[1]林少芳,余靓平,陈 凌,等.极低出生体质量儿肠外营养相关性胆汁淤积影响因素及APRI的预测价值分析[J].肠外与肠内营养杂志,2022,(06):331-336.[doi:10.16151/j.1007-810x.2022.06.002]
　LIN Shao-fang,YU Liang-ping,CHEN Ling,et al.Influencing factors of parenteral nutrition-related cholestasis in very low birth weight infants and the predictive value of APRI[J].PARENTERAL & ENTERAL NUTRITION,2022,(06):331-336.[doi:10.16151/j.1007-810x.2022.06.002]
点击复制

极低出生体质量儿肠外营养相关性胆汁淤积影响因素及APRI的预测价值分析
分享到：

《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2022年06期
页码:
331-336
栏目:
论著
出版日期:
2022-11-10

文章信息/Info

Title:
Influencing factors of parenteral nutrition-related cholestasis in very low birth weight infants and the predictive value of APRI
作者:
林少芳1; 余靓平1; 陈 凌2; 杨羡球2; 汤 颖 2; 谢素治 3
厦门大学附属中山医院，1.药学部；2.儿科，福建厦门361001；3.厦门市海沧医院药学部，福建厦门 361026
Author(s):
LIN Shao-fang1;  YU Liang-ping1;  CHEN Ling2;  YANG Xian-qiu2;  TANG Ying2;  XIE Su-zhi3
1. Department of Pharmacy；2. Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361001, Fujian, China；3. Department of Pharmacy, Xiamen Haicang Hospital, Xiamen 361026, Fujian, China
关键词:
极低出生体质量儿 ; 肠外营养相关性胆汁淤积 ; 危险因素 ; APRI
Keywords:
Very low birth weight infants;  PNAC;  Risk factors;  APRI
分类号:
R459.3，R563.1
DOI:
10.16151/j.1007-810x.2022.06.002
文献标志码:
A
摘要:
目的：探讨极低出生体质量儿(VLBWI)肠外营养相关性胆汁淤积(PNAC)的危险因素及验证天门冬氨酸氨基转移酶(AST)与血小板(PLT)比值指数(APRI)对PNAC的预测价值。 方法：对新生儿重症监护室120例肠外营养(PN)时间≥14 d的VLBWI病例资料进行回顾性分析。根据PN期间DB及TB的检测值，分为PNAC组和非PNAC组。应用SPSS 26.0统计学软件，比较两组病儿临床资料及生后不同时间段检验指标和APRI的差异。采用多因素Logistic回归模型，分析VLBWI发生PNAC的独立相关危险因素。绘制受试者工作（ROC）曲线验证APRI 的预测价值。 结果：纳入120例VLBWI中发生PNAC 19例（15.83%）。两组比较，PNAC组病儿的Apgar评分低，支气管肺发育不良发生率高，达全EN时间长（P < 0.05）。多因素Logistic回归模型分析显示，胎龄和PN持续时间是发生 PNAC 的独立危险因素（P = 0.002, P = 0.003）。在 PN 第 3 周，APRI 预测 PANC 发生的效能最优 (AUC =0.669，灵敏度 52.6%，特异性 86.9%，P = 0.048)。 结论：胎龄小、PN 持续时间长是 PNAC 发生的独立危险因素；APRI对极低出生体质量儿PNAC的发生具有一定的预测价值。
Abstract:
Objective: The aim of this study was to determine the risk factors of parenteral nutrition associated cholestasis(PNAC) in very low birth weight infants(VLBWI), and evaluate the predictive value of aspartate aminotransferase(AST) to platelet ratio index(APRI) for PNAC. Methods: Medical records of 120 infants with PN ≥ 14 days, birth weight ≤1 500 g in NICU were reviewed. According to the detected values of DB and TB during PN, they were divided into PNAC group and non-PNAC group. The differences in clinical data, test indexes and APRI at different time periods after birth were compared between the two groups. We analyzed clinical data by using logistic regression. In addition, the accuracy of APRI were evaluated by the receiver operating characteristic(ROC) curve. All statistical analyses were carried out using SPSS 26.0. Results: Among the 120 VLBW infants, 19 (15.83%) were diagnosed with PNAC. Compared with the two groups, the Apgar score of the children in the PNAC group was lower, the incidence of bronchopulmonary dysplasia was higher, and the time to achieve enteral nutrition was longer (P < 0.05). Multivariate logistic regression analysis showed that the gestational age and duration of parenteral were the independent risk factors(P = 0.002, P = 0.003). The APRI at third week of PN, had the best performance in predicting the occurrence of PANC(AUC = 0.669; Sensitivity, 52.6%; Specificity ,86.9%; P = 0.048). Conclusion: This study suggests that the gestational age and duration of parenteral are independent risk factors for PNAC. APRI has a reliable predictive value of PNAC development in VLBW infants.

