谷草转氨酶与血小板比值指数联合总胆汁酸对胎龄<34周早产儿肠外营养相关性胆汁淤积症的预测价值

Value of the combined use of aminotransferase-to-platelet ratio index and total bile acid for predicting parenteral nutrition-associated cholestasis in preterm infants with gestational age <34 weeks

摘要:

目的 探讨谷草转氨酶与血小板比值指数（aspartate aminotransferase-to-platelet ratio index，APRI）联合总胆汁酸（total bile acid，TBA）对胎龄<34周早产儿肠外营养相关性胆汁淤积症（parenteral nutrition-associated cholestasis，PNAC）的预测价值。方法 回顾性分析2019年1月—2022年9月在皖南医学院第一附属医院住院期间接受肠外营养（parenteral nutrition，PN）的270例胎龄<34周早产儿的临床资料，包括PNAC 128例和非PNAC 142例。比较两组的临床资料，通过多因素logistic回归分析探讨PNAC发生的预测因素，并采用受试者操作特征曲线（receiver operating characteristic curve，ROC曲线）评价APRI、TBA单独及二者联合预测PNAC的价值。结果 PNAC组在PN 1、2及3周后的TBA水平均高于非PNAC组（P<0.05）；PN 2、3周后PNAC组APRI均高于非PNAC组（P<0.05）。多因素logistic回归分析显示，PN 2周后APRI和TBA升高是早产儿发生PNAC的预测因素（P<0.05）。ROC曲线分析显示，PN 2周后APRI联合TBA预测PNAC发生的灵敏度、特异度及曲线下面积（area under the curve，AUC）分别为0.703、0.803、0.806；APRI联合TBA预测PNAC发生的AUC高于APRI、TBA单独预测的AUC（P<0.05）。结论 在PN 2周后，APRI联合TBA对胎龄<34周早产儿PNAC的预测价值较高。

Abstract:

Objective To explore the value of the combined use of aspartate aminotransferase-to-platelet ratio index (APRI) and total bile acid (TBA) for predicting parenteral nutrition-associated cholestasis (PNAC) in preterm infants with gestational age <34 weeks.Methods A retrospective analysis was performed on medical data of 270 preterm infants born at <34 weeks of gestation who received parenteral nutrition (PN) during hospitalization in the First Affiliated Hospital of Wannan Medical College from January 2019 to September 2022, including 128 infants with PNAC and 142 infants without PNAC. The medical data between the two groups were compared, and predictive factors for the development of PNAC were explored through multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the value of APRI alone, TBA alone, and the combination of both for predicting PNAC.Results TBA levels in the PNAC group after 1, 2, and 3 weeks of PN were higher than those in the non-PNAC group (P<0.05). APRI in the PNAC group after 2 and 3 weeks of PN was higher than that in the non-PNAC group (P<0.05). Multivariate logistic regression analysis showed that elevated APRI and TBA after 2 weeks of PN were predictive factors for PNAC in preterm infants (P<0.05). ROC curve analysis showed that the sensitivity, specificity, and area under the curve (AUC) for predicting PNAC by combining APRI and TBA after 2 weeks of PN were 0.703, 0.803, and 0.806, respectively. The AUC for predicting PNAC by combining APRI and TBA was higher than that of APRI or TBA alone (P<0.05).Conclusions After 2 weeks of PN, the value of combining APRI and TBA for predicting PNAC is high in preterm infants with gestational age <34 weeks.