高胆红素血症新生儿碳氧血红蛋白检测的意义

Clinical Significance of Determination of Carboxyhemoglobin in Neonatal Hyperbilirubinemia

目的探讨高胆红素血症新生儿碳氧血红蛋白(COHb)检测的意义。方法用德国800系列生化血气分析仪附加的270-血氧仪测定189例高胆红素血症新生儿及142例日龄匹配无病理性黄疸(对照组)患儿动脉化毛细血管血COHb及静脉血血清总胆红素(STB)。新生儿溶血组予大剂量静脉用丙种免疫球蛋白治疗,2 d后测定COHb及STB水平。结果溶血组COHb及STB水平均显著高于对照组(P均<0.001);颅内出血组COHb明显高于对照组(P<0.05),STB水平显著高于对照组(P<0.001);感染、母乳性黄疸组STB水平均显著高于对照组(P均<0.001),而COHb水平与对照组比较差异无显著性(P>0.05)。新生儿溶血组大剂量静脉用丙种免疫球蛋白治疗后COHb及STB水平均显著降低(P均<0.001)。结论COHb测定可作为胆红素水平的指标,有助于高胆红素血症新生儿病因诊断及治疗指导。

Objective To explore clinical significance of determination of carboxyhemoglobin （COHb） in neonatal hyperbilirubinemia. Methods Arterial capillary blood COHb was detected by 270 CO oximeter connected to 800 series system in 189 infants with common causes of neonatal hyperbilirubinemia which included hemolytic disease （ n - 75）, infective jaundice （ n - 52）, intracranial bemorrhage （ n 32）, and breast milk jaundice （ n - 30）. Serum total bilirubin （STB） was measured at the ,same time. COHb and STB were detected in 142 cases without pathological jaundice in the same age （ control group）. COHb and STB were detected in hemolytic disease after treated with intravenous gammaglobulin. Results COHb and STB were significantly higher in hemolytic disease than those in control group （all P〈 0. 001 ）. COHb were significantly higher and STB were significantly higher in intracranial hemorrhage than those in control group （ P 〈 0.05 ）. STB in infective jaundice and breast milk jaundice were significantly higher than those in control group （ all P〈0. 001 ）. While COHb showed no significant difference between infective jaundice and breast milk jaundice in control group （all P〉 0.05 ）. COHb and STB had significantly descend in hemolytic disease after treated with intravenous gammaglobulin （ P〈 0. 001 ）. Conclusion COHb indicates production of bilirubin in neonatal hyperbilirubinemia, which is helpful to diagnose the cause of hyperbilirubinemia and taken as a guide in therapy.