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目的研究极低出生体重儿(VLBWI)肠道外营养相关性胆汁淤积(PNAC)的发生率、危险因素及预后。方法回顾分析43名接受肠道外营养(PN)超过14d的VLBWIPN相关的临床及实验室指标,并行多因素Logistic回归分析及单因素分析。结果PNAC发生率20.9％。PNAC组和无PNAC组相比,PN持续时间及全肠道外营养时间久、氨基酸及脂肪乳累计用量大、生后14d时静脉非蛋白热卡所占比例高。多因素分析显示,氨基酸累计用量及感染为PNAC发生的危险因素。随PN持续时间的延长,所有患儿结合胆红素(DBIL)、碱性磷酸酶(ALP)、总胆汁酸(TBA)均有明显的升高,出生2周以后的血清DBIL、DBIL/TBIL、ALP及TBA水平在PNAC组与无PNAC组间差异有显著性。9例PNAC患儿中2例死亡,7例好转出院。结论感染及氨基酸累计用量为PNAC发生的危险因素。PN持续时间越久,肠道外营养成分用量越大,PNAC发生的危险性越高。动态监测DBIL、ALP、TBA对早期发现PNAC有帮助。
Objective To study the incidence, risk factors and prognosis of parenteral nutrition-associated cholestasis (VLAC) in very low birth weight infants (VLBWI). Methods The clinical and laboratory parameters of 43 patients with VLBWIPN receiving parenteral nutrition (PN) over 14 days were retrospectively analyzed. Multivariate logistic regression analysis and univariate analysis were performed. Results The incidence of PNAC was 20.9%. Compared with PNAC group and non-PNAC group, PN duration and total parenteral nutrition took a long time, amino acid and fat emulsion accumulated in large amount, and the proportion of non-protein hot card was higher at 14 days after birth. Multivariate analysis showed that the cumulative amount of amino acids and infection risk factors for the occurrence of PNAC. With the prolongation of PN duration, all patients had significantly increased DBIL, ALP and TBA. After 2 weeks of birth, serum DBIL, DBIL / TBIL The difference of ALP and TBA between PNAC group and non-PNAC group was significant. Two of nine children with PNAC died and seven were discharged. Conclusions Infection and the cumulative amount of amino acids are the risk factors of PNAC. The longer the duration of PN, the greater the amount of parenteral nutrition, the higher the risk of PNAC. Dynamic monitoring of DBIL, ALP, TBA is helpful for early detection of PNAC.