新生儿乳糖酶缺乏及乳糖不耐受危险因素分析

Analysis of risk factors of neonatal lactase deficiency and lactose intolerance

目的分析新生儿乳糖酶缺乏及乳糖不耐受的危险因素,为临床前瞻性预防乳糖不耐受提供临床依据。方法选取2021年1月-2022年12月常州市儿童医院新生儿科病房住院的259名的新生儿为研究对象,收集胎龄、年龄、体重、Apgar评分、喂养等临床资料,所有患儿均排空尿液并饮奶10ml/kg,留取饮奶后1-2 h期间的尿液10ml,2h内送检,行尿半乳糖测定,检测结果阳性者为乳糖酶缺乏。如果乳糖酶缺乏同时伴有腹胀、腹痛、呕吐等临床症状为乳糖不耐受。根据乳糖酶缺乏与否分为乳糖酶缺乏组及乳糖酶不缺乏组,尿乳糖阳性并存在乳糖不耐受症状的为乳糖不耐受组。比较临床资料的差异,进行单因素分析和Logistic回归分析新生儿乳糖酶缺乏及乳糖不耐受的风险因素。结果①单因素分析及三组间交叉分割,乳糖酶缺乏组和不缺乏组间除了在胎龄25-33周、出生体重两组之间差异有统计学意义(P<0.01)外,在年龄、呼吸支持模式、喂养方式、抗生素应用、激素应用等方面均无显著性差异(P>0.017);乳糖酶缺乏组和乳糖不耐受组间在胎龄、出生体重、年龄等所有研究因素方面均无显著性差异(P>0.017);乳糖酶缺乏组和乳糖不耐受组间比较显示,两组之间在胎龄、出生体重、年龄等所有研究因素方面均无显著性差异(P>0.017);乳糖酶不缺乏组和乳糖不耐受组间比较显示胎龄25-33周、出生体重、激素、贫血、呼吸支持、呼吸窘迫、抗生素7个方面,两组间存在显著性差异(P<0.017)。②logistic回归分析,胎龄25-33周是新生儿乳糖酶缺乏的独立危险因素(P<0.01);胎龄25-33周是新生儿乳糖不耐受的独立危险因素(P<0.01)。结论胎龄是乳糖酶缺乏及乳糖不耐受的高危因素,胎龄越小风险越高。

Objective To investigate the risk factors of neonatal lactase deficiency and lactose intol-erance,provide clinical basis for prospective prevention of lactose intolerance.Method 259 newborns hospitalized in the neonatal ward of Changzhou Children's Hospital from January 2021 to December 2022 were selected as research objects,and clinical data such as gestational age,age,weight,Apgar score,feed-ing and other clinical data were collected,all children emptied urine and drank 10ml/kg,retained urine during 1~2 h after drinking,urine volume of 10ml,urine test within 2h,urine galactose measurement,positive test result for lactase deficiency.If lactase deficiency is accompanied by abdominal distension,ab-dominal pain,vomiting and other clinical symptoms,lactose intolerance.According to the lactase deficien-cy,it was divided into lactase deficiency group and no lactase deficiency group,and the lactose intoler-ance group was lactose intolerant group with positive urine lactose intolerance symptoms.To compare dif-ferences in clinical data,univariate analysis and logistic regression were performed to analyze risk factors for lactase deficiency and lactose intolerance in neonates.Results①Univariate analysis and cross-seg-mentation between the three groups:except for the statistically significant difference between the lactase deficiency group and the no deficiency group(P<0.01),there were no significant differences in age respira-tory support mode,feeding mode,antibiotic application,and hormone application(P>0.017),except for the statistically significant difference between the two groups with gestational age 25~33 weeks and birth weight.There were no significant differences between lactase deficiency and lactose intolerance groups in all factors studied,including gestational age,birth weight,and age(P>0.017);Comparisons between lac-tase deficiency and lactose intolerance showed no significant differences between the two groups in all fac-tors studied,such as gestational age,birth weight,and age(P>0.017);Comparison between the no defi-ciency group and the lactose intolerance group showed 25-33 weeks gestational age,birth weight,hor-mone,anemia,respiratory support seven aspects,respiratory distress,antibiotics,significant differences between the two groups(P<0.017).②Logistic regression analysis:gestational age of 25-33 weeks is an independent risk factor for neonatal lactase deficiency(P<0.01);Gestational age 25 to 33 weeks are inde-pendent risk factors for neonatal lactose intolerance(P<0.01).Conclusion Gestational age is the high risk factor of the lactase deficiency and lactose intolerance,The smaller the gestational age,the higher the risk.