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摘要：
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摘要：目的 分析婴儿胆汁淤积性肝病（infantile cholestatic hepatopathy，ICH）脂溶性
维生素（fat-soluble vitamin，FSV）水平。方法 选取2017年1月至2019年2月收治的42例
ICH患儿为病例组，选取同期在本院出生的44例健康婴儿为对照组，根据孕妇孕后期及
婴儿早期是否补充FSV，将病例组分为病例一组（18例）和病例二组（24例），其中病
例一组孕妇孕后期及婴儿均未补充FSV，病例二组孕妇孕后期及婴儿均补充FSV，对照
组根据以上标准分为对照一组（22例）和对照二组（22例）。采用随机数字表法将病
例组分为母乳喂养组、人工喂养组和混合喂养组，每组14例。采用AU5811全自动生化
分析仪检测肝功能指标，包括丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天
门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、总胆红素（total bilirubin，
TBil）、直接胆红素（direct bilirubin，DBil）、总胆汁酸（total bile acid，TBA）。采用
血凝仪透射比浊测定法检测凝血功能，包括凝血酶原时间（prothrombin time，PT）、
活化部分凝血活酶时间（activated partial thromboplastin time，APTT）。使用高效液相
色谱串联质谱法进行血清FSV测定，包括维生素A、维生素D3、维生素E、维生素K。
两组间上述指标的比较采用独立样本t检验或秩和检验。FSV与ALT、AST、TBil和DBil
的相关性采用Spearman秩相关分析。结果 病例组和对照组婴儿年龄分别为（96.53 ±
9.21）d和（93.84 ± 8.67）d，差异无统计学意义（t = 1.395，P = 0.083）。病例组婴儿
维生素A [（244.521 ± 124.213）μg/L vs（380.705 ± 133.289）μg/L]、维生素D3 [（17.459 ±
6.399）μg/L vs（31.962 ± 7.348）μg/L]、维生素E [（6.020 ± 2.302）μg/L vs（18.735 ±
4.326）μg/L]及维生素K [（10.945 ± 3.447）μg/L vs（22.375 ± 5.655）μg/L] 水平均显
著低于对照组，差异均有统计学意义（P均＜ 0.05）。病例一组与病例二组婴儿维生
素A [（242.155 ± 106.981）μg/L vs（246.296 ± 157.712）μg/L]、维生素D3 [（16.401 ±
4.319）μg/L vs（18.001 ± 8.179）μg/L]、维生素E [（5.678 ± 2.436）mg/L vs（6.276 ±
3.110）mg/L]及维生素K [（10.249 ± 3.141）μg/L vs（11.467 ± 4.073）μg/L] 水平差异
均无统计学意义（P均＞ 0.05）。对照一组维生素A [（408.875 ± 115.493）μg/L vs
（352.535 ± 97.732）μg/L]、维生素D3 [（34.185 ± 8.379）μg/L vs（26.835 ± 6.983）μg/L]、
维生素E [（24.152 ± 4.089）mg/L vs（13.318 ± 2.544）mg/L] 及维生素K [（26.341 ±
6.376）μg/L vs（18.409 ± 4.205）μg/L]水平均显著高于对照二组，差异均有统计学意义
（P均＜ 0.05）。病例组PT （中位数：11.7 s vs 11.2 s）、ALT（中位数：99.58 U/L
vs 60.23 U/L）、AST（中位数：178.45 U/L vs 140.80 U/L）、TBil（中位数：173.86 μmol/L vs
139.68 μmol/L）、DBil（中位数：103.66 μmol/L vs 77.84 μmol/L）及TBA（中位数：
104.30 μmol/L vs 85.59 μmol/L）水平均显著高于对照组（P均＜ 0.05），APTT（中位
数：36 s vs 36 s）水平差异无统计学意义（z = -0.379，P = 0.705）。母乳喂养组、人
工喂养组和混合喂养组ICH患儿维生素A [（244.312 ± 54.480）μg/L vs（241.646 ±
59.462）μg/L vs（163.438 ± 33.153）μg/L]、维生素D3 [（9.655 ± 2.941）μg/L vs
（18.192 ± 4.078）μg/L vs（9.148 ± 2.564）μg/L]、维生素E [（7.053 ± 2.756）mg/L
vs（10.118 ± 3.798）mg/L vs（10.134 ± 5.699）mg/L] 和维生素K [（9.267 ± 2.173）μg/L vs
（4.750 ± 1.637）μg/L vs（7.013 ± 2.809）μg/L] 水平均差异无统计学意义（P均＞
0.05）。病例组FSV水平与ALT、AST、TBil和DBil均无相关性（P均＞ 0.05），维生
素D3与TBA呈负相关（rs = -0.506，P = 0.042），维生素A、维生素E和维生素K与TBA
无显著相关性（P均＞ 0.05）。结论 ICH患儿普遍存在FSV缺乏，婴儿补充正常剂量的
维生素A和维生素D不能满足机体对FSV的需求。患儿常伴凝血功能障碍，表现为PT
延长。不同喂养方式ICH患儿的FSV水平无显著差异。ALT、AST、TBil和DBil水平与
FSV无显著相关性，TBA水平与维生素D3呈负相关。
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Abstract: Objective To analyze the fat-soluble vitamin (FSV) levels of infants with cholestatic
hepatopathy. Methods A total of 42 cases with infantile cholestatic hepatopathy (ICH) in
Sheyang County People’s Hospital from January 2017 to February 2019 were selected as case
group and 44 infants born in our hospital at the same period were selected as the control group.
