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 nutrition-associated 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。
Abstract
Objective To explore the value of the combined use of aspartate aminotransferase-to-platelet ratio index (APRI) and total bile acid (TBA) for predicting parenteral nutrition-associated cholestasis (PNAC) in preterm infants with gestational age <34 weeks. Methods A retrospective analysis was performed on medical data of 270 preterm infants born at <34 weeks of gestation who received parenteral nutrition (PN) during hospitalization in the First Affiliated Hospital of Wannan Medical College from January 2019 to September 2022, including 128 infants with PNAC and 142 infants without PNAC. The medical data between the two groups were compared, and predictive factors for the development of PNAC were explored through multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the value of APRI alone, TBA alone, and the combination of both for predicting PNAC. Results TBA levels in the PNAC group after 1, 2, and 3 weeks of PN were higher than those in the non-PNAC group (P<0.05). APRI in the PNAC group after 2 and 3 weeks of PN was higher than that in the non-PNAC group (P<0.05). Multivariate logistic regression analysis showed that elevated APRI and TBA after 2 weeks of PN were predictive factors for PNAC in preterm infants (P<0.05). ROC curve analysis showed that the sensitivity, specificity, and area under the curve (AUC) for predicting PNAC by combining APRI and TBA after 2 weeks of PN were 0.703, 0.803, and 0.806, respectively. The AUC for predicting PNAC by combining APRI and TBA was higher than that of APRI or TBA alone (P<0.05). Conclusions After 2 weeks of PN, the value of combining APRI and TBA for predicting PNAC is high in preterm infants with gestational age <34 weeks.
关键词
肠外营养相关性胆汁淤积症 /
谷草转氨酶与血小板比值指数 /
总胆汁酸 /
早产儿
Key words
Parenteral nutrition-associated cholestasis /
Aspartate aminotransferase-to-platelet ratio index /
Total bile acid /
Preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Xu Z, Harvey KA, Pavlina T, et al. Steroidal compounds in commercial parenteral lipid emulsions[J]. Nutrients, 2012, 4(8): 904-921. PMID: 23016123. PMCID: PMC3448078. DOI: 10.3390/nu4080904.
2 李媛, 杨云成, 周熙惠, 等. PNAC的危险因素分析及血清总胆汁酸对极低出生体重儿PNAC的预测价值[J]. 中国妇幼健康研究, 2022, 33(6): 7-12. DOI: 10.3969/j.issn.1673-5293.2022.06.002.
3 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]. J Pediatr Surg, 2015, 50(9): 1528-1531. PMID: 25783319. DOI: 10.1016/j.jpedsurg.2014.11.046.
4 黄涌, 马超. 血清甘胆酸联合总胆汁酸对早产儿胃肠外营养相关性胆汁淤积的预测价值[J]. 国际儿科学杂志, 2017, 44(10): 720-722. DOI: 10.3760/cma.j.issn.1673-4408.2017.10.017.
5 中华医学会肠外肠内营养学分会儿科学组, 中华医学会儿科学分会新生儿学组, 中华医学会小儿外科学分会新生儿外科学组, 等. 中国新生儿营养支持临床应用指南[J]. 中华小儿外科杂志, 2013, 34(10): 782-787. DOI: 10.3760/cma.j.issn.0253-3006.2013.10.016.
6 吕朦, 刘秀香. 新生儿肠外营养相关性胆汁淤积的研究进展[J]. 中国医药导报, 2019, 16(36): 46-49.
7 Dani C, Pratesi S, Raimondi F, et al. Italian guidelines for the management and treatment of neonatal cholestasis[J]. Ital J Pediatr, 2015, 41: 69. PMID: 26428285. PMCID: PMC4591626. DOI: 10.1186/s13052-015-0178-7.
8 李彤, 李冬. 早产低出生体质量儿肠外营养相关性胆汁淤积的临床危险因素及近期结局[J]. 临床儿科杂志, 2020, 38(7): 518-523. DOI: 10.3969/j.issn.1000-3606.2020.07.010.
