碳氧血红蛋白对新生儿溶血病的诊断价值

Diagnostic value of carboxyhemoglobin on hemolytic disease of the newborn

目的探讨碳氧血红蛋白(COHb)辅助诊断新生儿溶血病的价值。方法 选择2009年10月至2010年9月本科收治的足月儿,确诊新生儿溶血病者为溶血组,存在母子血型不合和病理性黄疸但未确诊溶血病者为非溶血性黄疸组,无母子血型不合及病理性黄疸者为对照组。分别于生后5天内测定COHb、血红蛋白(Hb)、网织红细胞(Ret)和总胆红素(STB),并进行比较。建立受试者工作曲线(ROC曲线),确定COHb、Hb、Ret的曲线下面积(AUC),同时分析三者不同截断值的敏感度、特异度、阳性和阴性预测值。结果 (1)溶血组COHb、Ret和STB较非溶血性黄疸组及对照组增高,Hb降低(P均<0.001);非溶血性黄疸组STB较对照组增高(P<0.001),但COHb、Hb和Ret差异无统计学意义(P>0.05)。(2)COHb、Hb和Ret的AUC分别为96.0%、74.9%、85.7%,三者比较差异有统计学意义(P<0.05)。COHb预计溶血病的最佳截断值为1.2%(敏感度86.8%、特异度91.2%、阳性预测值93.0%、阴性预测值83.9%),敏感度、特异度均优于Hb和Ret。三指标联合诊断的特异度可提高到98.2%。结论 COHb是敏感的新生儿溶血病诊断指标,与Hb和Ret联合检测,对于早期筛查和辅助诊断新生儿溶血病有重要意义。

Objective To study the diagnostic value of carboxyhemoglobin（COHb） on hemolytic disease of the newborn（HDN）.Methods Full-term infants diagosed serologically with HDN in our department from October,2009 to September,2010 were categorized as hemolytic group.Infants with ABO or Rh blood group incompatibility and pathologic jaundice but without HDN were categorized as non-hemolytic jaundice group,while those without blood group incompatibility and pathologic jaundice were studied as contol.COHb level,serum total bilirubin（STB）,hemoglobin（Hb） and reticulocyte（Ret） count were measured within five days after birth and were compared within the three groups.Area under the receiver operating characteristic（ROC） curve（AUC） and optimum sensitivity,specificity and predictive values for COHb,Hb and Ret were evaluated.Results（1） In hemolytic group,COHb,Ret and STB were significantly higher and Hb were lower than that of non-hemolytic jaundice group and control group（P0.001）,but they had no statistical differences between non-hemolytic jaundice group and control group except STB.（2）The AUC were 96.0% for COHb,74.9% for Hb and 85.7% for Ret respectively.There were statistically different within the three markers（P0.05）.The cut-off value of COHb for optimum prediction of HDN was 1.2%,sensitivity was 86.8%,specificity was 91.2%,positive predictive value was 93.0%,negative predictive value was 83.9%,sensitivity and specificity were higher than Hb and Ret.Multi-biomakers detection showed that the specificity could be raised to 98.2%.Conclusions COHb is a sensitive adjunctive marker for detecting HDN,and it has an important role in screening for early stage HDN patients when combined with Hb and Ret.