胆道闭锁自体肝生存患儿生长发育评估及影响因素分析

Growth and Development Assessment and Influencing Factors Analysis of Children with Biliary Atresia Autologous Liver Survival

目的评估胆道闭锁自体肝生存患儿的生长发育情况,探讨与生长发育相关的影响因素。方法收集2013年5月至2019年8月在我科行Kasai手术且自体肝生存时间大于2年的胆道闭锁患儿资料。使用年龄别体质量和年龄别身高来评估胆道闭锁自体肝生存患儿术后生长发育情况。术后2年的身高和(或)体质量处于小于2个标准差区间定义为生长发育迟缓,将患儿分为生长发育迟缓组和生长发育正常组,比较两组患儿的手术日龄、术前体质量、性别、术前三酰甘油、术前高密度脂蛋白、术前低密度脂蛋白、是否合并巨细胞病毒感染、是否合并肝硬化、术后胆管炎次数、术后黄疸清除时间。结果34例自体肝生存时间大于2年的胆道闭锁患儿中,男16例,女18例。其中,2例年龄别体质量和年龄别身高均<-2SD,6例年龄别体质量<-2SD,5例年龄别身高<-2SD,共13例(38.2%)纳入生长发育迟缓组,其余21例(61.8%)为生长发育正常组。两组患儿在手术日龄、术前体质量、性别、术前三酰甘油、术前高密度脂蛋白、术前低密度脂蛋白、是否合并巨细胞病毒感染、是否合并肝硬化方面差异无统计学意义。生长发育迟缓组患儿术后反复发生胆管炎次数更多、黄疸清除时间更长(P<0.05)。结论胆道闭锁自体肝生存患儿部分存在生长发育不良,术后胆管炎次数以及黄疸清除时间是影响生长发育的影响因素,应进行长期随访和及时营养指导。

Objective To evaluate the growth and development of children with native liver survival biliary atresia and to explore the factors related to growth and development.Methods The data of biliary atresia patients who underwent Kasai operation in the our department from May 2013 to August 2019 with native liver for more than 2 years were collected.According to the 2006 WHO Child Growth Standards,weight-for-age and heightfor-age were used to evaluate the postoperative growth and development of children.Growth retardation was defined as height and/or weight less than 2 standard deviations(SD)at 2 years after surgery.The children were divided into the growth retardation group and the normal growth group.The age of operation,preoperative weight,gender,preoperative triglyceride,preoperative high-density lipoprotein,preoperative low-density lipoprotein,preoperative cytomegalovirus infection,preoperative cirrhosis,postoperative cholangitis frequency,postoperative jaundice clearance time of two groups were compared.Results 34 biliary atresia children with native liver survival longer than 2 years were included.16 were male and 18 were female.Among them,2 cases of weight-for-age and height-for-age<-2SD,6 cases of weight-for-age<-2SD,and 5 cases of height-for-age<-2SD.A total of 13 cases(38.2%)were included in the growth retardation group,and the remaining 21 cases(61.8%)were included in the normal growth group.There was no significant difference between the two groups in the age of operation,preoperative weight,gender,preoperative triglyceride,preoperative high-density lipoprotein,preoperative low-density lipoprotein,cytomegalovirus infection,or cirrhosis.In the growth retardation group,postoperative cholangitis was more frequent and children with jaundice resolution time less than 3 months were less than that in the normal group(P<0.05).Conclusion Growth retardation is a certain incidence in biliary atresia patients with native liver survival.The frequency of postoperative cholangitis and the clearance time of jaundice are influencing factors related to growth and development.Long-term follow-up and timely nutritional guidance should be carried out.