早产儿胃肠外营养相关性胆汁淤积危险因素的主成分Logistic回归分析

Logistic regression based on principal component analysis of risk factors 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（PNAC）的临床特征,筛选高危因素。方法收集239例进行胃肠外营养（PN）≥14 d的早产儿,分为PNAC组和非PNAC组,比较2组间PNAC相关因素的差异,并进行主成分改进的Logistic回归分析,探讨PNAC的危险因素。结果纳入PNAC组35例,非PNAC组204例。35例PNAC患儿中,伴肝细胞损伤13例。发生在使用PN第8~68日,其ALT峰值、PN时间与DB峰值呈正相关（P均〈0.05）。单因素分析显示,PNAC组与非PNAC组早产儿的出生体质量、SGA、辅助通气时间、氨基酸、脂肪乳和葡萄糖累积剂量、PN热卡总量、平均每日葡萄糖剂量、平均每日PN热卡及PN持续时间比较差异均有统计学意义（P均〈0.05）。主成分改进的多因素分析显示,氨基酸、脂肪乳及葡萄糖累积剂量、PN热卡总量及PN持续时间均是PNAC发生的高危因素（P均〈0.01）。当PN持续时间取临界值32 d时,预测PNAC的敏感度为80.0%,特异度为77.9%。结论 PN持续时间过长,易致早产儿发生胆汁淤积,损害肝功能。当早产儿PN应用时间≥32 d时,需警惕PNAC的发生。

Objective To analyze the clinical features and identify the risk factors of parenteral nutrition associated cholestasis（ PNAC） in preterm infants. Methods A total of 239 preterm infants receiving parenteral nutrition（ PN） for at least 14 days were recruited and divided into the PNAC（ n = 35） and nonPNAC groups（ n = 204）. Relevant factors of PNAC were statistically compared between two groups. Logistic regression based on principal component analysis was performed to evaluate the risk factors of PNAC. Results Thirty five patients were included in the PNAC group,and 204 in the non-PNAC group. Among 35 PNAC infants,13 were complicated with hepatocytes injury during 8-68 d of PN. Positive correlation was observed among the peak value of ALT,PN time and peak value of DB（ all P〈0. 05）. Single-factor regression analysis revealed that birth weight,SGA,duration of ventilation,accumulative dosage of amino acid,lipid emulsion and glucose,total calorie of PN,daily dosage of glucose,daily calorie and duration of PN significantly differed between the PNAC and non-PNAC groups（ all P〈0. 05）. Multi-factor logistic regression based on principal component analysis demonstrated that accumulative dosage of amino acid,lipid emulsion and glucose,total calorie and duration of PN were the risk factors of PNAC（ all P〈0. 01）. When PN endured for the threshold time of 32 d,the sensitivity was 80. 0% and the specificity was 77. 9% for predicting the incidence of PNAC. Conclusions Long duration of PN is likely to cause cholestasis and liver function injury in preterm infants. When PN endures for ≥ 32 d,the risk of PNAC will be significantly enhanced.