小于胎龄早产儿胆汁淤积症的临床特征及危险因素

Clinical features and risk factors of cholestasis in small for gestational age preterm infants

摘要:

目的 探讨小于胎龄（small for gestational age infant, SGA）早产儿胆汁淤积症临床特征及其发生的高危因素。方法 选取胎龄<37周且在出生24 h内收住苏州大学附属儿童医院新生儿科的SGA早产儿为研究对象，将其分为胆汁淤积症和非胆汁淤积症两组，收集并回顾性分析2017年7月—2022年6月的临床数据。结果 纳入的553例SGA早产儿中，100例（18.1%）发生胆汁淤积症。不同胎龄和出生体重组别的发生率分别为：超早产儿50.0%，极早产儿46.6%，中期早产儿32.7%，晚期早产儿9.8%；出生体重（birth weight, BW）<1 000 g 60.9%，1 000 g≤BW<1 500 g 33.9%，1 500 g≤BW<2 500 g 10.7%。多因素回归分析显示，低出生体重、颅内出血、有创通气时间、第2周氨基酸累积量、第1周脂肪乳累积量、第2周脂肪乳累积量是SGA早产儿发生胆汁淤积症的独立危险因素（P<0.05）。结论 SGA早产儿胆汁淤积症的发生率随胎龄和出生体重的降低而升高；SGA早产儿胆汁淤积症的发生受低出生体重、颅内出血、有创通气及氨基酸、脂肪乳累积量等多种危险因素综合影响，需采取综合治疗措施减少其发生。

Abstract:

Objective To investigate the clinical features and risk factors of cholestasis in small for gestational age (SGA) preterm infants.Methods This study selected SGA preterm infants born at less than 37 weeks of gestation and admitted to the Department of Neonatology, Children's Hospital of Soochow University within 24 hours after birth. The infants were divided into two groups: a cholestasis group and a non-cholestasis group. Clinical data from July 2017 to June 2022 were collected and retrospectively analyzed.Results Among the 553 SGA preterm infants included, 100 infants (18.1%) developed cholestasis. The incidence rates in different gestational age and birth weight groups were as follows: extremely preterm infants 50.0%, very preterm infants 46.6%, moderate preterm infants 32.7%, and late preterm infants 9.8%; birth weight (BW) <1 000 g 60.9%, 1 000 g≤BW<1 500 g 33.9%, and 1 500 g≤BW<2 500 g 10.7%. Multivariate regression analysis showed that low birth weight, intracranial hemorrhage, duration of invasive ventilation, total amino acid accumulation in the second week, total lipid emulsion accumulation in the first week, and total lipid emulsion accumulation in the second week were independent risk factors for cholestasis in SGA preterm infants (P<0.05).Conclusions The incidence of cholestasis in SGA preterm infants increases with decreasing gestational age and birth weight. The occurrence of cholestasis in SGA preterm infants is influenced by multiple risk factors, including low birth weight, intracranial hemorrhage, invasive ventilation, and the accumulation of amino acids and lipid emulsions, highlighting the need for comprehensive treatment measures to reduce its occurrence.