早产儿NEC并胆汁淤积相关因素及对骨代谢的影响

Risk factors of NEC complicated with cholestasis in premature infants and their effects on bone metabolism

目的:探讨早产儿新生儿坏死性小肠结肠炎(NEC)并胆汁淤积(CHO)的相关因素及对骨代谢的影响。方法:回顾性分析145例NECⅡ期或NECⅢ期患儿及母亲临床资料,其中NEC合并CHO为观察组(56例),非CHO为对照组(89例),分析两组患儿临床特点、骨代谢生化指标及长骨X线表现。结果:NECⅢ期(OR=3.083,95%CI:1.125~8.446)是NEC并CHO的危险因素,全胃肠内营养前时间长(OR=1.090,95%CI:1.039~1.143)也是危险因素,即全胃肠内营养是保护因素;观察组血磷及25-羟维生素D3均较对照组低,而碱性磷酸酶(ALP)较对照组高;观察组长骨X线更易出现骨质稀疏、骨皮质变薄,甚至骨折等异常改变,均有统计学意义。结论:NECⅢ期是NEC并CHO的危险因素,全胃肠内营养是保护因素。早产儿NEC并CHO容易骨代谢紊乱,应加强骨营养的管理。

Objective:To explore the risk factors of neonatal necrotizing enterocolitis(NEC)complicated with cholestasis(CHO)in premature infants and its influence on bone metabolism.Methods:A retrospective analysis was performed on the clinical data of 145 neonates and their mothers with confirmed NECⅡor NECⅢ,and the neonates were divided into observation group(NEC+CHO group,56 cases)and control group(non-NEC group,89 cases).Clinical characteristics,biochemical indexes of bone metabolism,and X-ray of long bone of the two groups were compared.Results:NEC stageⅢ(OR=3.083,95%CI:1.125-8.446)was a risk factor for NEC complicated with CHO,and prolonged time to reach total enteral nutrition(OR=1.090,95%CI:1.039-1.143)was another risk factor,so total enteral nutrition was a protective factor.Serum phosphorus and 25-hydroxyvitamin D3 in observation group were lower than those in control group,while alkaline phosphatase(ALP)was higher.As compared with those in control group,the X-ray of long bone showed that abnormal changes such as bone sparseness,thinning of bone cortex,and even fractures were more in observation group with statistically significant difference.Conclusion:NEC stageⅢis a risk factor for NEC complicated with CHO,and total enteral nutritional is a protective factor.Premature infants with NEC and cholestasis are prone to bone metabolism disorders,and bone nutrition management should be strengthened.