94例新生儿肝脏酶学异常患者临床表现及病因分析

Clinical manifestations and etiological analysis of 94 neonates with abnormal hepatic enzymes

目的回顾性分析94例新生儿肝脏酶学异常患者临床资料,探讨肝脏酶学异常病例临床表现及其病因,为临床实践中该类患者的早期诊治提供有效信息。方法回顾2019年1月—2021年9月南阳市中心医院收治的新生儿肝脏酶学异常患者94例(男56例,女38例),年龄22(10,25)d。肝脏酶学异常的特异性表现包括黄疸、肝肿大、脾肿大、腹腔积液及凝血功能异常。分析新生儿肝脏酶学异常患者的临床表现及病因。结果94例肝脏酶学异常患儿中,32例(34.0%)存在肝损伤特异性表现,部分患儿各表现同时存在,包括黄疸15例(16.0%)、肝脾肿大9例(9.6%)、黄疸且肝脾肿大2例(2.1%)、肝肿大2例(2.1%)、脾肿大2例(2.1%)、腹腔积液1例(1.1%)、出血倾向1例(1.1%)。根据患儿原发疾病、临床表现及辅助检查结果,发现感染性疾病52例(55.3%)、非感染性疾病16例(30.8%)、不明原因26例(27.6%)。感染性疾病病因包括病毒感染、细菌感染,其中病毒感染包括巨细胞病毒14例(26.9%)、呼吸道合胞病毒7例(13.5%)及肠道病毒6例(11.5%);细菌感染包括败血症16例(30.8%)、化脓性脑膜炎6例(11.5%)、颅内感染2例(3.8%)及阑尾炎1例(1.9%)。非感染性疾病病因包括解剖结构异常、外伤及遗传代谢性疾病,其中解剖结构异常包括胆道闭锁6例(37.5%)、胆道狭窄4例(25.0%)及胆道扩张2例(12.5%);外伤包括器官或软组织挫伤2例(12.5%)及骨折1例(6.2%);遗传代谢性疾病包括糖原累积症1例(6.2%)。结论感染性疾病为新生儿患者肝脏酶学异常的主要原因,以病毒感染常见,其中巨细胞病毒最多;非感染性疾病中以解剖结构异常最常见,其中胆道闭锁最多。

Objective The clinical data of 94 neonates with abnormal liver enzymes were retrospectively analyzed,and the clinical manifestations and etiology of abnormal liver enzymes were discussed,so as to provide effective information for early diagnosis and treatment of such patients in clinical practice.Methods From January 2019 to September 2021,94 neonates with abnormal liver enzymes(56 males and 38 females),aged 22(10,25)days,were reviewed.Specific manifestations of abnormal liver enzymes included jaundice,hepatomegaly,splenomegaly,ascites and abnormal coagulation function.To analyze the clinical manifestations and causes of abnormal liver enzymes in neonates.Results Among the 94 neonates with abnormal liver enzymes,32 cases(34.0%)had specific manifestations of liver damage,and some neonates had simultaneous manifestations,including jaundice in 15 cases(16.0%),hepatosplenomegaly in 9 cases(9.6%),jaundice with hepatosplenomegaly in 2 cases(2.1%),hepatomegaly in 2 cases(2.1%)and splenomegaly in 2 cases(2.1%).According to the primary diseases,clinical manifestations and auxiliary examination results,52 cases of infectious diseases(55.3%),16 cases of non-infectious diseases(30.8%)and 26 cases of unknown causes(27.6%)were found.The causes of infectious diseases included viral infection and bacterial infection,among which viral infection included cytomegalovirus in 14 cases(26.9%),respiratory syncytial virus in 7 cases(13.5%)and enterovirus in 6 cases(11.5%).Bacterial infections included septicemia in 16 cases(30.8%),purulent meningitis in 6 cases(11.5%),intracranial infection in 2 cases(3.8%)and appendicitis in 1 case(1.9%).The causes of non-infectious diseases included anatomical abnormalities,trauma and genetic metabolic diseases,among which anatomical abnormalities included biliary atresia in 6 cases(37.5%),biliary stricture in 4 cases(25.0%)and biliary dilatation in 2 cases(12.5%).Trauma included 2 cases(12.5%)of traumatic organ or soft tissue contusion and 1 case(6.2%)of fracture.Metabolic diseases included glycogen storage disease in 1 case(6.2%).Conclusion Infectious diseases are the main cause of abnormal liver enzymes in neonates,and viral infections are common,among which cytomegalovirus is the most common.Anatomical abnormalities are the most common non-infectious diseases,among which biliary atresia is the most common.