碳氧血红蛋白测定对新生儿黄疸诊断的价值

Value of carboxyhemoglobin in the diagnosis of neonatal jaundice

目的探讨碳氧血红蛋白测定在新生儿黄疸诊断中的临床价值。方法189例新生儿黄疸患儿(新生儿溶血病75例,感染52例,颅内出血32例,晚发母乳黄疸30例)及142例对照组患儿同步测定动脉化毛细血管血碳氧血红蛋白(COHb)和血清总胆红素(STB);溶血组予大剂量静脉免疫球蛋白治疗后测定COHb及STB,应用SAS6.12统计软件进行处理。结果溶血组COHb及STB分别为(3.64±0.83)%,330.84±77.15μmol/L,显著高于对照组的(2.38±0.35)%和130.18±32.86μmol/L(P<0.01);颅内出血组COHb及STB分别为(2.48±0.53)%,184.15±29.35μmol/L,高于对照组的(2.24±0.32)%及112.11±17.45μmol/L(P<0.05);感染及母乳黄疸组STB分别为286.71±45.66μmol/L,299.15±44.14μmol/L,显著高于对照组146.23±31.26μmol/L及57.33±7.83μmol/L(P<0.01),而COHb为(2.36±0.50)%及(1.84±0.49)%与对照组(2.20±0.39)%及(1.67±0.43)%比较,差异无显著性(P>0.05)。溶血性高间胆组STB低于非溶血性高间胆组(P<0.01),而COHb显著高于后者(P<0.01)。溶血组大剂量静脉免疫球蛋白治疗前后COHb分别为(3.64±0.83)%及(2.68±0.51)%,STB分别为330.84±77.15μmol/L及230.18±42.96μmol/L,治疗前后比较差异有显著性(P<0.01)。结论COHb测定可作为胆红素产量的指标,有助于新生儿黄疸病因诊断及指导治疗。

Objective To study the value of carboxyhemoglobin （COHb） in the diagnosis of neonatal jaundice. Methods This study consisted of 189 patients with neonatal jaundice due to hemolytic disease （ n = 75 ）, infectious disease （ n = 52 ） , intracranial hemorrhage （ n = 32 ） and breast-milk feeding （ n = 30 ） . One hundred and forty-two neonates without pathological jaundice that were gestational age-, postnatal age- and birth weight-matched were used as the Control group. The level of arterial capillary blood COHb was detected by a 270 CO-oximeter connected to an 800 series system. Total serum bilirubin （STB） content was measured using an Abbott Spectrum CCX chemistry analyzer. The levels of COHb and STB were measured at baseline, and again in patients with jaundice due to hemolytic disease after intravenous gammaglobulin treatment for 2 days. Results The levels of COHb [ （3.64 ±0.83 ）% ] and STB （330.84 ± 77.15 μmol/L） in patients with jaundice due to hemolytic disease were significantly higher than those measured in the Control group [ COHb （ 2.38 ± 0.35 ） % ; STB 130.18 ±32.86 μmol/L ] （ P 〈 0.01 ）. The levels in patients with jaundice due to intracranial hemorrhage were also significantly higher than those in the Control group [ COHb （2.48 ±0.53 ） % vs （2.24 ±0.32） % ; STB 184.15 ±29.35 μmol/L vs 112.11 ±17.45 μmol/L; P 〈 0.05 ）. The patients with jaundice due to infectious disease or breastmilk feeding only demonstrated higher levels of serum STB （ P 〈 0.01 ） while COHb levels were not different compared with the Control group. The patients with jaundice due to hemolytic disease or intracranial hemorrhage presented with hemolytic unconjugated hyperbilirubinemia and had significantly higher COHb levels and lower STB levels than those patients with nonhemolytic unconjugated hyperbilirubinemia （ caused by breast jaundice） （ P 〈 0.01 ）. The levels of COHb [ （ 2.68 ±0.51 ） % ] and STB （ 230.18 ±42.96 μmol/L） in patients with jaundice due to hemolytic disease decreased markedly after intravenous gammaglobulin treatment （ P 〈 0.01 ）. Conclusions The COHb level can be used as a supplementary indicator of increased bilirubin production. The elevation of COHb can be useful in the diagnosis of neonatal jaundice since COHb is elevated in hemolytic disease and intracranial hemorrhage.