Infants in case group were divided into case group 1 (18 cases) and case group 2 (24 cases)
according to whether pregnant women in late pregnancy and infants supplemented FSV or
not. Infants in control group were divided into control group 1 (22 cases) and control group
2 (22 cases) according to the above criteria. Infants in case group were divided into breast
feeding group, artificial feeding group and mixed feeding group, 14 cases in each group.
AU5811 automatic biochemical analyzer was used to detect liver function indexes, including
alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil),
direct bilirubin (DBil) and total bile acid (TBA). Blood coagulation fuction indexes including
prothrombin time (PT) and activated partial thromboplastin time (APTT) were detected by
turbidimetry. Hperformance liquid phase tandem mass spectrometry was used to detect serum
FSV levels, including vitamin A, vitamin D3, vitamin E and vitamin K. Comparison of the
above indexes between the two groups were performed using an independent sample t test
or rank sum test. Spearman rank correlation was used to analyze the correlation of FSV
with ALT, AST, TBil and DBil. Results The age of infants in case group and control group
were (96.53 ± 9.21) d and (93.84 ± 8.67) d, respectively, the difference was not statistically
significant (t = 1.395, P = 0.083). The levels of vitamin A [(244.521 ± 124.213) μg/L vs
(380.705 ± 133.289) μg/L], vitamin D3 [(17.459 ± 6.399) μg/L vs (31.962 ± 7.348) μg/L],
vitamin E [(6.020 ± 2.302) μg/L vs (18.735 ± 4.326) μg/L] and vitamin K [(10.945 ± 3.447) μg/L vs
(22.375 ± 5.655) μg/L] of infants in case group were significantly lower than those in control group,
the differences were statistically significant (all P ＜ 0.05). There were no significant differences
in vitamin A [(242.155 ± 106.981) μg/L vs (246.296 ± 157.712) μg/L], vitamin D3 [(16.401 ±
4.319) μg/L vs (18.001 ± 8.179) μg/L], vitamin E [(5.678 ± 2.436) mg/L vs (6.276 ± 3.110) mg/L]
and vitamin K [(10.249 ± 3.141) μg/L vs (11.467 ± 4.073) μg/L] of infants between case group
1 and case group 2 (all P ＞ 0.05). The levels of vitamin A [(408.875 ± 115.493) μg/L vs (352.535 ±
97.732) μg/L], vitamin D3 [(34.185 ± 8.379) μg/L vs (26.835 ± 6.983) μg/L], vitamin E [(24.152 ±
4.089) mg/L vs (13.318 ± 2.544) mg/L] and vitamin K [(26.341 ± 6.376) μg/L vs (18.409 ±
4.205) μg/L] of infants in control group 1 were significantly higher than those in control group
2, the differences were statistically significant (all P ＜ 0.05). The levels of PT (median: 11.7 s vs
11.2 s), ALT (median: 99.58 U/L vs 60.23 U/L), AST (median: 178.45 U/L vs 140.80 U/L), TBil
(median: 173.86 μmol/L vs 139.68 μmol/L), DBil (median: 103.66 μmol/L vs 77.84 μmol/L)
and TBA (median: 104.30 μmol/L vs 85.59 μmol/L) of infants in case group were significantly
higher than those in control group (all P ＜ 0.05), while there was no significant difference
in APTT level (median: 36 s vs 36 s; z = -0.379, P = 0.705). There were no significant
differences in vitamin A [(244.312 ± 54.480) μg/L vs (241.646 ± 59.462) μg/L vs (163.438 ±
33.153) μg/L], vitamin D3 [(9.655 ± 2.941) μg/L vs (18.192 ± 4.078) μg/L vs (9.148 ± 2.564) μg/L],
vitamin E [(7.053 ± 2.756) mg/L vs (10.118 ± 3.798) mg/L vs (10.134 ± 5.699) mg/L] and
vitamin K [(9.267 ± 2.173) μg/L vs (4.750 ± 1.637) μg/L vs (7.013 ± 2.809) μg/L] levels
among infants in breast feeding group, artificial feeding group and mixed feeding group (all P ＞
0.05). There was no correlation between FSV levels with either ALT, AST, TBil or DBil in
case group (all P ＞ 0.05). Vitamin D3 level was negatively correlated with TBA (rs = -0.506,
P = 0.042), while vitamin A, Vitamin E and vitamin K were not correlated with TBA (all
P ＞ 0.05). Conclusions FSV deficiency was common in ICH children, and the normal dose
of vitamin A and vitamin D supplementation could not meet the needs for FSV. Children with
ICH often accompanied with coagulation dysfunction, presenting with prolonged PT. There
were no differences in FSV levels among ICH children with different feeding methods. ALT,
AST, TBil and DBil levels were not correlated with FSV, while TBA level was negatively
correlated with vitamin D3.
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