胃肠道外营养的新生儿血清总胆汁酸水平变化及临床意义

目的探讨胃肠道外营养的新生儿血清总胆汁酸(TBA)水平的变化及临床意义。方法56例行胃肠道外营养的新生儿(足月儿34例,早产儿22例)作为观察组,20例无需胃肠道外营养的新生儿作为对照组(足月儿10例,早产儿10例)。测定胃肠道外营养前后TBA水平变化,比较足月儿与早产儿TBA水平变化的差别。结果新生儿胃肠道外营养前TBA水平与对照组比较,差异无显著性(P>0.05);胃肠道外营养后TBA较胃肠道外营养前明显升高,差异有非常显著性(P<0.01);早产儿胃肠道外营养后TBA水平较足月儿明显升高,差异有非常显著性(P<0.01)。结论胃肠道外营养对新生儿肝胆系统功能有影响,且以早产儿为明显。     

早产儿胃肠道外营养总胆汁酸的变化

目的　探讨胃肠道外营养早产儿总胆汁酸 (TBA)的变化。方法　分析 5 2例进行胃肠道外营养的早产儿在胃肠道外营养前及胃肠道外营养停止后TBA的变化 ;比较胎龄 <32周与≥ 32周早产儿胃肠道外营养前后TBA变化的差别。结果　早产儿胃肠道外营养前TBA(15 9± 9 9) μmol/L与对照组TBA(2 2 9± 16 2 ) μmol/L无显著性差别 ,胃肠道外营养后TBA(32 5± 18 9) μmol/L较胃肠道外营养前TBA明显增高 (P <0 0 1) ;胎龄 <32周早产儿胃肠道外营养后TBA(40 6± 2 3 2 ) μmol/L较胎龄≥ 32周早产儿胃肠道营养后TBA(2 7 7± 14 3)μmol/L明显增高。 结论　目前使用的胃肠道外营养方法仍存在着影响早产儿肝胆系统功能的情况 ;胎龄越小 ,影响越明显     

早产儿胃肠道外营养总胆汁酸的变化

胃肠道外营养是提高早产儿成活率的主要手段之一,本文对60例胃肠道外营养早产儿的总胆汁酸(TBA)的变化情况进行分析.     

血清总胆汁酸对早产儿胃肠外营养相关性胆汁淤积的诊断价值

目的探讨总胆汁酸(TBA)对早产儿胃肠外营养相关性胆汁淤积(PNAC)的诊断价值。方法回顾性分析胃肠外营养持续>14天的早产儿资料,按是否合并PNAC分为观察组及对照组,评价两组血清总胆红素(TBil)、直接胆红素(DBil)、TBA、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、谷草转氨酶(AST)、谷丙转氨酶(ALT)之间的差异,并构建受试者工作(ROC)曲线。结果应用胃肠外营养2周后,平均(20.7±3.6)天时,PNAC组血TBA、DBil、ALP、GGT、AST、ALT均高于对照组,差异有统计学意义(P<0.01)。血TBA的ROC曲线下面积为0.908,AST、GGT、ALT、ALP的曲线下面积分别为0.765、0.712、0.711、0.662,均小于TBA,差异有统计学意义(P<0.001)。血TBA取截断值26.2μmol/L时,诊断灵敏度为87.9%,特异度为87.7%,此时诊断的准确度最高,且灵敏度及特异度均大于其他指标。血TBA、ALT、AST、GGT、ALP与DBil呈正相关,r值分别为0.563、0.328、0.331、0.277、0.246(P<0.01)。结论血TBA是诊断PNAC灵敏度和特异度均较高的指标,动态联合监测DBil与TBA更有利于早产儿PNAC的早期诊断。     

早产儿胃肠道外营养总胆汁酸的变化

胃肠道外营养是提高早产儿成活率的主要手段之一,本文对60例胃肠道外营养早产儿的总胆汁酸(TBA)的变化情况进行分析。 资料和方法 一、临床资料 我科1999年1月至2001年8月进行胃肠道外营养的早产儿60例,男34例,女26     

