胃肠道外营养对早产儿肝胆功能的影响

目的：胃肠道外营养是提高早产儿成活率的主要手段之一,但由于早产儿肝肾功能、脂质清除等不成熟,胃肠道外营养的运用还存在某些争议的问题,胃肠道外营养时早产儿肝胆功能的损害已日益受到重视。该研究探讨胃肠道外营养对早产儿肝胆功能的影响。方法：对75例实行胃肠道外营养的早产儿及49例未实行胃肠道外营养的早产儿,各营养成分输入后的监测结果进行统计分析。结果：治疗后研究组及对照组谷草转氨酶、总胆红素、未结合胆红素均比治疗前明显下降,统计学差异有非常显著性(P<0.01);而谷丙转氨酶、结合胆红素则在治疗前后变化不明显,差异无显著性(P>0.05);治疗后研究组总胆汁酸(TBA)水平升高,差异有非常显著性(P<0.01),与胃肠道外营养持续时间呈正相关,与胎龄呈负相关;对照组治疗后总胆汁酸变化不明显,差别无统计学意义(P>0.05)。结论：早产儿胃肠道外营养时血清总胆汁酸(TBA)水平升高,应警惕胆汁淤积。

Effects of parenteral nutrition on the hepatobiliary function in preterm infants

OBJECTIVE: Prenteral nutrition therapy helps to increase the survival rate of preterm infants. However, due to their immature functions of liver, kidneys and lungs, and the poor capacity of lipid clearances and antioxidation, the dysfunction of hepatobiliary system induced by parenteral nutrition has drawn more attentions. Thus, this study was designed to investigate the effects of parenteral nutrition on the hepatobiliary function in preterm infants. METHODS: Seventy-five preterm infants who received partial parenteral nutrition from 1999 to 2004 were enrolled (Study group). Forty-nine preterm infants whose calories were provided only by glucose or glucose-containing electrolyte solutions were used as Control group. The two groups were matched in gender, gestational age, birth weight and Apgar scores at birth. The results of hepatobiliary function-related biochemical markers during parenteral nutritional administration were analyzed. RESULTS: After parenteral nutritional administration, the levels of serum glutamic oxaloacetic transaminase(AST), total bilirubin(TBIL), and indirect bilirubin(IBIL)in both groups decreased significantly(P<0.01), but the levels of serum glutamic pyruvic transaminase(ALT)and direct bilirubin(DBIL) remained unchanged. In the Study group, the level of serum total bile acid(TBA)increased significantly after parenteral nutritional administration (32.09±18.23 μmol/L vs 14.92±10.87 μmol/L , P<0.01). It was positively correlated to the duration of parenteral nutrition,and negatively to the gestational age. The TBA level of the Control group was not significantly different before and after nutritional administration. CONCLUSIONS: The TBA level significantly increased after parenteral nutrition administration, suggesting that parenteral nutrition-related cholestasis might developed in preterm infants.