总胆红素与白蛋白比值对胆红素神经毒性的预测

发布时间：2018-05-15 01:07

本文选题：高胆红素血症 + 胆红素　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：分析总胆红素与白蛋白比值（B/A）和胆红素脑损伤的关系。比较B/A与TSB值预测神经毒性的能力。方法：选取我院2011年12月至2013年12月考虑可能发生新生儿胆红素脑损伤的患儿111例，分析其血清总胆红素（total serumbilirubin，TSB）值、B/A、BAEP、NBNA评分、MRI等资料。根据BAEP结果是否异常将其分为BAEP正常组和BAEP异常组，分别比较两组TSB值、 B/A；根据TSB值（TSB342μmol/L，342μmol/L TSB428μmol/L，TSB428μmol/L）分为三组，根据B/A（B/A7.2（mg/g），7.2（mg/g）B/A8.5（mg/g），B/A8.5（mg/g））分为三组，分别比较两者在不同水平的BAEP异常情况。结果： 1、将111例患儿根据BAEP结果是否正常分成两组。BAEP正常组有76例，异常组有35例。正常组中时龄177.84±141.86h，胎龄275.72±8.08d，产重3339.41±409.85g，男42例，女34例，剖宫产30例，自然分娩46例。异常组中时龄178.60±114.78h，胎龄273.69±7.30d，产重3320.86±390.74g，男17例，女18例，剖宫产10例，自然分娩25例，两组的基本资料（即时龄、胎龄、产重、性别、分娩方式）比较，，差异均无统计学意义（P0.05）。 2、111例患儿中，考虑感染因素58例；溶血因素45例，其中ABO溶血病40例，Rh溶血病5例；原因不明者有8例。 3、BAEP正常组TSB值为418.7896.89μmol/L，B/A为6.32±1.43（mg/g），BAEP异常组的TSB值为451.72135.07μmol/L，B/A为7.23±2.39（mg/g），两组的TSB值比较，差异无统计学意义（t=-1.297，P0.05），两组的B/A进行比较，差异有统计学意义（t=-2.079，P0.05）。 4、将111例患儿根据TSB值水平分成三组，BAEP异常率比较差异无统计学意义（χ2=0.157，P0.05），各组两两比较差异也无统计学意义（P0.050.05/3）；将111例患儿根据B/A水平分成的三组，BAEP异常率比较差异有统计学意义（χ2=12.060，P0.05）。 5、111例患儿中，NBNA评分异常者共25例，异常率22.5%。BAEP正常组中NBNA评分异常者15例，正常者61例，异常率19.7%；BAEP异常组中NBNA评分异常者10例，正常者25例，异常率28.6%。两组异常率比较差异无统计学意义（χ2=1.072，P0.05）。结论： 1、不能依赖单一TSB值预测胆红素神经毒性，可将B/A作为预测指标之一。 2、胆红素的神经毒性是多因素综合作用的结果，不能仅仅依靠TSB值或B/A评估病情及预后，尚需同时考虑患儿血脑屏障状态、是否合并高危因素等。 3、对高胆红素血症患儿应争取做到早期准确的评估和及时恰当的治疗，这将影响患儿病情的转归和预后。
[Abstract]:Aim: to analyze the relationship between total bilirubin and albumin ratio B / A) and bilirubin brain injury. The ability of B / A and TSB to predict neurotoxicity was compared. Methods: 111 cases of neonatal bilirubin brain injury were selected from December 2011 to December 2013 in our hospital. The data of total bilirubin total (TSBB) and NBNA scores were analyzed. They were divided into normal BAEP group and abnormal BAEP group according to the results of BAEP. The two groups were divided into three groups: TSB value, B / A value; TSB value: t SB 342 渭 mol / L = 342 渭 mol/L TSB428 渭 mol / L; TSB 428 渭 mol / L). According to B / A, B / A 7.2 mg / g / g = 7.2 mg / g / g, B / A / A 8.5 mg / g / L, respectively, they were divided into three groups, and they were divided into three groups to compare the BAEP anomalies at different levels. Results: 1. According to the results of BAEP, 111 cases were divided into two groups: 76 cases in normal group and 35 cases in abnormal group. In the normal group, the age was 177.84 卤141.86 hours, the gestational age was 275.72 卤8.08 days, the birth weight was 3339.41 卤409.85 g, male 42 cases, female 34 cases, cesarean section 30 cases, natural delivery 46 cases. In the abnormal group, the age was 178.60 卤114.78 h, the gestational age was 273.69 卤7.30 d, the birth weight was 3320.86 卤390.74 g, male 17, female 18, cesarean section 10 and natural delivery 25. There was no significant difference in basic data (instant age, gestational age, birth weight, sex, delivery mode) between the two groups. Among the 2111 cases, 58 cases were considered infection factors, 45 cases were hemolytic factors, 5 cases were ABO hemolytic disease, 8 cases were unknown reason. 3The TSB value of the normal group was 418.7896.89 渭 mol / L (6.32 卤1.43 mg / g / A). The TSB value of the abnormal BAEP group was 451.72135.07 渭 mol / L (7.23 卤2.39) mg / g / g respectively. There was no significant difference in TSB between the two groups. The difference between the two groups was statistically significant (P < 0.05). 4. There was no significant difference in abnormal rate of TSB between the three groups according to the level of TSB (蠂 2: 0. 157, P 0. 05), and there was no significant difference between the two groups (P 0. 05, P 0. 05, P < 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P < 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05). There were 25 cases of abnormal 22.5%.BAEP score in 5111 cases. The abnormal rate of NBNA score was abnormal in 15 cases and normal in 61 cases in normal group. The abnormal rate of NBNA score was abnormal in 10 cases and normal in 25 cases in the abnormal rate of 19.7B BAEP. The abnormal rate was 28.6%. There was no significant difference in abnormal rate between the two groups (蠂 2 + 1.072% P 0.05). Conclusion: 1. The bilirubin neurotoxicity could not be predicted by a single TSB value, and B / A could be used as one of the predictors. 2. The neurotoxicity of bilirubin is the result of multifactorial action. We should not only evaluate the condition and prognosis by TSB or B / A, but also consider the blood-brain barrier status and risk factors. 3. Children with hyperbilirubinemia should make early and accurate evaluation and timely and appropriate treatment, which will affect the prognosis and prognosis of children with hyperbilirubinemia.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.1

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