早期胃肠外营养治疗对早产儿低出生体质量儿电解质、生长调节因子及炎症细胞因子的影响

Effects of early parenteral nutrition therapy on electrolytes,growth regulators,and inflammatory cytokines in infants with preterm low birth weight.

目的探讨早期胃肠外营养治疗对早产儿低出生体质量儿(PLBW)电解质、生长调节因子及炎症细胞因子的影响。方法选取2020年6月至2021年3月西安大兴医院新生儿科收治的92例PLBW新生儿作为研究对象,按随机数表法分为观察组与对照组,每组46例,观察组新生儿给予早期胃肠外营养治疗,对照组新生儿给予延迟胃肠外营养方案治疗,比较两组新生儿出生时及出生后7 d体格指标[体质量、身长、头围]、营养指标[总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)]、电解质[血钾、血钠、血钙]、生长调节因子[生长激素(GH)、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP-3)]、炎症细胞因子[转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)]水平。结果两组新生儿出生后7 d体质量、身长、头围比较差异均无统计学意义(P>0.05);两组新生儿出生后7 d的血营养指标ALB、PA、TP水平均较出生时升高,且观察组的上述各项指标[(35.09±4.05)g/L、(115.63±8.01)mg/L、(52.92±3.87)g/L]明显高于对照组[(32.18±3.42)g/L、(108.07±7.45)mg/L、(49.23±4.14)g/L],差异均有统计学意义(P<0.05);两组新生儿出生后7 d的血清IGFBP-3、GH水平比较差异均无统计学意义(P>0.05);两组新生儿出生后7 d的血清IGF-1水平较出生时升高,且观察组为(43.65±4.01)ng/mL,明显高于对照组的(40.04±3.33)ng/mL,差异均有统计学意义(P<0.05);两组新生儿出生后7 d血钠水平比较差异无统计学意义(P>0.05);观察组新生儿出生后7 d血钾水平为(4.31±0.39)mmol/L,明显低于对照组的(4.62±0.53)mmol/L,血钙水平为(1.27±0.13)mmol/L,明显高于对照组的(1.15±0.18)mmol/L,差异均有统计学意义(P<0.05);两组新生儿出生后7 d的血清TGF-β、IL-10水平较出生时升高,且观察组分别为(21.30±3.05)ng/mL、(38.45±4.13)pg/mL,明显高于对照组的(18.06±3.39)ng/mL、(35.91±3.24)pg/mL,TNF-α水平较出生时降低,且观察组为(51.26±6.03)pg/mL,明显低于对照组的(56.32±7.26)pg/mL,差异均有统计学意义(P<0.05)。结论PLBW新生儿给予早期胃肠外营养治疗有利于改善新生儿营养状态,促进IGF-1合成分泌,促进电解质平衡恢复,调节促炎性细胞因子与抗炎性细胞因子间的平衡。

Objective To explore the effects of early parenteral nutrition therapy on electrolytes,growth regulators,and inflammatory cytokines in infants with preterm low birth weight(PLBW).Methods A total of 92 neonates with PLBW admitted to Department of Neonatology,Xi'an Daxing Hospital between June 2020 and March 2021 were enrolled as the research objects.According to random number table method,they were divided into an observation group and a control group,with 46 cases in each group.The neonates in observation group was given early parenteral nutrition therapy,while the neonates in control group was given delayed parenteral nutrition regimen.The levels of physical indexes[body weight,length,head circumference],nutritional indexes[total protein(TP),albumin(ALB),prealbumin(PA)],electrolytes(blood potassium,blood sodium,blood calcium),growth regulators[growth hormone(GH),insulin-like growth factor-1(IGF-1),insulin-like growth factor binding protein 3(IGFBP-3)],and inflammatory cytokines[transforming growth factor-β(TGF-β),tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)]at birth and 7 d after birth were compared between the two groups.Results At 7 d after birth,there was no significant difference in body weight,length or head circumference between the two groups(P>0.05).At 7 d after birth,levels of ALB,PA,and TP were higher than those at birth in both groups,and those indexes in the observation group were(35.09±4.05)g/L,(115.63±8.01)mg/L,(52.92±3.87)g/L,significantly higher than(32.18±3.42)g/L,(108.07±7.45)mg/L,(49.23±4.14)g/L in the control group(P<0.05).There was no significant difference in serum IGFBP-3 and GH levels between the two groups at 7 d after birth(P>0.05).At 7 d after birth,level of serum IGF-1 was higher than that at birth in both groups,and that in the observation group was(43.65±4.01)ng/mL,significantly higher than(40.04±3.33)ng/mL in the control group(P<0.05).There was no significant difference in the blood sodium level at 7 d after birth between the two groups(P>0.05).At 7 d after birth,level of blood potassium in the observation group was(4.31±0.39)mmol/L,which was significantly lower than(4.62±0.53)mmol/L in the control group,while level of blood calcium in the observation group was(1.27±0.13)mmol/L,significantly higher than(1.15±0.18)mmol/L in the control group(P<0.05).At 7 d after birth,levels of serum TGF-βand IL-10 were higher than those at birth in both groups,and those indexes in the observation group were(21.30±3.05)ng/mL,(38.45±4.13)pg/mL,significantly higher than(18.06±3.39)ng/mL,(35.91±3.24)pg/mL in the control group;while the level of TNF-αwas lower than that at birth,and that in the observation group was(51.26±6.03)pg/mL,significantly lower than(56.32±7.26)pg/mL in the control group(P<0.05).Conclusion Early parenteral nutrition therapy in PLBW neonates is beneficial to improve nutritional status,promote the synthesis and secretion of IGF-1,promote the recovery of electrolytes balance,and regulate the balance between pro-inflammatory cytokines and anti-inflammatory cytokines.