胃肠道外营养早产儿总胆汁酸的变化

为探讨胃肠道外营养早产儿的总胆汁酸 (ＴＢＡ)的变化 ,总结分析 5 2例早产儿在胃肠道外营养前及停止后ＴＢＡ的变化 ;比较胎龄 <32周早产儿与胎龄 >32周早产儿胃肠道外营养前后ＴＢＡ的变化。结果早产儿胃肠道外营养前ＴＢＡ(15 .9± 9.9μｍｏｌ/Ｌ)与对照组ＴＢＡ(2 2 .9± 16 .2 μｍｏｌ/Ｌ)无显著性差别 ,胃肠道外营养后ＴＢＡ(32 .5± 18.9μｍｏｌ/Ｌ)较胃肠道外营养前ＴＢＡ明显增高 (Ｐ <0 .0 1) ;胎龄 <32周早产儿胃肠道外营养后ＴＢＡ(40 .6± 2 3.2 μｍｏｌ/Ｌ)较胎龄 >32周者ＴＢＡ(2 7.7± 14 .3μｍｏｌ/Ｌ)明显增高 (Ｐ<0…     

胃肠外营养相关性胆汁淤积症早产儿血MDR3基因mRNA表达

目的 研究MDR3基因表达与早产儿胃肠外营养相关性胆汁淤积症（PNAC）发病的相关性。方法 将2011年6月至2017年11月收治的行胃肠外营养超过14 d且未合并PNAC的早产儿80例为非PNAC组,患有PNAC的早产儿76例为PNAC组,所有研究对象均分别于生后1、14、30、60、90 d动态观察血清肝胆生化（丙氨酸氨基转移酶、总胆红素、直接胆红素、总胆汁酸和γ-谷氨酰转肽酶）及纤维化指标（透明质酸、层黏连蛋白、Ⅲ型前胶原N端肽、Ⅳ型胶原）变化,以及临床表现;采用实时荧光定量PCR法检测两组MDR3 mRNA水平的相对表达量;分析MDR3 mRNA表达水平与血清肝胆生化指标的相关性。结果 PNAC组早产儿血清肝胆生化及纤维化指标水平在生后14 d上升,至生后30 d达最高峰,生后60 d下降,且PNAC组生后第14、30、60、90天的血清肝胆生化及纤维化指标均高于非PNAC组（P < 0.05）。PNAC组早产儿外周血细胞MDR3 mRNA的相对表达水平高于非PNAC组（P < 0.05）。PNAC组患儿外周血细胞MDR3 mRNA的相对表达量与血清肝胆生化指标水平（丙氨酸氨基转移酶、总胆红素、直接胆红素、总胆汁酸和γ-谷氨酰转肽酶）均呈负相关（P < 0.001）。结论 MDR3 mRNA高表达可能与早产儿PNAC发病有关,但具体机制仍需进一步研究探讨。     

部分胃肠外营养在早产儿的临床应用

目的探讨早产儿胃肠外营养对血浆渗透压、血糖、生化及胆红素代谢、免疫功能、生长发育的影响。方法早产儿70例随机分为对照组和治疗组,在胃肠道喂养的基础上治疗组予静脉营养,对照组静滴10%葡萄糖、生理盐水和电解质;对两组进行有关指标监测。结果1.应用静脉营养后早产儿血浆渗透压、血糖、生化与输注前无显著性差异;2.两组黄疸出现时间、持续天数无显著性差异;3.治疗组血浆IgGI、gAI、gM、C3、CD4及CD4/CD8均高于对照组;4.治疗组出生体质量恢复时间、住院天数和体质量增长均优于对照组。结论胃肠外营养对血浆渗透压、生化、血糖及胆红素代谢无影响,胃肠外营养能促进早产儿体质量增长,缩短住院天数和能促进免疫功能。     

