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中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (05) : 545 -551. doi: 10.3877/cma.j.issn.1673-5250.2021.05.007

论著

极/超低出生体重儿胃肠外营养相关性胆汁淤积的临床特点分析
龙丽娟1,1, 闭宏娟1,†,1(), 黄谊思2,2, 韦秋芬1,1, 姚丽平1,1   
  • 收稿日期:2020-04-21 修回日期:2021-07-19 出版日期:2021-10-01
  • 通信作者: 闭宏娟

Analysis of clinical characteristics of parenteral nutrition associated cholestasis in very/extremely low birth weight infants

Lijuan Long1,1, Hongjuan Bi1,1,†(), Yisi Huang2,2, Qiufen Wei1,1, Liping Yao1,1   

  • Received:2020-04-21 Revised:2021-07-19 Published:2021-10-01
  • Corresponding author: Hongjuan Bi
  • Supported by:
    Medical and Health Technology Development and Application Project of Guangxi Zhuang Autonomous Region(S2018115)
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引用本文：

龙丽娟, 闭宏娟, 黄谊思, 韦秋芬, 姚丽平. 极/超低出生体重儿胃肠外营养相关性胆汁淤积的临床特点分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2021, 17(05): 545-551.

Lijuan Long, Hongjuan Bi, Yisi Huang, Qiufen Wei, Liping Yao. Analysis of clinical characteristics of parenteral nutrition associated cholestasis in very/extremely low birth weight infants[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(05): 545-551.

目的

探讨对极低出生体重儿/超低出生体重儿(VLBWI/ELBWI)采取胃肠外营养(PN)治疗后，发生胃肠外营养相关性胆汁淤积(PNAC)的影响因素。

方法

选择2017年7月至2019年7月，于广西壮族自治区妇幼保健院诊治的88例胎龄<32周的VLBWI/ELBWI为研究对象。根据住院期内是否发生PNAC，将其分为PNAC组(n＝42，发生PNAC)及非PNAC组(n＝46，未发生PNAC)。回顾性分析2组患儿临床病例资料。采用t检验及χ2检验，对2组患儿一般临床资料，PN及肠内营养(EN)支持及并发症情况进行比较，并对差异具有统计学意义的指标，采用多因素非条件logistic回归分析，对VLBWI/ELBWI采取PN治疗后发生PNAC的独立影响因素进行分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①单因素分析结果显示：2组患儿胎龄、母乳喂养比例、PN持续时间、败血症及喂养不耐受发生率比较，差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示：PN持续时间长(OR＝1.423，95%CI：1.151~1.758，P＝0.001)，合并败血症(OR＝5.067，95%CI：1.355~18.951，P＝0.016)，喂养不耐受(OR＝7.258，95%CI：2.659~19.816，P<0.001)，均为VLBWI/ELBWI给予PN后发生PNAC的独立危险因素；而母乳喂养(OR＝0.149，95%CI：0.048~0.458，P＝0.001)则为独立保护因素。

结论

对VLBWI/ELBWI采用PN持续时间长，发生喂养不耐受及感染等，更易发生PNAC。同时，应重视对VLBWI/ELBWI的母乳喂养，以降低PNAC发生率。

关键词: 胃肠外营养, 胆汁淤积, 脓毒症, 母乳喂养, 营养支持, 婴儿，极低出生体重, 婴儿，超低出生体重
Objective

To investigate the influencing factors of parenteral nutrition associated cholestasis (PNAC) in very-/extremely-low birth weight infant (VLBWI/ELBWI) after parenteral nutrition (PN) treatment.

Methods

From July 2017 to July 2019, a total of 88 VLBWI/ELBWI (gestational age<32 weeks) hospitalized in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region were selected as research objects. According to whether PNAC occurred or not during hospitalization period, they were divided into PNAC group (n=42, complicated with PNAC) and non-PNAC group (n=46, without PNAC). Clinical data of subjects of two groups were retrospectively analyzed. The general clinical data, PN and enteral nutrition (EN) supports treatment and their related complications were compared between two groups by t test and chi-square test. And for indicators with statistical significance, multivariate unconditional logistic regression analysis was performed to analyze independent influencing factors of PNAC occurrence in VLBWI/ELBWI after PN treatment. The procedures followed in this study was in line with the World Medical Association Declaration of Helsinki revised in 2013.

