摘要
目的探讨血清总胆红素(total serum bilirubin,TSB)和胆红素/白蛋白比值(the ratio of bilirubin to albumin,B/A)在新生儿急性胆红素脑病(acute bilirubin encephalopathy,ABE)中的预测价值。方法选择2018年3月至2019年8月南京市妇幼保健院、广西壮族自治区妇幼保健院、西北妇女儿童医院、银川市妇幼保健院、聊城市人民医院收治的极重度高胆红素血症新生儿(TSB≥425μmol/L)进行前瞻性研究,根据胆红素诱发神经损伤评分,将研究对象分为ABE组和非ABE组,分析TSB峰值、B/A值对新生儿ABE的预测价值。结果研究期间5家医院共收治194例极重度高胆红素血症患儿,其中ABE组20例,非ABE组174例,胆红素峰值范围427~979μmol/L。受试者工作特征(receiver operating characteristics,ROC)曲线分析TSB峰值、B/A值预测ABE的最佳临界值分别为530μmol/L和9.48,TSB峰值与B/A值联合应用识别ABE的敏感度为85.0%,特异度为92.8%。结论TSB峰值联合B/A值可有效识别新生儿ABE,当TSB峰值>530μmol/L、B/A值>9.48时,患儿发生ABE的风险较高。
Objective To study the predictive value of total serum bilirubin(TSB)and the ratio of bilirubin to albumin(B/A)in neonatal acute bilirubin encephalopathy(ABE).Methods Neonates with extremely severe hyperbilirubinemia(TSB≥425μmol/L)treated in the Nanjing Maternal and Child Health Hospital,Maternity and Child Health Care of Guangxi Zhuang Autonomous Region,Northwest Women and Children's Hospital,Yinchuan Maternal and Child Health Hospital and Liaocheng People's Hospital from March 2018 to August 2019 were selected as prospective subjects for this study.According to the score of brain injury induced by bilirubin,the subjects were divided into ABE group and non-ABE group,and the predictive value of TSB peak and B/A for neonatal ABE were analyzed.Results A total of 194 infants with extremely severe hyperbilirubinemia were recruited in this study,including 20 in ABE group and 174 in non-ABE group.The peak value of bilirubin ranged from 427 to 979μmol/L.The optimal critical values of TSB peak value and B/A for ABE prediction were 530μmol/L and 9.48,respectively.The sensitivity and specificity of ABE prediction were 85.0%and 92.8%when combined with TSB peak and B/A values.Conclusions TSB peak combined with B/A value can effectively identify neonatal ABE.When the TSB peak value was greater than 530μmol/L and the B/A value was greater than 9.48,the neonates had a higher risk of neonatal ABE.
作者
孙小凡
韦秋芬
李占魁
顾洁
钱静
蒙丹华
郭金珍
贺晓莉
南慧
余章斌
韩树萍
董小玥
Sun Xiaofan;Wei Qiufen;Li Zhankui;Gu Jie;Qian Jing;Meng Danhua;Guo Jinzhen;He Xiaoli;Nan Hui;Yu Zhangbin;Han Shuping;Dong Xiaoyue(Department of Neonatology,Women's Hospital of Nanjing Medical University(Nanjing Maternity and Child Health Care Hospital),Nanjing 210004,China;Department of Neonatology,Maternity and Child Health Care of Guangxi Zhuang Autonomous Region,Nanning 538001,China;Department of Neonatology,Northwest Women's and Children's Hospital,Xi'an 710061,China;Department of Neonatology,Yinchuan Maternal and Child Health Care Hospital,Yinchuan 750001 China;Department of Pediatrics,Liaocheng People's Hospital,Liaocheng 252004,China)
基金
江苏省卫生计生委科研项目(H2018011)
江苏省妇幼保健协会科研项目(FYX201805)
南京市医学科技发展基金(201803015)
江苏省重点研发计划(社会发展)(BE2019620)。
关键词
胆红素脑病
急性
高胆红素血症
新生儿
血清总胆红素
B/A值
Bilirubin encephalopathy,acute
Hyperbilirubinemia,newborn
Total serum bilirubin
The ratio of bilirubin to albumin
