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目的探讨熊脱氧胆酸(UDCA)对早产儿胃肠外营养相关性胆汁淤积(PNCA)的疗效。方法选取给予胃肠外营养并PNAC的早产儿65例为研究对象,根据不同UDCA治疗剂量,将其分成低剂量治疗组、高剂量治疗组、对照组。其中高剂量治疗组24例。UDCA 20 mg.kg-1.L-1,分2、3次服用。治疗前ALT(73.5±31.9)U.L-1,谷氨酰转肽酶(GGT)(107.5±27.9)U.L-1,总胆红素(TBIL)(217.0±24.3)μmol.L-1,结合胆红素(DBIL)(71.8±18.8)μmol.L-1,总胆汁酸(TBA)(61.5±18.2)μmol.L-1。低剂量治疗组18例。UDCA 10 mg.kg.L-1,分2、3次服用。ALT(76.8±32.1)U.L-1,GGT(116.8±29.8)U.L-1,TBIL(207.7±20.8)μmol.L-1,DBIL(71.0±20.1)μmol.L-1,TBA(63.9±19.8)μmol.L-1。对照组23例采用综合治疗,但未服用UDCA。ALT(70.3±33.8)U.L-1,GGT(108.3±30.8)U.L-1,TBIL(220.0±25.8)μmol.L-1,DBIL(67.9±19.7)μmol.L-1,TBA(63.5±22.6)μmol.L-1。治疗2～4周比较3组肝功能指标改善情况。结果高剂量治疗组3例因不能耐受高剂量转为低剂量治疗,统计时将其剔除。其他UDCA治疗患儿均未观察到有变应性皮疹、腹泻、血糖升高、白细胞升高等UDCA的不良反应。治疗前3组肝功能指标差异均无统计学意义(Pa>0.05),治疗2周、4周,高剂量治疗组与对照组ALT、GGT、TBIL、DBIL、TBA比较差异均有统计学意义(Pa<0.05),肝功能指标明显降低;低剂量治疗组与对照组指标比较差异均有统计学意义(Pa<0.05),肝功能指标明显降低;高、低剂量治疗组间各指标比较差异均无统计学意义(Pa>0.05)。结论各剂量UDCA治疗早产儿PNCA疗效显著且安全。
Objective To investigate the effect of ursodeoxycholic acid (UDCA) on parenteral nutrition-associated cholestasis (PNCA) in preterm infants. Methods 65 cases of preterm infants given parenteral nutrition and PNAC were divided into low dose treatment group, high dose treatment group and control group according to different doses of UDCA. In which high-dose treatment group of 24 cases. UDCA 20 mg.kg-1.L-1, administered in 2, 3 times. The levels of ALT (73.5 ± 31.9) UL-1, GGT (107.5 ± 27.9) UL-1 and TBIL (217.0 ± 24.3) μmol.L- DBIL (71.8 ± 18.8) μmol.L-1, TBA (61.5 ± 18.2) μmol.L-1. Low-dose treatment group of 18 cases. UDCA 10 mg.kg.L-1, administered 2, 3 times. ALT 76.8 ± 32.1 UL-1, GGT 116.8 ± 29.8 UL-1, TBIL 207.7 ± 20.8 μmol.L-1, DBIL 71.4 ± 19.0 ± 20.1 μmol.L- μmol.L-1. The control group of 23 patients with comprehensive treatment, but did not take UDCA. ALT 70.3 ± 33.8 UL-1, GGT 108.3 ± 30.8 UL-1, TBIL 220.0 ± 25.8 μmol.L-1, DBIL 67.9 ± 19.7 μmol.L-1, TBA 63.5 ± 22.6, μmol.L-1. The treatment of 2 to 4 weeks to compare the three groups of liver function improvement. Results In the high-dose treatment group, 3 cases were unable to tolerate the high-dose to low-dose treatment, and were excluded when statistics were made. No adverse reactions such as allergic rash, diarrhea, hyperglycemia, leukocytosis and other UDCA were observed in other UDCA children. There was no significant difference in the indexes of liver function among the three groups before treatment (Pa> 0.05). There were significant differences in ALT, GGT, TBIL, DBIL and TBA between the high-dose treatment group and the control group at 2 weeks and 4 weeks Pa <0.05). The indexes of liver function were significantly decreased. The indexes of low-dose treatment group and control group were significantly different (Pa <0.05), and the indexes of liver function were significantly decreased. Not statistically significant (Pa> 0.05). Conclusions The effect of UDCA at each dosage on PNCA in preterm infants is significant and safe.