参考文献/References:


[1] K?glmeier J, Day C, Puntis JW. Clinical outcome in patients from a single region who were dependent on parenteral nutrition for 28 days or more. Arch Dis Child, 2008, 93(4):300-302.
[2] Lauriti G, Zani A, Aufieri R, et al. Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and intestinal failure-associated liver disease in infants and children: a systematic review. JPEN J Parenter Enteral Nutr, 2014, 38(1):70-85.
[3] Yan W, Hong L, Wang Y, et al. Retrospective Dual-Center Study of Parenteral Nutrition-Associated Cholestasis in Premature Neonates: 15 Years' Experience. Nutr Clin Pract, 2017, 32(3):407-413.
[4] Rangel SJ, Calkins CM, Cowles RA, et al. Parenteral nutrition associated cholestasis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg, 2012, 47(1):225-240.
[5] Lee HH, Jung JM, Nam SH, et al. Risk factor analysis of parenteral nutrition-associated cholestasis in extremely low birth weight infants. Acta Paediatr, 2016, 105(7):e313-e319.
[6] 王 玲. 胃肠外营养相关性胆汁淤积症的治疗. 肠外与肠内营养, 2003, (04): 239-240.
[7] 胡玉莲, 胡长霞 . 早产儿肠外营养相关性肝病的诊断与治疗 .中华实用儿科临床杂志, 2018, 33(19):1454-1459.
[8] Hwang JH, Chung ML. Predictive value of the aspartate aminotransferase to platelet ratio index for parenteral nutrition associated cholestasis in extremely low birth weight infants. BMC Pediatr, 2019, 19(1):126.
[9] Vongbhavit K, Underwood MA. Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition Associated Cholestasis in Premature Infants With Intestinal Perforation. JPEN J Parenter Enteral Nutr, 2018, 42(4):797-804.
[10] Dani C, Pratesi S, Raimondi F, et al. Italian guidelines for the management and treatment of neonatal cholestasis. Italian journal of pediatrics, 2015, 41: 69.
[11] 蔡 威, 汤庆娅, 王 莹, 等. 中国新生儿营养支持临床应用指南. 临床儿科杂志, 2013, 31(12):1177-1182.
[12] Mihatsch WA, Braegger C, Bronsky J, et al. ESPGHAN/ESPEN/ ESPR/CSPEN guidelines on pediatric parenteral nutrition. Clin Nutr, 2018, 37(6 Pt B): 2303-2305.
[13] 谢春艳, 胡景玉, 牟 娜, 等. APRI对慢性乙型肝炎肝脏炎症和纤维化程度的预测性能评价 . 中国免疫学杂志, 2020, 36(2):210-214.
[14] Beath SV, Kelly DA. Total Parenteral Nutrition-Induced Cholestasis: Prevention and Management. Clin Liver Dis, 2016, 20(1):159-176.
[15] Kim AY, Lim RK, Han YM, et al. Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience. Pediatr Gastroenterol Hepatol Nutr, 2016, 9(1):61-70.
[16] Madnawat H, Welu AL, Gilbert EJ, et al. Mechanisms of Parenteral Nutrition-Associated Liver and Gut Injury. Nutr Clin Pract, 2020, 35(1):63-71.
[17] 周 丽, 徐晓红, 蒋成鹏, 等. 早产儿早期微量喂养预防肠外营养相关性胆汁淤积的Meta分析. 中国妇幼保健, 2019, 34(17):4100-4104.
[18] 陈海燕, 张飞忠, 周 华,等. 早产儿胃肠外营养相关性胆汁淤积的危险因素分析及防治措施. 肠外与肠内营养, 2014, 21(6):352-354,357.
[19] Hsieh MH, Pai W, Tseng HI, et al. Parenteral nutrition-associated cholestasis in premature babies: risk factors and predictors. Pediatr Neonatol, 2009, 50(5):202-207.
[20] 蔡瑞宏, 杨长仪, 修文龙, 等. 中/长链脂肪乳及长链脂肪乳对早产儿静脉营养性胆汁淤积的影响. 中国临床药理学与治疗学, 2017, 22(10):1167-1171.
[21] Wang N, Yan W, Hong L, et al. Risk factors of parenteral nutrition-associated cholestasis in very-low-birthweight infants. J Paediatr Child Health, 2020, 56(11):1785-1790.
[22] 中华医学会肠外肠内营养学分会. 鱼油脂肪乳剂临床应用中国专家共识（2022 版）. 中华消化外科杂志, 2022, 21(10): 1313-1325.
[23] 廉晓晓, 钤培国, 郭晓霞. 肝纤维化患者无创诊断模型建立与诊断价值评估.胃肠病学和肝病学杂志, 2017, 26(10):1165-1169.
[24] Suominen JS, Lampela H, Heikkil? P, et al. APRi predicts native liver survival by reflecting portal fibrogenesis and hepatic neovascularization at the time of portoenterostomy in biliary atresia. J Pediatr Surg, 2015, 50(9):1528-1531.
[25] Grieve A, Makin E, Davenport M. Aspartate Aminotransferase-to Platelet ratio index (APRi) in infants with biliary atresia: prognostic value at presentation. J Pediatr Surg, 2013, 48(4):789-795.
[26] 李艳红, 邱 红, 门光国, 等. 血天冬氨酸氨基转移酶与血小板比值在极低/超低出生体重儿肠外营养相关胆汁淤积中的诊断价值. 浙江医学, 2021, 43(13): 1415-1419.

备注/Memo

备注/Memo:
作者简介 ：林少芳，主管药师，主要从事肠内肠外营养相关工作。E-mail：linsophie2018@163.com 通讯作者 ：余靓平，E-mail：yuliangping4120@126.com
更新日期/Last Update: 1900-01-01