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目的探讨血清脂联素(APN)与极低出生体重早产儿胃肠外营养相关性胆汁淤积(PNAC)的相关性。方法所有符合标准的早产儿均于入院后24~48h内取静脉血检测血清APN水平,以中位数13.15mg/L为界,将≥13.15mg/L患者分为高APN组63例,<13.15mg/L为低APN组72例,记录随后5周内患儿PNAC发病率;以发生PNAC为事件终点,用Kaplan-Meier方法对PNAC发生率进行分析;Cox单因素回归分析血清APN与PNAC发生率的相关性。结果随访期间,低脂联素组第2、3、4和5周PNAC发生率分别为21.8%、43.1%、64.0%、和79.2%,血清APN水平有逐渐下降趋势,3周、4周下降更明显(P<0.01);高APN组不同时段PNAC发生率分别为17.9%、33.1%、49.3%和67.8%,APN水平无明显变化(P>0.05)。分析显示两组PNAC发生率差异有统计学意义(P<0.01),Cox单因素分析,APN水平是影响患者远期预后的独立危险因素(P<0.05)。结论随访过程中,在低APN组,伴随着APN水平的降低,PNAC发生逐渐增多。APN与极低体重早产儿胃肠外营养相关性胆汁淤积具有相关性。
Objective To investigate the relationship between serum adiponectin (APN) and parenteral nutrition-associated cholestasis (PNAC) in very low birth weight preterm infants. Methods All standard-compliant preterm infants were tested for venous blood serum levels of APN 24 to 48 hours after admission, with a median of 13.15 mg / L as the threshold and 63.15 mg / L of the patients were divided into high APN group (63 cases, The incidence of PNAC was recorded in 13.15mg / L for the low APN group, and the incidence of PNAC was recorded in the following 5 weeks. The incidence of PNAC was analyzed by Kaplan-Meier method in the presence of PNAC. Cox regression analysis was used to analyze the relationship between serum APN and PNAC The incidence of the correlation. Results During the follow-up period, the incidence of PNAC in the low-adiponectin group was 21.8%, 43.1%, 64.0%, and 79.2% at the 2nd, 3rd, 4th and 5th weeks, respectively. The serum APN levels gradually decreased and decreased 3 weeks and 4 weeks (P <0.01). The incidence of PNAC in the high APN group was 17.9%, 33.1%, 49.3% and 67.8% at different time points, respectively. There was no significant change in the APN level (P> 0.05). The analysis showed that there was significant difference in the incidence of PNAC between the two groups (P <0.01). Cox univariate analysis and APN level were independent risk factors affecting long-term prognosis of patients (P <0.05). Conclusions During follow-up, in the low APN group, the occurrence of PNAC gradually increased with the decrease of APN level. APN is associated with parenteral nutrition-related cholestasis in very low birth weight preterm infants.