Total parenteral nutrition-associated cholestasis and risk factors in preterm infants.
Total parenteral nutrition-associated cholestasis and risk factors in preterm infants.
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DOI：
10.4103/1319-3767.141688
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发表时间：
2014-09
期刊：
影响因子：
--
通讯作者：
AlFaleh KM
中科院分区：
文献类型：
--
作者：
Alkharfy TM;Ba-Abbad R;Hadi A;Sobaih BH;AlFaleh KM
肝功能障碍的发展是早产儿全肠外营养的公认并发症。以前的研究报道了全胃肠外营养相关胆汁淤积的发病率，并描述了其发病机制的可能影响因素，但很少有人试图确定其可能的预测风险因素。本研究的目的是确定全胃肠外营养相关胆汁淤积的发生率，并建立一个可能的预测模型。对2001年1月至2003年12月期间入住沙特阿拉伯利雅得哈立德国王大学医院新生儿重症监护室的所有极低出生体重儿的病历进行了审查。根据直接血清胆红素>34 μmol/L分为胆汁淤积组和非胆汁淤积组。采用多因素Logistic回归分析计算危险因素的统计学意义。采用受试者工作特征曲线确定显著危险因素的最佳临界点，并计算其敏感性和特异性。显著性水平设定为P ≤ 0.05。共有307名患者被纳入分析。胆汁淤积的发生率为24.1%（74例患者）。胆汁淤积组新生儿出生体重（735.4 ± 166.4）g低于非胆汁淤积组（1185.0 ± 205.6）g（P < 0.001），而两组的平均胎龄分别为25.4 ± 2.1周和28.9 ± 2.1周（P < 0.001）。胆汁淤积症发生的重要危险因素是出生体重（P = 0.006），比值比为0.99 [95%可信区间（CI），0.98，0.99]，敏感性为92%，特异性为87%;全肠外营养持续时间（P < 0.001），优势比为1.18（95% CI，1.10，1.27），敏感性为96%，特异性为89%。低出生体重和较长的全肠外营养持续时间是早产儿胆汁淤积症发生的强预测风险因素。
Development of hepatic dysfunction is a well-recognized complication of total parenteral nutrition in preterm infants. Previous studies reported the incidence of total parenteral nutrition–associated cholestasis and described possible contributing factors to its pathogenesis, but little is done trying to determine its possible predictive risk factors. The aims of this study was to determine the incidence of total parenteral nutrition–associated cholestasis and to develop a possible predictive model for its occurrence. A review of medical records of all very low birth weight infants admitted to neonatal intensive care unit at King Khalid University Hospital, Riyadh, Saudi Arabia, between January 2001 and December 2003 was carried out. The infants were divided into two groups: Cholestasis and noncholestasis, based on direct serum bilirubin level >34 μmol/L. A multivariate logistic regression analysis was performed to calculate the statistical significance of risk factors. Receiver–operating characteristic curve was used to determine the optimal cutoff points for the significant risk factors and to calculate their sensitivity and specificity. The level of significance was set at P ≤ 0.05. A total of 307 patients were included in the analysis. The incidence of cholestasis in the whole population was 24.1% (74 patients). Infants with cholestasis had a lower birth weight, 735.4 ± 166.4 g vs. 1185.0 ± 205.6 g for noncholestasis group (P < 0.001), whereas the mean gestational age for the two groups was 25.4 ± 2.1 week and 28.9 ± 2.1 week, respectively (P < 0.001). The significant risk factors for the development of cholestasis were birth weight (P = 0.006) with an odds ratio of 0.99 [95% confidence interval (CI), 0.98, 0.99]; sensitivity of 92%, specificity of 87%; and total parenteral nutrition duration (P < 0.001) with an odds ratio of 1.18 (95% CI, 1.10, 1.27); sensitivity of 96%, specificity of 89%. A lower birth weight and longer duration of total parenteral nutrition were strong predictive risk factors for the development of cholestasis in preterm infants.
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影响因子：
25.7
作者：
Chen, HL;Chen, HL;Chang, MH
通讯作者：
Chang, MH
DOI：
10.1515/jpem.1999.12.4.549
发表时间：
1999-07-01
影响因子：
1.4
作者：
Levine, A;Maayan, A;Sirotta, L
通讯作者：
Sirotta, L
影响因子：
4.4
作者：
Takagi, K;Yamamori, H;Tashiro, T
通讯作者：
Tashiro, T
影响因子：
13.5
作者：
Buchman, AL;Iyer, K;Fryer, J
通讯作者：
Fryer, J
影响因子：
3.6
作者：
Carter, Beth A.;Taylor, Olga A.;Karpen, Saul J.
通讯作者：
Karpen, Saul J.