早期足量胃肠道外营养对早产儿出院时体重的影响

目的探讨早期足量胃肠道外营养对早产儿出院时体重的影响。方法将我院收治的适于胎龄的存活低出生体重早产儿256例随机分为两组,各128例,治疗组应用早期足量胃肠道外营养,对照组应用传统新生儿胃肠道外营养。计算两组患儿各营养指标及出院时宫外生长发育迟缓(EUGR)的发生率,进行统计学分析。结果治疗组除生后第7天热卡与对照组相比 (P>0．05)无显著性差异外,其他各营养指标,如生后体重下降幅度、恢复至出生体重时间、每天体重增长克数、经胃肠达到摄入标准时间、应用胃肠道外营养天数、生后第3天热卡、平均住院天数等均优于对照组(P<0．01),具有非常显著性差异;治疗组出院时发生EUGR 60例,发生率为 46．9％,对照组出院时发生EUGR 87例,发生率为68．0％(x2=11．65,P<0．01),具有非常显著性差异。结论早期足量胃肠道外营养,可减少早产低出生体重儿或极低出生体重儿EUGR的发生率,为今后实现追赶性生长打下良好基础,且未见有严重副作用,值得临床推广应用。     

谷草转氨酶与血小板比值指数联合总胆汁酸对胎龄<34周早产儿肠外营养相关性胆汁淤积症的预测价值北大核心CSCD

目的探讨谷草转氨酶与血小板比值指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合总胆汁酸(total bile acid,TBA)对胎龄<34周早产儿肠外营养相关性胆汁淤积症(parenteral nutritionassociated cholestasis,PNAC)的预测价值。方法回顾性分析2019年1月—2022年9月在皖南医学院第一附属医院住院期间接受肠外营养(parenteral nutrition,PN)的270例胎龄<34周早产儿的临床资料,包括PNAC 128例和非PNAC 142例。比较两组的临床资料,通过多因素logistic回归分析探讨PNAC发生的预测因素,并采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价APRI、TBA单独及二者联合预测PNAC的价值。结果PNAC组在PN 1、2及3周后的TBA水平均高于非PNAC组(P<0.05);PN 2、3周后PNAC组APRI均高于非PNAC组(P<0.05)。多因素logistic回归分析显示,PN 2周后APRI和TBA升高是早产儿发生PNAC的预测因素(P<0.05)。ROC曲线分析显示,PN 2周后APRI联合TBA预测PNAC发生的灵敏度、特异度及曲线下面积(area under the curve,AUC)分别为0.703、0.803、0.806;APRI联合TBA预测PNAC发生的AUC高于APRI、TBA单独预测的AUC(P<0.05)。结论在PN 2周后,APRI联合TBA对胎龄<34周早产儿PNAC的预测价值较高。     

胃肠外营养早产儿血清总胆汁酸变化的意义

目的 探讨胃肠外营养(PN)早产儿血清总胆汁酸(TBA)的变化及其与胆汁淤积症的关系.方法 对本院2008-2010年68例应用PN支持治疗2周以上的早产儿(男35例,女33例;胎龄28～36周)进行血清TBA水平检测,比较应用PN前后血清TBA水平的变化,并依据血清TBA水平(TBA<15 μmol·L-1或≥15 μmol·L-1)分为2组[TBA<15 μmol·L-1者30例,TBA≥15 μmol·L-1者38例],比较2组出生2个月时胆汁淤积症的发生率.采用SPSS 13.0软件进行统计学分析.结果 早产儿在PN 2周后的血清TBA水平为(20.17±6.58) μmol·L-1,与PN前[(11.77±1.90) μmol·L-1]比较,差异有统计学意义(t=2.91,P<0.01).当PN 2周后血清TBA水平≥15 μmol·L-1组胆汁淤积症的发生率较TBA<15 μmol·L-1组高(21.05% vs 3.33%,χ2=4.58,P<0.05).结论 血清TBA可作为早产儿PN时胆汁淤积症的早期监测指标.     

