早期血清蛋白生化指标对不同胎龄早产儿的营养评估价值

目的：通过测定不同胎龄、不同相对体质量早产儿早期血清白蛋白、前白蛋白及总蛋白水平，探讨早产儿早期蛋白生化指标对评价早产儿成熟度、宫内营养状况以指导营养支持治疗的临床意义。方法选取2010年1月～2013年8月同期住院的新生儿189例，分为≤28周组16例、28～32周组53例、32～37周组72例、足月儿组48例。于出生后24h内采集静脉血2mL，测定白蛋白、前白蛋白、总蛋白水平。结果四个胎龄组间，胎龄越小，白蛋白、前白蛋白、总蛋白水平越低，差异具有统计学意义（P＜0.05）。28～32周、32～37周及足月儿组三组中相对体质量越低，前白蛋白水平越低，差异具有统计学意义（P＜0.05），≤28周组中不同相对体质量间前白蛋白水平差异无统计学意义（P＞0.05）。各胎龄组内不同相对体质量间白蛋白、总蛋白水平差异无统计学意义（P＞0.05）。结论早产儿胎龄越小，白蛋白、前白蛋白、总蛋白水平越低，前白蛋白是目前评价早产儿成熟度及营养状况最敏感的指标。监测早产儿血清蛋白水平变化，对临床合理营养支持治疗及预防疾病具有指导意义。

Assessment value of early serum biochemical indexes to the nutrition statue of premature infants in different gestational ages

Objective To discuss the assessment value of early serum biochemical indexes to the maturity and intrauterine nutrition statue of the premature infant and its guiding significance for nutrition support therapy in clinical by detecting the levels of early serum albumin （ALB）,prealbumin （PA）,and total proteins （TP） of the premature infants at different gestational ages with different relative body weight （RBW）. Methods 189 newborns who have hospitalized between 2010-01 and 2013-08 were selected and divided into four groups based on their gestational age.There were 16 cases ≤ 28 weeks;53 cases belong to 28＋1-32 weeks group;72 cases belong to 32＋1-36＋6 weeks group,and the rest 48 belong to full-term infant group.For all the infants, 2mL venous blood was collected within 24 hours after the birth in order to determine the ALB,PA and TP levels. Results Among the four groups,the smaller the gestational age was,the lower the ALB,PA and TP levels were, and the difference was statistically significant （P〈0.05）. In 28＋1-32 weeks group, 32＋1-36＋6 weeks group and full-term infant group, the lower the RBM was,the lower the PA level was, and the difference was statistically significant （P 〈0.05）;while in the ≤28 weeks group,no statistically significant difference was observed in the PA level of infants with different RBM（P〉0.05）.Albumin and total protein levels were not statistically different between infants with different RBM in each group （P 〉 0.05）. Conclusion The smaller the gestational age of the premature is, the lower the ALB, PA and TP levels are.In addition,PA is the most sensitive indicator to evaluate the maturity and nutritional status of the premature infant.Therefore, monitoring the changes of the serum protein levels in premature infant has a guiding significance for rational nutrition support treatment and disease prevention in clinical.