熊去氧胆酸对极低出生体重儿胃肠外营养相关性胆汁淤积的疗效

Effect of ursodeoxycholic acid on parenteral nutrition associated cholestasis in very low birth weight infants

目的:探讨熊去氧胆酸对极低出生体重儿胃肠外营养相关性胆汁淤积(PNAC)的疗效。方法:收集2017年1月至2020年12月在武汉大学中南医院新生儿重症监护室的68例接受≥14 d胃肠外营养的体重<1500 g且胎龄<32周的胆汁淤积的患儿进行分析,其中使用熊去氧胆酸的34例为观察组,未使用熊去氧胆酸的34例为对照组,比较分析两组患儿的相关指标改善情况。结果:对照组[(17.32±1.82)d]患儿出现PNAC的时间较观察组[(15.82±0.77)d]无明显差异(P=0.07),观察组患儿直接胆红素峰值(P=0.03)、胆汁淤积持续时间(P=0.03)、总胆汁酸(P=0.002)、碱性磷酸酶(P=0.03)等均低于对照组,但发生消化功能紊乱(如便秘或稀便)的例数较对照组多(P=0.62)。结论:熊去氧胆酸对极低出生体重儿PNAC的疗效显著。

Objective:To explore the effect of ursodeoxycholic acid on parenteral nutrition associated cholestasis(PNAC)in very low birth weight infants.Methods:A total of 68 infants with birth weight no more than 1500 grams and gestation age no more than 32 weeks were involved into this study from January 2017 to December 2020 in Neonatal Intensive Care Unit of Zhongnan Hospital of Wuhan University.All cases received no less than 14 days of parenteral nutrition,and among them,34 cases who received ursodeoxycholic acid were in the observation group,and the other 34 cases without ursodeoxycholic acid treatment were in the control group.The improvement of related serum biochemical indexes of the two groups was compared and analyzed.Results:No significant difference in the time of PNAC appearance was found between the two groups as(17.32±1.82)d vs(15.82±0.77)d,P=0.07.The peak values of direct bilirubin(DB)(P=0.03),duration of DB(P=0.03),total bile acid(TBA)(P=0.002),and alkaline phosphatase(ALP)(P=0.03)in the observation group were lower than those in the control group,but more digestive disorders such constipation or loose stools occurred than in the control group(P=0.62).Conclusion:Ursodeoxycholic acid has a significant effect on PNAC in very low birth weight infants.