早产儿胃肠外营养相关性胆汁淤积症临床研究

目的 探讨生后早期使用静脉营养的早产儿胆汁淤积症的临床特点,分析胃肠外营养相关性胆汁淤积症(parenteral nutrition associated cholestasis,PNAC)的相关因素及防治措施.方法 回顾性分析2011年1月至2016年4月出生并在盛京医院住院治疗的早产儿,生后均早期使用静脉营养2周,后出现胆汁淤积,共89例,分为两组,PNAC组即符合PNAC诊断(未发现其他导致胆汁淤积原因)41例,多病因组(除胃肠外营养因素还有其他病因)48例.通过病例对照研究分析其临床特点.结果 早产儿胆汁淤积症的男女比例为2.18:1,平均胎龄(31.05 ±2.15)周,平均出生体重(1360.55±421.14)g,静脉营养平均使用时间为(26.22±9.78)d.PNAC组根据丙氨酸氨基转移酶是否升高又分为肝炎组与非肝炎组,两组在胎龄、静脉营养开始时间、生后黄疸出现时间、开奶时间、氨基酸起始剂量及脂肪乳最大剂量方面的差异均有统计学意义,(P＜0.05);根据胃肠外营养时间分为长期组(≥20d)与短期组(＜20 d),长期组的谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素及胆汁酸水平均高于短期组,但P均≥0.05.多病因组患儿多合并感染,依次为细菌感染(75.0％)、真菌感染(20.83％)、巨细胞病毒感染(8.33％)和梅毒感染(2.08％)等.PNAC组和多病因组其他并发疾病的发生率差异无统计学意义.在预后方面,两组患儿经过保肝治疗后肝功能均较前明显好转,PNAC组的各项指标较多病因组降低更为显著(P＜0.05).结论 PNAC是早产儿胆汁淤积症发生的主要因素,PNAC早产儿肝损伤程度与胃肠外营养开始时间、使用时间、肠内喂养时间、氨基酸起始剂量及脂肪乳最大剂量有关.经保肝对症治疗后肝功能可以明显恢复,且效果优于多病因所致的胆汁淤积症.     

早产儿血清总胆汁酸升高的危险因素分析

目的 探讨早产儿血清总胆汁酸（TBA）升高的危险因素。方法 回顾性分析入住新生儿重症监护病房的216例早产儿的临床资料。以是否发生TBA升高（TBA > 24.8 μmol/L）,将早产儿分为TBA升高组（53例）和非TBA升高组（163例）。对可能导致TBA升高的影响因素进行单因素分析和非条件多因素logistic回归分析。结果 单因素分析显示,TBA升高和非TBA升高两组出生胎龄、出生体重、小于胎龄儿比例、呼吸机辅助通气比例、禁食时间、静脉营养时间以及新生儿呼吸衰竭、新生儿败血症的发生率的比较差异有统计学意义（P < 0.05）。非条件多因素logistic回归分析显示,低出生体重（OR=3.84,95% CI：1.53~9.64）、新生儿败血症（OR=2.56,95% CI：1.01~6.47）是早产儿TBA升高的独立危险因素。结论 低出生体重及新生儿败血症可导致TBA升高。     

Anti-oxidant enzymes and related elements in term and preterm newborns

Background:  Although oxidative stress-related diseases mostly affect neonates with extremely low birthweight, healthy preterm newborns might also be at risk of oxidative damages. The aim of the present study was to verify this possibility.
Methods:  Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), erythrocyte glutathione peroxidase (GSHPx) and superoxide dismutase (SOD), plasma and erythrocyte concentrations of selenium, zinc and copper were measured until 100 days of life in 30 preterm infants with mean ± SD birthweight and gestational age of 1605 ± 122 g and 34.5 ± 0.5 weeks. The control group included 30 term infants with birthweight 3123 158 g and gestational age 39.6 0.7 weeks.
Results:  Throughout the study period urinary 8-OHdG, taken as a marker of oxidative stress, was significantly higher in the preterm than in the term group. Up until 20 days of life, GSHPx activity was significantly lower in the preterm than in the term infants but this was not associated with any apparent selenium deficiency. Conversely, up until 100 days, preterm infants had significantly reduced SOD levels that appeared to reflect a shortage of the elements needed for this enzyme's activity, notably copper, the plasma concentrations of which were constantly and significantly below the control values.
Conclusion:  The nutritional status of the elements related to the anti-oxidant enzymes, especially zinc and copper, should be carefully assessed in preterm infants, even if their birthweight is not extremely low.     

