不同胎龄早产儿血脂生化指标的临床意义

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　　作者：尹力扬，王红兵，徐丽，刘淑华，董雪萍，梁世磊，张大葵，李文斌
  　　【摘要】 目的 通过测定不同胎龄早产儿血脂生化指标的变化，探讨其作为评价早产儿成熟度、营养状况及营养支持指标的临床意义。方法 早产儿组30例在入院后12 h内(出生后24 h)采集股静脉血2 ml，采血前2 h未喂养及输液。足月儿组30例在胎儿娩出、清理呼吸道后即刻采脐带血2 ml。测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)等生化指标。结果 早产儿组血清TC、TG、HDL-C、LDL-C、ApoA1、ApoB水平均低于足月儿组，2组之间差异具有统计学意义(P<0.01)。28～31 周的早产儿组血清TC、TG、HDL-C、LDL-C、ApoA1、ApoB水平均低于32～36 周的早产儿组，2组之间差异具有统计学意义(P<0.01)。结论 血脂生化指标可作为评价早产儿成熟度及营养状况的依据。检测血脂水平变化，对临床合理营养支持具有指导意义。
  　　【关键词】 早产儿;血脂;成熟度;营养状况;营养支持
  　　Abstract: Objective By measuring the biochemical changes in blood lipids in premature infants of different gestational age, to explore their clinical significance as biochemical indexes to evaluate the maturity, nutritional status and nutritional support in premature infants. Methods 30 premature infants admitted to hospital were designated as the premature group. Blood collection of 2 ml was performed from the femoral vein within 12 hours after admission (24 hours after birth). 2 hours before blood collection, the premature infants received no transfusion or feeding. 30 neonates of term delivery underwent blood collection of 2 ml from the umbilical cord immediately after delivery and airway clearance. Determinations were conducted on the biochemical indicators including serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB).Results Serum TC, TG, HDL-C, LDL-C, ApoA1 and ApoB levels in the premature infant group were lower than in the mature neonate group. The results had statistical difference (P<0.01). Serum TC, TG, HDL-C, LDL-C, ApoA1 and ApoB levels in the premature infants of 28-31 weeks were lower than in those of 32-36 weeks. The levels between the two subgroups of premature infants were statistically different (P<0.01). Conclusion Biochemical indicators of blood lipid can be used as evidence of maturity and nutritional status in premature infants and the determination of the variations in the levels of blood lipids plays the role of a reasonable guide to clinical nutritional support.
  　　Key words： premature infants; blood lipids; maturity; nutritional status; nutritional support
  　　早产儿全身各系统发育未成熟，体质量低，营养差，且容易出现消化系统等许多并发症[1]。给予早喂养、部分或完全静脉营养等营养支持治疗，是提高早产儿成活率的重要措施。本文旨在通过测定不同胎龄、体质量的早产儿血脂生化指标，并与正常足月新生儿血脂水平进行对照研究，探讨血脂生化指标对评价早产儿成熟度、营养状况及临床给予合理营养支持的临床意义。
  　　1 对象和方法
  　　1.1 研究对象 选择2008 年12月—2009年12月在我院新生儿科住院的早产儿和产科出生的足月新生儿60例，均为适于胎龄儿，无宫内窘迫及出生窒息史，无先天畸形、感染表现。早产儿组:30例，男17例，女13例，胎龄28～36(34.19±2.32)周，体质量950～2 495(1 620±355)g;其中28～31周12例，男7 例,女5 例，体质量950～1 595(1 220±285)g;32～36周18例，男10例,女8 例，体质量1 450～2 495(1 920±320)g。足月儿组：30例，男14例，女16例，胎龄37～41(40.19±1.32)周，体质量2 550～3 560(3 120±255)g。
  <P>　　1.2 方法 早产儿组入院后按照中华医学会儿科学分会新生儿学组制订的早产儿管理指南[2]，给予防治早产儿并发症、尽早给予胃肠道喂养和部分或完全静脉营养，补充水、能量、氨基酸等各种营养成分。本组病例分别于入院后12 h内(出生后24 h)采集股静脉血2 ml，采血前2 h未喂养及输液。足月儿组在胎儿娩出、清理呼吸道后即刻采脐带血2 ml。血标本不抗凝，离心后取血清2 h内测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL