监护室新生儿长期胃肠外营养致胆汁淤积症的表现及预后

Clinical manifestations and prognosis of long-term parenteral nutrition induced cholestasis in neonates

目的:探讨监护室新生儿长期胃肠外营养相关性胆汁淤积症(parenteral nutrition associated cholestasis,PNAC)的表现及预后.方法:选择2010-01/2013-12在我院新生儿监护室接受持续胃肠外营养≥14 d的102例新生儿为研究对象,其中42例发生了PNAC,作为研究组(PNAC组),未发生PNAC的60例患儿为对照组(非PNAC组).观察PNAC患儿PNAC发生时间、持续时间、肝功能损害及预后等情况.结果:PNAC组患儿发生PNAC的平均时间为开始接受胃肠外营养(parenteral nutrition,PN)后3.4 wk±1.5 wk,平均持续时间为13.4 wk±5.2 wk,平均总胆红素(total bilirubin,TB)峰值为198.9μmol/L±95.8μmol/L,平均直接胆红素(direct bilirubin,DB)峰值为137.1μmol/L±64.3μmol/L;PNAC组患儿中有77.8%(28/36)伴有肝功能损害,肝损一般发生于PN后6.5 wk±2.9 wk,持续9.6 wk±5.2 wk.多重线性回归分析显示,胆汁淤积程度与PN持续时间呈正相关(r=0.287,P<0.05),与其他各项指标无线性关系.结论:PNAC患儿总体预后良好,临床应用中应该避免长时间持续PN,同时防治感染、尽早开始肠内营养、改善PN配方等,可以有效减少PNAC发生.

AIM： To explore the clinical manifestations and prognosis of parenteral nutrition induced cho- lestasis （PNIC）. METHODS： One hundred and two newborns receiving continuous parenteral nutrition （PN） ≥ 14 d from January 2010 to December 2013 were divided into either a PNIC group （n = 42） or a non-PNIC group （n = 60）. PNAC onset time, duration and hepatic injury were compared be- tween the two groups. RESULTS： PNIC occurred 3.4 wk ± 1.5 wk after PN administration, and its mean duration was 13.4 wk ± 5.2 wk. The maximum total bilirubin was 198.9 μmol/L ± 95.8μmol/L, and the direct bilirubin was 137.1 μmol/L± 64.3 μmol/L. In the PNIC group, 77.8% （28/36） suffered fromhepatic injury. Hepatic injury occurred 6.5 wk ± 2.9 wk after PN administration, and lasted for 9.6 wk ± 5.2 wk. Multiple linear regression analysis showed that the severity of cholestasis was posi- tively correlated with the duration of PN （r = 0.287, P 〈 0.05）. CONCLUSION： The prognosis of PNIC was fa- vorable. To reduce the incidence of PNIC, long- term PN and infections should be avoided, en- teral feeding should be started early and the PN formula should be improved.