脐血胆红素联合溶血三项预测新生儿ABO溶血病及高胆红素血症的价值

发布时间：2019-01-28 13:33

【摘要】：目的:通过分析脐带血胆红素浓度,探讨脐血胆红素水平及溶血三项预测新生儿ABO溶血病及发生高胆红素血症风险的价值。方法:选取193例足月健康新生儿为研究对象,母亲均为O型血,测定脐血胆红素浓度及溶血三项。于生后每天测定经皮胆红素(TCB),并动态监测其变化,对时龄0~24 h TCB≥100μmol/L;~48 h TCB≥150μmol/L;~72 h TCB≥200μmol/L;72 h≥250μmol/L者,抽取静脉血测血清胆红素值(TSB)。将新生儿按脐血胆红素水平分为0μmol/L~,34.2μmol/L~,42.8μmol/L~,51.3μmol/L,59.9μmol/L~共5组,比较发生ABO溶血病及达到高胆红素血症和光疗指征的比率。建立受试者工作特性(ROC)曲线,对结果进行统计学分析。同时,比较溶血组与非溶血组的脐血胆红素浓度;比较高胆组与非高胆组的脐血胆红素浓度;并分析溶血三项不同模式的脐血胆红素特点。结果:1.新生儿ABO溶血病及高胆红素血症的发生率:脐血胆红素浓度越高,新生儿ABO溶血病及高胆红素血症的发生率就越大。当脐血胆红素水平》59.9μmol/L时发生ABO溶血病及高胆红素血症的几率分别为60%和90%,与各组比较均有显著性差异(P0.01)。2.脐血胆红素预测新生儿ABO溶血病的ROC曲线下面积是0.782±0.02,(P0.001,95%的可信区间为0.74-0.82)。脐血胆红素预测ABO-HDN的最佳截断值是47.45μmol/L(灵敏度53.6%,特异性91.8%)。3.脐血胆红素预测高胆红素血症的ROC曲线下面积为0.877±0.03,(P0.001,95%的可信区间为0.82-0.92)。脐血胆红素预测高胆红素血症的最佳截断值是40.8μmol/L(灵敏度85.1%,特异性84.9%)。4.高胆组脐血胆红素浓度(48.97±14.16μmol/L)明显高于非高胆组(40.27±10.17μmol/L),P0.01。5.溶血组脐血胆红素浓度(42.77±8.25μmol/L)明显高于非溶血组(30.21±6.62μmol/L),P0.01。6.溶血三项中抗体释放试验阳性组的脐血胆红素浓度及高胆红素血症比率均明显高于抗体试验阴性组(P0.01),但直接抗人球蛋白试验阳性组与其他组的脐血胆红素浓度无显著性差异(P0.05)。溶血三项的不同模式在预测高胆红素血症方面无参考价值。结论:1.脐血胆红素水平可作为预测新生儿ABO溶血病患儿发生高胆红素血症的有效指标。2.脐血胆红素联合溶血三项可很好地预测O型血母亲的新生儿发生ABO溶血病及高胆红素血症和需要光疗的风险。
[Abstract]:Objective: to study the value of cord blood bilirubin level and hemolysis in predicting neonatal ABO hemolytic disease and risk of hyperbilirubinemia. Methods: 193 full-term healthy newborns were selected as study subjects. The mothers were all of O blood. The concentration of bilirubin and hemolysis in umbilical cord blood were measured. Percutaneous bilirubin (TCB),) was measured every day after birth and its changes were dynamically monitored. The serum bilirubin (TSB). Was measured by venous blood samples for patients whose TCB 鈮，

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