9 Zhang Y, Zhang X. Prognostic value of aspartate aminotransferase to platelet ratio index as a noninvasive biomarker in patients with hepatocellular carcinoma: a meta-analysis[J]. Cancer Manag Res, 2018, 10: 3023-3032. PMID: 30214297. PMCID: PMC6124471. DOI: 10.2147/CMAR.S174095.
10 Lacaille F, Gupte G, Colomb V, et al. Intestinal failure-associated liver disease: a position paper of the ESPGHAN working group of intestinal failure and intestinal transplantation[J]. J Pediatr Gastroenterol Nutr, 2015, 60(2): 272-283. PMID: 25272324. DOI: 10.1097/MPG.0000000000000586.
11 丁瑞伟. 早产儿肠外营养相关性胆汁淤积症研究进展[J]. 国际儿科学杂志, 2019, 46(7): 478-481. DOI: 10.3760/cma.j.issn.1673-4408.2019.07.005.
12 Premkumar MH, Carter BA, Hawthorne KM, et al. Fish oil-based lipid emulsions in the treatment of parenteral nutrition-associated liver disease: an ongoing positive experience[J]. Adv Nutr, 2014, 5(1): 65-70. PMID: 24425724. PMCID: PMC3884101. DOI: 10.3945/an.113.004671.
13 孙僮, 富建华. 早产儿胃肠外营养相关性胆汁淤积症的危险因素及防治进展[J]. 中华新生儿科杂志, 2021, 36(5): 68-71. DOI: 10.3760/cma.j.issn.2096-2932.2021.05.018.
14 孙金龙, 姚芳, 曾丽娟, 等. ≤34周早产儿静脉营养相关性胆汁淤积的发生与血清胆汁酸、血清脂联素相关性研究[J]. 医学理论与实践, 2022, 35(17): 2897-2899. DOI: 10.19381/j.issn.1001-7585.2022.17.006.
15 Perrem L, Semberova J, O'Sullivan A, et al. Effect of early parenteral nutrition discontinuation on time to regain birth weight in very low birth weight infants: a randomized controlled trial[J]. JPEN J Parenter Enteral Nutr, 2019, 43(7): 883-890. PMID: 30613992. DOI: 10.1002/jpen.1502.
16 Khalaf RT, Sokol RJ. New insights into intestinal failure-associated liver disease in children[J]. Hepatology, 2020, 71(4): 1486-1498. PMID: 32003009. PMCID: PMC8245203. DOI: 10.1002/hep.31152.
17 ?zkan H, K?ksal N, Do?an P, et al. The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants[J]. Turk J Pediatr, 2019, 61(1): 26-33. PMID: 31559718. DOI: 10.24953/turkjped.2019.01.005.
18 Madnawat H, Welu AL, Gilbert EJ, et al. Mechanisms of parenteral nutrition-associated liver and gut injury[J]. Nutr Clin Pract, 2020, 35(1): 63-71. PMID: 31872510. PMCID: PMC7014933. DOI: 10.1002/ncp.10461.
19 Scoville SD, Mundy-Bosse BL, Zhang MH, et al. A progenitor cell expressing transcription factor RORγt generates all human innate lymphoid cell subsets[J]. Immunity, 2016, 44(5): 1140-1150. PMID: 27178467. PMCID: PMC4893782. DOI: 10.1016/j.immuni.2016.04.007.
20 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[J]. JPEN J Parenter Enteral Nutr, 2018, 42(4): 797-804. PMID: 28792861. DOI: 10.1177/0148607117722755.
21 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[J]. BMC Pediatr, 2019, 19(1): 126. PMID: 31018837. PMCID: PMC6482507. DOI: 10.1186/s12887-019-1493-8.
基金
安徽省自然科学基金项目（1908085MH274）。
PDF(587 KB)
