住院新生儿乳糖酶缺乏及其体格生长的随访研究

Investigation of follow-up for lactase deficiency and physical growth in hospitalized newborns

目的调查住院新生儿乳糖酶缺乏及乳糖不耐受发生率,随访乳糖不耐受患儿的体格生长。方法根据纳入标准选取2017年2月至2018年7月在杭州师范大学附属医院新生儿病房住院的250例新生儿为研究对象,留取喂奶后1～2 h内的尿液,进行尿半乳糖测定,检测结果阳性者诊断为乳糖酶缺乏。乳糖酶缺乏患儿如伴随腹胀、腹泻、呕吐等临床症状为乳糖不耐受。根据胎龄分为早产儿组(72例)与足月儿组(178例),对两组乳糖酶缺乏发生率进行比较。研究对象随访至12月龄,进行身高、体重测量,计算Z评分值。根据检测、随访结果分为乳糖不耐受组(42例)与乳糖酶非缺乏组(60例),比较两组的体格生长情况。采用t检验、χ~2检验或Fisher确切概率法进行统计分析。结果 250例研究对象中181例为尿半乳糖检测阳性,乳糖酶缺乏发生率为72.4%。早产儿组乳糖酶缺乏的发生率为84.7%(61/72);足月儿组乳糖酶缺乏的发生率为67.4%(120/178),差异有统计学意义(χ~2=7.684,P<0.05)。46例乳糖酶缺乏患儿同时伴随乳糖不耐受症状,乳糖不耐受发生率为18.4%。随访发现在12月龄时,乳糖不耐受组的ΔWLZ、ΔWAZ值低于乳糖酶非缺乏组[(0.6±1.1)与(1.9±1.2)、(0.8±1.1)与(1.5±0.9),P值均<0.05],而两组间ΔLAZ值无统计学意义(P>0.05)。乳糖不耐受组低体重发生率高于乳糖酶非缺乏组(19.1%与5.0%,P<0.05),肥胖发生率低于乳糖酶非缺乏组(0%与10.0%,P<0.05),差异有统计学意义(P值均<0.05)。结论新生儿期乳糖酶缺乏发生率高,早产儿乳糖酶缺乏发生率高于足月儿。部分乳糖酶缺乏患儿表现出乳糖不耐受,影响患儿的体重、营养状况增长速度,但不影响身高增长速度。

Objective To investigate the incidence of lactase deficiency and lactose intolerance in hospitalized newborns, and follow-up the physical growth of the patients with lactose intolerance. Methods From February 2017 to July 2018, 250 neonates in the Department of Pediatrics , The Affiliated Hospital of Hangzhou Normal University were included according to the criterion. Urine was extracted within 1-2 h after feeding for the urine galactose qualitative determination test, and the positive result of the test was diagnosed as lactase deficiency. The infants of lactase deficiency with abdominal distension,diarrhea, vomiting and other clinical symptoms would be diagnosed as lactose intolerance. The incidence of lactase deficiency was compared between the premature newborns (72 cases) and term newborns (178 cases) according to gestational age. The cases were followed up to 12 months and their height and weight were measured. The Z-score values were calculated. According to the results of detection and follow-up, they were divided into lactose intolerance group (42 cases) and lactase non-deficiency group (60 cases). The growth was compared between the two groups. T test,χ^2 test or Fisher exact probability method were used for statistical analysis. Results 181 cases were positive result from the urine galactose qualitative determination test in 250 newborns, the incidence of lactase deficiency was 72.4 %. The incidence of lactase deficiency in the preterm groups and term groups was 84.7%(61/72) and 67.4%(120/178) respectively with statistical significance (χ^2=7.684, P<0.05). 46 cases of lactase deficiency with lactose intolerance, the incidence of lactose intolerance was 18.4 %.The follow-up results showed at 12 months of age, the △ WLZ、△ WAZ of the lactase intolerance groups were lower than that of the lactase non-deficiency groups[(0.6±1.1) vs (1.9±1.2),(0.8±1.1) vs (1.5±0.9), all P<0.05], there was no significant difference in △ LAZ between the two groups (P>0.05). The incidence of low weight in the lactase intolerance groups was higher than that in the lactase non-deficiency groups (19.1% vs 5.0%, P<0.05). The incidence of obesity in the lactase intolerance groups was lower than that in the lactase nondeficiency groups (0% vs 10.0%, P<0.05). There was statistical significance (all P<0.05). Conclusions The incidence of lactase deficiency is high in neonatal period, the incidence of lactase deficiency in preterm infants is higher than that in term infants. Only a part of the infants with lactase deficiency have lactose intolerance and affect the growth rate of weight and nutritional status for the infants, but there is no affection for the growth rate of height.