熊去氧胆酸联合腺苷蛋氨酸治疗不同胎龄段新生儿胆汁淤积的临床疗效

The Effect of Ursodeoxycholic Acid Combined with Adenosyl Methionine in the Treatment of Parenteral Nutrition-Associated Cholestasis in Different Gestational Age Preterm Infants

目的:观察熊去氧胆酸(UDCA)联合腺苷蛋氨酸(SAMe)治疗不同胎龄段早产儿肠外营养相关性胆汁淤积(PNAC)的疗效。方法:将发生肠外营养相关性胆汁淤积症的小于33周胎龄儿(41例)、大于33周胎龄儿(45例)、足月儿(44例)三个胎龄段新生儿分别随机分为治疗组和对照组,对照组进行护肝、添加微量元素和维生素及防治感染等综合治疗,治疗组在综合治疗的基础上应用熊去氧胆酸联合腺苷蛋氨酸治疗,对比各胎龄段治疗组与对照组入院治疗后第2周的各项生化指标。结果:小于33周胎龄患儿中治疗组与对照组各项检测指标比较差异无统计学意义(P>0.05);大于33周胎龄患儿中治疗组与对照组生后2周GGT、TBIL、DBIL比较差异有统计学意义(P<0.05),而ALT、ALP、TBA比较差异无统计学意义(P>0.05);足月儿治疗组与对照组比较各项检测指标差异均有统计学意义(P<0.05)。结论:熊去氧胆酸联合腺苷蛋氨酸治疗早产儿PNAC,对小于33周胎龄早产儿无效,对大于33周胎龄和足月儿有效。

Objective： To observe the effects of ursodeoxycholic acid（UDCA） combined with adenosyl methionine（SAMe） in the treatment of parenteral nutrition-associated cholestasis in preterm infants（PNAC）.Methods： Newborns including less than 33 weeks gestational age（41 cases）,more than 33 weeks gestational age（45 cases）,and full-term（44 cases）,with parenteral nutrition-related cholestasis,were randomly divided into a treatment group and a control group.Both groups were given comprehensive treatment.The treatment group received UDCA and SAMe additionally.Biochemical values in each gestational age of both groups were compared after treatment for one week.Results： There was no difference in biochemical values in newborns less than 33 weeks gestational age between the treatment group and the control group（P0.05）.The differences of GGT,TBIL and DBIL in newborns morn than 33 weeks gestational age in the second week after birth,between the two groups were statistically significant（P0.05）,but there were no significant differences in ALT,ALP and TBA（P0.05）.The differences of each biochemical values in full-term children in both groups were statistically significant（P0.05）.Conclusions： There is no effect of UDCA combined with SAMe in the treatment of parenteral nutrition-associated cholestasis in preterm infants less than 33 weeks gestational age.But it is effective in infants more than 33 weeks gestational age and full-term newborns.