Long Qi,Tou Jinfa,Chen Fei,et al.Nutritional status of children with biliary atresia surviving well after Kasai surgery[J].Journal of Clinical Pediatric Surgery,2020,19(06):491-495.[doi:10.3969/j.issn.1671-6353.2020.06.006]
胆道闭锁Kasai术后自体肝生存良好患儿的营养状况调查
- Title:
- Nutritional status of children with biliary atresia surviving well after Kasai surgery
- Keywords:
- Biliary Atresia; Transplantation; Autologous; Liver Transplantation; Mutrition Surveys; Biliary Tract Surgical Procedures
- 分类号:
- R722;R575.7;R725.7;R151.4+2
- 摘要:
- 目的 回顾性调查胆道闭锁行肝门空肠吻合术（Kasai术）后自体肝生存良好患儿的营养状况，为制定个体化营养方案提供依据。方法 收集46例胆道闭锁Kasai手术后1年且自体肝生存良好患儿的临床资料，包括年龄、身高/身长、体重、血清脂溶性维生素（A、D、E、K）水平。以WHO生长曲线软件分别计算患儿年龄别身高Z评分（height-for-age，HAZ）、年龄别体重Z评分（weight-for-age，WAZ）、身高别体重Z评分（weight-for-height，WHZ）；以正常参考值为标准，计算营养不良和维生素缺乏的比例。结果 46例患儿中男童26例，女童20例，平均年龄（14.5±0.8）个月。患儿HAZ评分为（-0.14±0.86），WAZ评分为（0.21±0.81），WHZ评分为（0.62±1.80），其中生长迟缓2例（4.3%），无低体重及消瘦患儿。25例行脂溶性维生素检查的患儿，其临床和实验室指标与46例自体肝生存良好的患儿均无明显差异（P>0.05）。25例患儿维生素A、D、E、K的水平分别为（290.61±80.26） ng/mL、（30.88±16.15） ng/mL、（7.69±2.77）μg/mL和（1.34±0.98） ng/mL。其中维生素A缺乏4例（16%），维生素D缺乏5例（20%），维生素E缺乏1例（4%），无一例维生素K缺乏者；至少有一种维生素缺乏者有7例（28%）。结论 胆道闭锁行Kasai术后1年，自体肝生存良好的患儿营养状况良好；脂溶性维生素A、D缺乏较为常见，应在术后注意监测并补充。
- Abstract:
- Objective To explore the nutritional status of children with excellent liver autogenous survival after Kasai surgery for biliary atresia (BA) for personalized nutritional interventions.Methods A retrospective survey was conducted for 46 BA children surviving well with autologous liver at 1 year after Kasai surgery.Clinical data were collected for age,height/body length,weight and serum levels of fat-soluble vitamins.The Z scores of height-for-age (HAZ),weight-for-age (WAZ) and weight-for-height (WHZ) were calculated by WHO growth curve software.Malnutrition and vitamin deficiency were calculated according to normal reference values.Results There were 26 boys and 20 girls with an average age of (14.5±0.8) months.The mean scores of HAZ,WAZ and WHZ were (-0.14±0.86),(0.21±0.81) and (0.62±1.80) respectively.Two cases (4.3%) had growth retardation.There was no occurrence of low weight or emaciation; The mean levels of vitamins A,D,E and K in 25 children were (290.61±80.26) ng/ml,(30.88±16.15) ng/ml,(7.69±2.77)μg/ml and (1.34±0.98) ng/ml respectively.The deficient types were vitamin A (n=4,16%),vitamin D (n=5,20%) and vitamin E (n=1,4%).At least one vitamin deficiency was found (n=7,28%).Conclusion At 1 year after Kasai surgery for biliary atresia,most survivors with their autologous liver had excellent nutritional status.Lipid-soluble vitamin A/D deficiency is common and it should be monitored and supplemented postoperatively.
参考文献/References:
1 Chardot C,Buet C,Serinet MO,et al.Improving outcomes of biliary atresia:French national series 1986-2009[J].J Hepatol,2013,58(6):1209-1217.DOI:10.1016/j.jhep.2013.01.040.
2 Hsiao CH,Chang MH,Chen HL,et al.Universal screening for biliary atresia using an infant stool color card in Taiwan[J].Hepatology,2008,47(4):1233-1240.DOI:10.1002/hep.22182.
3 管志伟,詹江华,罗喜荣,等.天津及周边地区胆道闭锁的流行病学调查[J].临床小儿外科杂志,2012,11(5):329-331.DOI:10.3969/j.issn.1671-6353.2012.05.003.Guan ZW,Zhan JH,Luo XR,et al.Epidemiological investigation in biliary atresia of Tianjin and surrounding areas[J].J Clin Ped Sur,2012,11(5):329-331.DOI:10.3969/j.issn.1671-6353.2012.05.003.
