影响新生儿胆汁淤积症预后的多因素分析

Analysis of factors affecting the prognosis of neonatal cholestasis

目的分析影响新生儿胆汁淤积症预后的危险因素。方法收集2009年1月1日至2016年6月30日确诊的新生儿胆汁淤积症病例106例，口服熊去氧胆酸及内科综合治疗后观察疗效，无治疗无效的病例，根据疗效分组：治愈组99例，好转组7例，观察两组临床特点、病程，比较两组确诊当天血清总胆红素（TB）、直接胆红素（DB）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（γ-GT）、总胆汁酸（TBA）水平，比较两组新生儿合并细菌感染、合并巨细胞病毒（CMV）感染、性别构成、静脉营养（静脉营养时间≥ 7 d）、围生期缺氧、早产、母亲妊娠期肝内胆汁淤积症等情况。多因素分析采用多元Logistic回归分析。结果好转组血清ALT、AST、γ-GT、TB、DB和TBA水平明显高于治愈组，好转组病程明显长于治愈组，差异均有统计学意义（P 〈 0.05）；血清ALT、AST、TB、DB和TBA水平与病程呈直线正相关（tALT=13.050，tAST=14.696，tTB=12.771，tDB=13.776，tTBA=12.019，P 〈 0.05 ）。多元Logistic回归分析结果表明，新生儿合并细菌感染、合并CMV感染、静脉营养（静脉营养时间≥ 7 d）、早产是影响新生儿胆汁淤积症患儿预后的独立高危因素（OR值分别为9.375、7.909、11.333、11.333，P 〈 0.05）。结论新生儿胆汁淤积症患儿血清TB、DB、TBA、ALT、AST水平越高，其病程越长，疗效越差。新生儿合并细菌感染、合并CMV感染、静脉营养（静脉营养时间≥ 7 d）、早产是影响新生儿胆汁淤积症预后的高危因素，预防新生儿细菌及CMV感染，避免早产的发生，避免长时间静脉营养，对改善新生儿胆汁淤积症的预后有重要意义。

Objective To analyze the influential factors of the prognosis of neonatal cholestasis. Methods The data on 106 newborns with neonatal cholestasis collected from January 1, 2009 to June 30, 2016 was collected and analyzed retrospectively. All cases were divided into cure group （99 patients） and improvement group （7 patients） according to the effect of oral ursodeoxyeholie acid therapy and comprehensive medical treatment. There was no cure for invalid case. The clinical features, course of disease and curative effect were observed. The levels of total bilirubin （TB）, direct bilirubin （DB）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, gamma glutamyl transpeptidase （T-GT）, total bile acid （TBA） were compared between two groups. The ratio of neonatal bacterial infection, cytomegalovirus （CMV） infection, sex, total intravenous nutrition （more than 7 d）, perinatal hypoxia, premature birth, maternal complicated intrahepatic cholestasis of pregnancy （ICP） were compared between two groups. Multiple Logistic regression analysis was used to analyze the prognosis factors of neonatal cholestasis. Results The levels of serum ALT, AST, γ-GT, TB, DB and TBA in improvement group were significantly higher than those in cure group, the course of disease in improvement group was significantly longer than that in cure group, there were significant differences （P 〈 0.05）. A strong linear correlation was showed between course of disease and the levels of serum ALT, AST, TB, DB and TBA （tALT= 13.050, tAST= 14.696, tTB= 12.771, tDB= 13.776, tTBA= 12.019, P 〈 0.05）. Multiple Logistic regression analysis showed that the prognosis of neonatal cholestasis was associated with bacterial infection, CMV infection, total intravenous nutrition （more than 7 d） and premature （OR =9.375, 7.909, 11.333, 11.333, P 〈 0.05）. Conclusions The higher the level of serum TB, DB, TBA, ALT and AST, the longer the course of the disease. Bacterial infection, CMV infection, total venous nutrition（ ≥7 d） and premature are the risk factors of the prognosis of neonatal cholestasis. Therefore, prevention of neonatal bacterial and CMV infection, reduction of the occurrence of preterm delivery and reduction of the total parenteral nutrition time are very important to improve the prognosis of neonatal cholestasis.