Nutritional status in children receiving home parenteral nutrition

Nutrition status was evaluated in 19 children aged 4 to 65 months who received total parenteral nutrition as their only source of nutrition (nine patients, group 1) or who ingested 30% to 70% of their total energy requirements orally and received the remainder intravenously (10 patients, group 2). All patients had received parenteral nutrition for 31.8 +/- 9.8 SD and 33.1 +/- 17.1 months, respectively. All patients in group 1 and four in group 2 had short bowel syndrome; five in group 2 had pseudo-obstruction syndrome. The children in group 1 had normal height, weight, midarm circumference (MAC), midarm muscle circumference (MAMC), and triceps skinfold thickness (TSF). In group 2 patients, height, MAC, and TSF, were significantly below normal, and their weight, MAMC, and TSF, were lower than in group 1. Hemoglobin, total lymphocyte count, and serum albumin concentration were below normal in group 1; serum total protein concentration was low in both groups. Serum bilirubin concentration was higher in group 1; serum glutamic pyruvic transaminase activity was elevated in both groups. These data indicate that children receiving long-term total parenteral nutrition can obtain and maintain normal height, weight, and other anthropometric measurements of nutritional status. Group 1 patients had better nutritional status than those in group 2, perhaps because of differences in the underlying medical disorders between the two groups, or possibly because of a propensity to underestimate the amount of parenteral nutrition needed by patients who ingest some nutrients.     

深度水解蛋白配方乳对早产儿喂养和生长影响的多中心临床对照研究

目的 通过多中心临床对照研究,观察深度水解蛋白配方乳（eHF）对早产儿喂养和生长的影响。方法 随机选取2012 年2 月至2013 年12 月入住国内8 家三甲医院的早产儿,根据喂养方案分组：（1）胎龄结果 纳入研究的早产儿共328 例。胎龄PPPP>0.05）。胎龄32~34 周的观察组发生喂养不耐受后用eHF,生后第2 周血清总胆红素水平低于其相应的对照组（PPP>0.05）。结论 eHF 可促进早产儿胃肠动力功能、加速胆红素代谢和排泄,且未增加EUGR 的发生。     

Bone turnover in preterm infants

Total parenteral nutrition is associated with osteopenia in preterm infants. Insufficient calcium and phosphate are likely causes: aluminum contamination is another possible contributing factor as this adversely affects bone formation and mineralization. The study was designed to evaluate changes in biochemical markers of bone turnover in 22 preterm infants receiving total parenteral nutrition in comparison with 19 term infants. We collected urine and serum samples from 22 preterm infants, mean gestational age 29 wk, within 48 h and again at 3 wk of life. We also collected urine samples from 19 term infants, mean gestational age 39 wk, during the first day of life. Bone resorption was assessed by the measurement of urinary pyridinium cross-links by HPLC and ELISA and the N-telopeptide of type I collagen by ELISA. Bone formation was assessed in premature infants by the measurement of serum osteocalcin. The N-telopeptide of type I collagen was higher in the preterm infants compared with term at baseline (p < 0.01). There was no difference between the pyridinium cross-links in the preterm and term infants. All the biochemical markers of bone turnover increased significantly in the preterm infants during the first 3 wk of life, e.g. N-telopeptide was a 153% change from baseline (p < 0.001). Aluminum in the total parenteral nutrition solutions did not cause a decrease in bone formation at the level administered (3-6 microg, 0.1-0.2 micromol x kg(-1) x d(-1)).     

Aluminium in the neonate related to parenteral nutrition

Moreno A, Domínguez C, Ballabriga A. Aluminium in the neonate related to parenteral nutrition. Acta Pædiatr 1994;83:25–9. Stockholm. ISSN 0803–5253
Sources of aluminium loading and exposure in preterm and full-term newborns were studied. Parenteral nutrition solutions were the main source of aluminium representing 88.7% of total aluminium intake. Blood and urine aluminium levels were followed over a 28-day period in a group of 26 preterm and 9 term infants while receiving parenteral nutrition (duration 15.6 ± 8.7 days) and later when being formula fed. Urine levels were followed up to 13 weeks in a subgroup of the neonates. Serum aluminium levels (0.86 ± 0.38 μmol/l) and urine aluminium/crcatinine ratio (1.52 ± 0.81 μ mol/ mmol) were increased when the infants were receiving parenteral nutrition compared with the control group (p<0.001). The urine aluminium/creatinine ratio remained high up to 10 weeks following withdrawal of parenteral nutrition and suggested tissular loading. This was confirmed after high aluminium levels were found in post-mortem brain and bone samples from two preterm and one full-term infant. We conclude that both preterm and full-term neonates are susceptible to accumulation of aluminium in tissue while receiving parenteral nutrition.