新生儿经皮小时胆红素百分位曲线预测新生儿高胆红素血症价值的系统评价

Systematic review of the predictive value of hour-specific transcutaneous bilirubin nomogram for neonatal hyperbilirubinemia

目的对不同国家新生儿经皮小时胆红素百分位曲线预测新生儿高胆红素血症价值的文献进行系统评价,为新生儿高胆红素血症的诊治提供依据。方法检索Cochrane图书馆、PubMed、OVID、Springer数据库、中国期刊全文数据库、维普数据库、万方数据库和中国生物医学文献数据库,检索时间均从1990年1月至2011年3月。由2名系统评价员进行资料提取和质量评价。结果 10项研究进入分析,偏倚评价为B级6项、C级4项。不同国家制备的新生儿小时胆红素百分位曲线值有一定的差异,印度的小时胆红素百分位曲线值最高,希腊、以色列、中国次之,美国最低。在高度危险区（P95）,胆红素上升速度在生后24 h内最快;中度（P75）和低度（P40或P50）危险区,生后36 h内胆红素上升速度最快,其中印度上升速度最快最高,中国、美国、以色列次之,希腊上升速度最低。新生儿经皮小时胆红素百分位曲线预测高胆红素血症,高度危险区的敏感度为26.9%~75.0%,特异度为89.4%~97.3%;中度危险区的敏感度为78.7%~100.0%,特异度为48.3%~82.3%;低度危险区的敏感度为98.7%~100.0%,特异度为24.4%~56.1%;曲线下面积为0.766~0.990,其中泰国预测的准确性最高,印度、中国次之,美国最低。结论经皮小时胆红素百分位曲线图预测新生儿高胆红素血症有较高的准确性,具有临床推广应用价值。不同国家经皮小时胆红素百分位曲线有一定的差异,各国应根据本国新生儿小时总胆红素的变化趋势制备各自相对应的曲线图作为新生儿高胆红素血症的干预参考标准。

Objective Many countries analyzed the trend of hour-specific transcutaneous bilirubin after birth and developed hour-specific transcutaneous bilirubin nomogram for predicting the risk of neonatal hyperbilirubinemia.The predictive value of hour-specific transcutaneous bilirubin nomogram for neonatal hyperbilirubinemia was systematically reviewed.Methods The Cochrane library,PubMed,OVID,Springer,CNKI,VIP,Wanfang from January 1990 to March 2011 were searched.Two reviewers assessed the quality of including studies independantly,extracted data.Statistical analysis was performed employing Office Excel 2003 and SPSS 16.0.Results Ten studies were included.Six studies were assessed as B-class,four studies were C-class.The hour bilirubin percentile curve values of different countries and races showed some differences.India had the highest bilirubin percentile curve values,followed by Greece,Israel and China,and United States.In the high-risk areas,the rate of bilirubin within 24h after birth increased the fastest;the rate of bilirubin within 36 h after birth increased the fastest in the medium and low risk areas.India had the highest increased rate of bilirubin,followed by China,United States,Israel,and Greece.In the high-risk areas,the sensitivity of hour-specific transcutaneous bilirubin nomogram for predicting neonatal hyperbilirubinemia was 26.9%-75.0%,the specificity was 89.4%-97.3%;the sensitivity and specificity was 78.7%-100.0% and 48.3%%-82.3% respectively for the medium-risk areas,as well as 98.7%-100.0% and 24.4%-56.1% for low-risk areas.AUC was 0.766-0.990.Thailand had the highest accuracy for predicting neonatal hyperbilirubinemia,followed by India and China,and United States was the lowest.Conclusions The hour-specific transcutaneous bilirubin nomogram showed high predictive accuracy for neonatal hyperbilirubinemia,and was valuable in clinical application.The hour bilirubin percentile curve values vary among different countries and races.It is suggested that countries develop hour-specific transcutaneous bilirubin nomogram based on their own countries＇ value of bilirubin change and take it as the reference standard of intervention.