4 梁英杰,黄瑛.慢性肝病患儿的营养支持[J].临床肝胆病杂志,2012,28(12):902-906.DOI:10.3969/j.issn.1001-5256.2012.12.007.Liang YJ,Huang Y.Nutritional supports for children with chronic liver disease[J].J Clin Hep,2012,28(12):902-906.DOI:10.3969/j.issn.1001-5256.2012.12.007.
5 朱坚,韩天权,GAUTHIER F.胆道闭锁患儿Kasai术后远期预后研究-63例带自体肝患者生存20年评估[J].临床小儿外科杂志,2005,4(6):401-405.DOI:10.3969/j.issn.1671-6353.2005.06.001.Zhu J,Han TQ,Gauthier F.Evaluation of long-term prognosis for children with biliary atresia after Kasai operation:a report of 63 survivors of 2 decades with their native liver[J].J Clin Ped Sur,2005,4(6):401-405.DOI:10.3969/j.issn.1671-6353.2005.06.001.
6 Howard ER,Maclean G,Nio M,et al.Survival patterns in biliary atresia and comparison of quality of life of long-term survivors in Japan and England[J].J Pediatr Surg,2001,36(6):892-897.DOI:10.1053/jpsu.2001.23965.
7 钟志海,陈华东,黄利娥,等.胆道闭锁Kasai手术后自体肝存活20年以上研究[J].中华小儿外科杂志,2014,35(4):265-268.DOI:10.3760/cma.j.issn.0253-3006.2014.04.007.Zhong ZH,Chen HD,Huang LE,et al.20+-year transplant-free survival of biliary atresia after Kasai operation[J].Chin J Pediatr Surg,2014,35(4):265-268.DOI:10.3760/cma.j.issn.0253-3006.2014.04.007.
8 陈小丽,郑珊.胆道闭锁自体肝生存远期预后现状及影响因素[J].中华小儿外科杂志,2017,38(11):865-868.DOI:10.3760/cma.j.issn.0253-3006.2017.11.013.Chen XL,Zhen S.Long-term outcomes and influencing factors of non-transplanted biliary atresia[J].Chin J Pediatr Surg,2017,38(11):865-868.DOI:10.3760/cma.j.issn.0253-3006.2017.11.013.
9 Yang J,Gao W,Zhan J,et al.Kasai procedure improves nutritional status and decreases transplantation-associated complications[J].Pediatr Surg Int,2018,34(4):387-393.DOI:10.1007/s00383-018-4228-2.
10 闫非易,朱志军,孙丽莹,等.胆道闭锁患儿肝移植术后生长发育的情况分析[J].临床和实验医学杂志,2017,16(19):1881-1884.DOI:10.3969/j.issn.1671-4695.2017.19.005.Yan FY,Zhu ZJ,Sun LY,et al.Analysis of growth and development in biliary atresia patients after liver transplantation[J].J Clin Exp Med,2017,16(19):1881-1884.DOI:10.3969/j.issn.1671-4695.2017.19.005.
11 Ng VL,Haber BH,Magee JC,et al.Medical status of 219 children with biliary atresia surviving long-term with their native livers:results from a North American multicenter consortium[J].J Pediatr,2014,165(3):539-546.DOI:10.1016/j.jpeds.2014.05.038.
12 李英存,张明满,蒲从伦,等.132例胆道闭锁Kasai术后患儿生存率及影响因素分析[J].重庆医科大学学报,2018,43(1):72-76.DOI:10.13406/j.cnki.cyxb.001161.Li YC,Zhang MM,Pu CL,et al.Survival analysis after Kasai procedure in 132 children with biliary atresia[J].Journal of Chongqing Medical University,2018,43(1):72-76.DOI:10.13406/j.cnki.cyxb.001161.
13 Dong R,Sun S,Liu XZ,et al.Fat-soluble vitamin deficiency in pediatric patients with biliary atresia[J].Gastroenterol Res Pract,2017,2017:7496860.DOI:10.1155/2017/7496860.
14 Sathe MN,Patel AS.Update in pediatrics:focus on fat-soluble vitamins[J].Nutr Clin Prac,2010,25(4):340-346.DOI:10.1177/0884533610374198.
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Shen Qiulong,Chen Yajun,Peng Chunhui,et al.Predicting five-year native liver survival after Kasai procedure of biliary atresia by liver stiffness measurement[J].Journal of Clinical Pediatric Surgery,2020,19(06):486.[doi:10.3969/j.issn.1671-6353.2020.06.005]
备注/Memo
收稿日期:2019-08-07。
基金项目:浙江省卫生健康委员会一般科研项目（编号：Y201635973）
通讯作者:马鸣,Email:maming73@zju.edu.cn