低出生体质量胆汁淤积儿临床特征和结局随访研究

Clinical feature and prognosis of low birth weight infants with cholestasis

目的研究低出生体质量胆汁淤积儿的临床特征和转归情况,为患儿及时合理的诊治提供一个有效的依据。方法 2014年6月~2015年6月在我院治疗的低出生体质量胆汁淤积儿162例,其中由胃肠外营养相关的胆汁淤积(PNAC)患者143例,非PNAC患者19例。比较两组患儿相关临床资料,并分析影响患儿发生PNAC的危险因素。结果 PNAC和非PNAC患者出生体质量分别为【(1237.2±173.3)g和(1377.3±177.9)g,P<0.05】,PNAC组脂肪乳累计用量为(35.7±10.5)g·kg^(-1),显著高于非PNAC组【(27.3±12.3)g·kg^(-1),P<0.05】,氨基酸累计用量为(36.6±11.2)g·kg^(-1),显著高于非PNAC组【(28.2±11.7)g·kg^(-1),P<0.05】,PN持续时间为(30.7±14.1)d,显著长于非PNAC组【(22.1±6.2)d,P<0.05】,住院天数为(51.2±11.2)d,显著长于非PNAC组【(37.4±10.5)d,P<0.05】;PNAC患儿贫血发生率为85.3%,显著高于非PNAC组的68.4%(P<0.05),感染发生率为73.4%,显著高于非PNAC组的42.1%(P<0.05);多元Logistic回归分析发现,低体质量儿的出生体质量、累计脂肪乳和氨基酸用量和PN持续时间是影响PNAC发生的危险因素。结论影响低出生体质量患儿发生胆汁淤积的因素繁多,应科学喂养,缩短PN时间,及早恢复肠内营养,防治并发症,以利于其早期康复。

Objective To investigate the clinical feature and prognosis of low birth weight infants with cholestasis. Methods 162 low birth weight infants with cholestasis between June 2014 and June 2015 in our hospital were retrospectively analyzed,and 143 infants had with parenteral nutrition associated cholestasis （PNAC） and 19 were not. Multivariate Logistic regression analysis was applied for risk factors of PNAC occurrence. Results The body weight at birth in PNAC and non-PNAC infants were [（1237.2±173.3） g vs.（1377.3±177.9） g,respectively,P〈O.05],the cumulative amount of lipid emulsion in PNAC infants was （35.7±10.5）g kg-1,mueh higher than [ （27.3± 12.3 ）g kg-1, P〈0.05 ], amino acids was （ 36.6± 11.2 ）g kg-1, much higher than [ （28.2±11.7）g kg-1,P〈0.05],the duration for PN was （30.7±14.1）d,much longer than [（22.1±6.2）d,P〈0.05] and hospitalization stay was （51.2±11.2）d, much longer than [ （37.4±10.5）d, P〈0.05 ] in the non-PNAC infants; the incidences of anemia and infection in children with PNAC were 85.3 % and 73.4 % ,significantly higher than 68.4 % and 42.1% in non-PNAC group （P〈0.05）;Multivariate Logistic regression analysis showed that the low weight at birth,the cumulative amount of fat and amino acids,and the duration of PN were the risk factors for the occurrence of PNAC. Conclusions There are many factors influencing the occurrence of cholestasis in low birth weight infants, and we should give them an appropriate feeding,preventing and managing complications in time,and improving them recovery.