血清脂联素对极低出生体重早产儿胃肠外营养相关性胆汁淤积的相关性分析

Association between serum adiponectin and parenteral nutrition-associated cholestasis in very low birth weight infant

目的探讨血清脂联素（APN）与极低出生体重早产儿胃肠外营养相关性胆汁淤积（PNAC）的相关性。方法所有符合标准的早产儿均于入院后24~48h内取静脉血检测血清APN水平,以中位数13.15mg/L为界,将≥13.15mg/L患者分为高APN组63例,〈13.15mg/L为低APN组72例,记录随后5周内患儿PNAC发病率;以发生PNAC为事件终点,用Kaplan-Meier方法对PNAC发生率进行分析;Cox单因素回归分析血清APN与PNAC发生率的相关性。结果随访期间,低脂联素组第2、3、4和5周PNAC发生率分别为21.8%、43.1%、64.0%、和79.2%,血清APN水平有逐渐下降趋势,3周、4周下降更明显（P〈0.01）;高APN组不同时段PNAC发生率分别为17.9%、33.1%、49.3%和67.8%,APN水平无明显变化（P〉0.05）。分析显示两组PNAC发生率差异有统计学意义（P〈0.01）,Cox单因素分析,APN水平是影响患者远期预后的独立危险因素（P〈0.05）。结论随访过程中,在低APN组,伴随着APN水平的降低,PNAC发生逐渐增多。APN与极低体重早产儿胃肠外营养相关性胆汁淤积具有相关性。

Objective To investigate the association between serum adiponectin（APN）and parenteral nutrition-associated cholestasis（PNAC）in very low birth weight infant. Methods Fasting venous blood samples from preterm infants admitted to the First People＇s Hospital of Jining within 24~48hours were collected to evaluate the serum levels of adiponectin.The preterm infants were divided into two groups：≥13.15mg/L to high adiponectin group（n=63）and13.15mg/L to low adiponectin group（n=72）,based on a median of 13.15mg/L of adiponectin level.The incidence of PNAC was recorded in the next five weeks,and the occurrence of PNAC was used to determine the end point.Kaplan-Meier methods were used to analyze the incidence of PNAC,while the correlation of serum adiponectin level and the incidence of PNAC was estimated with the use of univariate Cox regression analysis. Results The incidence of PNAC in low adiponectin group at 2,3,4and 5weeks were 21.8%,43.1%,64.0%,and 79.2%,respectively.There was a trend for a lower adiponectin concentrations which become significantly lower at 3and 4weeks（P〈0.01）.The incidence of PNAC in high adiponectin group at different weeks were respectively 17.9%,33.1%,49.3%and 67.8%,However,the serum levels of adiponectin were similar（P〉0.05）.There were statistically significant differences in the incidence of PNAC between two groups（P〈0.01）.Univariate Cox regression analysis indicated that adiponectin levels was an independent predictor of long-term outcome in the patients（P〈0.05）. Conclusions Decreased adiponectin concentrations might be attributed to the higher incidence of PNAC in low adiponectin group during follow up.Adiponectin is associated with PNAC in very low birth weight infants.