小于胎龄早产儿胆汁淤积症的临床特征及危险因素

doi:10.7499/j.issn.1008-8830.2404095

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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。

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关键词 ：胆汁淤积症, 临床特征, 危险因素, 小于胎龄儿, 早产儿

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.

Key words： Cholestasis Clinical feature Risk factor Small for gestational age Preterm infant

收稿日期: 2024-04-15

基金资助:国家自然科学基金项目（82271741）；江苏省卫生健康委员会医学科研课题重点项目（ZD2021013）；姑苏领军人才（GSWS2022055）；临床科技高端平台和转化基地建设项目（ML13101523）；苏州大学附属儿童医院“遂园”临床研究项目（SY003）。

通讯作者: 朱雪萍，女，教授，主任医师。Email：zhuxueping4637@hotmail.com。 E-mail: zhuxueping4637@hotmail.com

作者简介: 陈瑜，女，硕士，主治医师；

引用本文:

陈瑜,朱雪萍. 小于胎龄早产儿胆汁淤积症的临床特征及危险因素[J]. 中国当代儿科杂志, 2024, 26(10): 1027-1033.

CHEN Yu,ZHU Xue-Ping. Clinical features and risk factors of cholestasis in small for gestational age preterm infants[J]. CJCP, 2024, 26(10): 1027-1033.

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