Results

① Univariate analysis showed that there were significant differences in gestational age, breast feeding ratio, PN duration, incidence of sepsis and feeding intolerance between two groups (P<0.05). ② Multivariate unconditional logistic regression analysis showed that long duration of PN (OR=1.423, 95%CI: 1.151-1.758, P=0.001), complicated with sepsis (OR=5.067, 95%CI: 1.355-18.951, P=0.016) and feeding intolerance (OR=7.258, 95%CI: 2.659-19.816, P<0.001) were independent risk factors of PNAC occurrence in VLBWI/ELBWI after given PN, on the contrary, breast feeding (OR=0.149, 95%CI: 0.048-0.458, P=0.001) was an independent protective factor.

Conclusions

When VLBWI/ELBWI with long duration of PN, feeding intolerance and infection, etc., are more prone to PNAC. At the same time, attention should be paid to breast feeding of VLBWI/ELBWI to reduce PNAC complication.

Key words: Parenteral nutrition, Cholestasis, Sepsis, Breast feeding, Nutritional support, Infant, very low birth weight, Infant, extremely low birth weight
表1 2组VLBWI/ELBWI一般情况，PN及EN支持及并发症发生率比较
组别 例数 娩出方式[例数(%)] 孕母羊水性质[例数(%)] 胎龄(周，±s ) 性别[例数(%)]
顺产 剖宫产 清亮 浑浊/血性 男 女
PNAC组 42 20(47.6) 22(52.4) 37(88.1) 5(11.9) 28.4±2.1 27(64.3) 15(35.7)
非PNAC组 46 17(37.0) 29(63.0) 38(82.6) 8(17.4) 29.4±1.5 25(54.3) 21(45.7)
检验值   χ2＝1.024 χ2＝0.525 t＝2.677 χ2＝0.897
P值   0.388 0.556 0.009 0.390
组别 例数 出生体重(g，±s ) 出生时窒息[例数(%)] 小于胎龄儿[例数(%)] 喂养方式[例数(%)] PN持续时间(d，±s ) 氨基酸开始输注时间(生后h，±s )
母乳 配方奶
PNAC组 42 1 042±188 9(21.4) 10(23.8) 7(16.7) 35(83.3) 55.3±15.0 13.5±8.6
非PNAC组 46 1 097±209 6(13.0) 15(32.6) 35(76.1) 11(23.9) 34.0±7.2 12.2±6.6
检验值   t＝1.275 χ2＝1.092 χ2＝0.836 χ2＝31.070 t＝-8.581 t＝-0.803
P值   0.206 0.397 0.479 <0.001 <0.001 0.424
组别 例数 最大输入量[g/(kg·d)，±s] 并发症[例数(%)]
氨基酸 脂肪乳 PDA NEC 败血症 喂养不耐受 PPHN
PNAC组 42 2.9±0.6 3.0±0.4 14(33.3) 8(19.0) 14(33.3) 27(64.3) 8(2.4)
非PNAC组 46 2.9±0.3 2.8±0.3 19(41.3) 9(19.6) 4(8.7) 9(19.6) 2(4.3)
检验值   t＝-0.669 t＝-1.881 χ2＝0.440 χ2＝0.004 χ2＝8.191 χ2＝18.163 χ2＝3.364
P值   0.505 0.064 0.511 0.950 0.007 <0.001 0.067
表2 对VLBWI/ELBWI采取PN治疗后，导致发生PNAC影响因素的多因素非条件logistic回归分析变量含义及赋值情况
自变量/因变量 变量名 赋值
PNAC y1 y1＝0表示发生，y1＝1表示未发生
胎龄(周) x1 x1为连续变量
PN持续时间(d) x2 x2为连续变量
喂养方式 x3 x3＝0表示配方奶喂养，x3＝1表示母乳喂养
败血症 x4 x4＝0表示未发生，x4＝1表示发生
喂养不耐受 x5 x5＝0表示未发生，x5＝1表示发生
表3 对VLBWI/ELBWI采取PN治疗后，导致发生PNAC影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
胎龄 0.033 0.220 0.023 0.880 1.034 0.672~1.591
PN持续时间 0.353 0.108 10.674 0.001 1.423 1.151~1.758
母乳喂养 -1.905 0.573 11.053 0.001 0.149 0.048~0.458
败血症 1.623 0.673 5.812 0.016 5.067 1.355~18.951
喂养不耐受 1.982 0.512 14.963 <0.001 7.258 2.659~19.816
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