早产儿肠外营养相关性胆汁淤积：宏量营养素的作用
为了评估胎龄小于32周早产儿经静脉摄入脂质是否与肠外营养相关性胆汁淤积（PNAC）具有相关性，美国罗切斯特大学医学中心戈利萨诺儿童医院对出生后48h内入住新生儿重症监护病房胎龄小于32周的46例早产儿进行了回顾性病例对照研究（1∶1）。排除染色体异常、TORCH（弓形虫病、梅毒、风疹、巨细胞病毒、疱疹、人类免疫缺陷病毒和细小病毒）感染、代谢障碍和/或肝胆系统解剖学畸形。将PNAC婴儿（直接胆红素≥2mg/dL）作为病例组，非PNAC婴儿作为对照组。将肠外营养时间、PNAC期间的静脉输液情况以及胎龄作为匹配标准。
结果发现，PNAC组婴儿与非PNAC组婴儿相比，日均静脉注射葡萄糖明显较高（分别为12.72±2.5g/kg/d和10.64±2.1g/kg/d，P=0.004）。比较两组接受者操作特性（ROC）曲线下面积（AUC），静脉注射葡萄糖摄入（0.74）显著高于（P=0.01）静脉注射脂质（0.59）和静脉注射蛋白质（0.52）。逻辑回归分析显示：在控制每日静脉注射蛋白质和静脉注射脂质摄入的情况下，每日静脉注射葡萄糖摄入量与PNAC发生有相关性（比值比为1.7；95%置信区间：1.04～2.9，P=0.03）。
因此，静脉注射葡萄糖的摄入可能与早产儿PNAC的发生相关，该研究提示与限制静脉注射脂质摄入相比，限制静脉注射葡萄糖摄入能够更好的降低早产儿PNAC的发生。
JPEN J Parenter Enteral Nutr. 2016;40(3):335-41.
Parenteral Nutrition-Associated Cholestasis in Premature Infants: Role of Macronutrients.
Gupta K, Wang H, Amin SB.
Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York, USA.
PURPOSE: To evaluate whether intravenous lipid (IL) intake is associated with the development of parenteral nutrition-associated cholestasis (PNAC) in infants younger than 32 weeks gestational age (GA).
METHODS: A retrospective matched case-control study (1:1) was performed including infants younger than 32 weeks GA admitted to the neonatal intensive care unit within 48 hours after birth. Infants with a chromosomal disorder, TORCH infection (toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes, human immunodeficiency virus, and parvovirus), metabolic disorder, and/or surgical abnormality of the hepatobiliary system were excluded. Infants with PNAC (direct bilirubin 2 mg/dL or higher) comprised the case group, while infants without PNAC comprised the control group. Duration of parenteral nutrition, intravenous fluid intake on the day of development of PNAC, and GA were used as matching criteria.
RESULTS: A total of 46 subjects were studied. Daily average intravenous dextrose (ID) intake was significantly higher in infants with PNAC compared with infants without PNAC (12.72 ± 2.5 g/kg/d and 10.64 ± 2.1 g/kg/d, respectively, P = .004). On comparison of receiver operating characteristic curves, the area under the curve for ID intake (0.74) was significantly higher (P = .01) compared with the area under the curve for IL intake (0.59) and intravenous protein (IP) intake (0.52). On logistic regression, daily ID intake was associated with PNAC (odds ratio 1.7; 95% CI, 1.04-2.9, P = .03) after controlling for daily IP and IL intake.
CONCLUSIONS: ID intake may be associated with the development of PNAC in premature infants. Our findings suggest that limiting ID intake may be more useful than limiting IL intake in reducing the incidence of PNAC in premature infants.
KEYWORDS: life cycle; lipids; neonates; nutrition; nutrition, liver disease; parenteral nutrition; research and diseases
PMID: 25316680
DOI: 10.1177/0148607114555161
