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目的 探讨早产儿肠外和肠内营养支持期间血游离肉碱和酰基肉碱水平的动态变化及其与营养方式、胎龄和体重增长速度的关系.方法 选择2017年1～12月生后24 h内入住上海交通大学医学院附属新华医院新生儿重症监护室并接受肠外营养支持的早产儿,根据胎龄分为超早产儿(＜28周)、极早产儿(28～ 31周)、中期早产儿(32～33周)和晚期早产儿(34～36周)4组,根据日均体重增长情况分为＜15 g/(kg·d)组和≥15 g/(kg·d)组,分别于出生后、完全肠外营养、肠内联合肠外营养和完全肠内营养期间采用干血滤纸片法收集血液标本,应用液相色谱-串联质谱联用技术检测游离肉碱和酰基肉碱浓度.应用SPSS 21.0统计软件比较不同营养支持方式、不同胎龄、不同体重增长速度早产儿血中游离肉碱和酰基肉碱水平的变化与差异.结果 共纳入早产儿124例,收集标本410份.早产儿出生后随着营养方式由肠外营养逐渐过渡至肠内营养,血游离肉碱和大部分血酰基肉碱(C3、C4、C10DC、C12、C12∶1、C12DC、C14、C16、C16∶1、C16-OH、C18等)水平呈下降趋势;胎龄较小的早产儿出生后血中C4-OH(P =0.001)和C5(P=0.001)水平更高;体重增长缓慢的早产儿出生后血C5-OH水平较低(P =0.006).结论 早产儿生后早期血游离肉碱和酰基肉碱水平随营养方式改变呈下降趋势,提示外源性摄入相对不足;C4-OH和C5水平与胎龄成负相关;出生后较低的C5-OH水平可能与短期内体重增长缓慢有关.“,”Objective To study the dynamic changes of blood carnitine and acylcarnitine levels in preterm infants during parenteral and enteral nutritional support,and the relationship between carnitine status and nutritional patterns,gestational age (GA) and weight gain.Method From January 2017 to December 2017,preterm infants admitted to the neonatal intensive care unit (NICU) within 24 hours after birth and received parenteral nutrition support were enrolled.They were assigned into 4 groups according to their GA:ultra-premature infants (＜ 28 weeks),very premature infants (28 ～ 31 weeks),mid premature infants (32 ～ 33 weeks) and late premature infants (34 ～ 36 weeks).They were assigned into 2 groups according to their average daily weight gain:＜ 15 g/(kg · d) group and ≥15 g/(kg · d) group.Blood samples were collected and examined as dried-blood spot specimens on filter paper for four times:after born,given total parenteral nutrition,given enteral combined parenteral nutrition,and given total parenteral nutrition.The concentrations of free carnitine and acylcarnitine were detected using liquid chromatographytandem mass spectrometry (LC-MS/MS).SPSS 21.0 statistical software was used for statistical analysis.Result A total of 124 preterm infants and 410 samples were collected.As the infants experienced gradual transition from parenteral nutrition to enteral nutrition,the free carnitine and most acylcarnitines levels were decreasing (C3,C4,C10DC,C12,C12∶1,C12DC,C14,C16,C16∶ 1,C16-OH and C18,P＜0.05).Preterm infants with small GA showed higher levels of C4-OH (P =0.001) and C5 (P =0.001).Preterm infants with lower velocity of weight gain showed lower concentration of C5-OH (P =0.006) in the early postnatal period.Conclusion Free carnitine and acylcarnitine in preterm infants during the early postnatal period are decreasing with the transition from parenteral nutrition to enteral nutrition,indicating that the exogenous nutrition is relatively insufficient.C4-OH and C5 levels are negatively correlated with GA.In addition,lower level of C5-OH may indicate slow weight gain during the early postnatal period.