.6） weeks after beginning PN, usually lasted for （13.3 ± 5.4） weeks. The maximum direct bilirubin was （ 135.2 ± 65. 5 ） μmol/L. Of the PNAC patients, 73.7% suffered from hepatic injury. Hepatic injury usually occurred （ 6. 6 ± 3.0 ） weeks after beginning PN, and lasted for （9. 5 ±5.4） weeks. The highest alanine aminotransferase （ALT） was （ 121.5 ±48.4） U/L. The logistic regression of the possible correlative factors showed that time to start enteric feeding, persistence time of PN,asphyxia, small for gestational age, intracranial hemorrhage, were related to PNAC. Conclusion The prognosis of PNAC was good. Early enteral feeding, shorter time of PN, avoidance of the complications such as asphyxia and sepsis, were the important measures to lower PNAC.