新生儿高胆红素血症的风险预测

Prediction of risk factors of neonatal hyperbilirubinemia

目的探讨一种无创性、按每小时计的经皮胆红素(TcB)百分位列线图,以预测新生儿高胆红素血症的发生风险。方法选择2010年1月至2010年3月出生、胎龄≥35周且出生体质量≥2 000 g的健康新生儿679例,测定其出生后152 h内的TcB值。将出生后68 h内对应最高危区域的胆红素测定值作为预测指标,利用以小时为单位的胆红素曲线图评估其高胆红素血症的危险度,利用诊断试验特征曲线(ROC曲线)分析胆红素百分位列线图预测高胆红素血症的发生风险。结果将679例新生儿7 482个对应不同小时龄的TcB值纳入分析。42例新生儿出生后68 h内的胆红素水平处于高危区,预测高胆红素血症的灵敏度为34.52%,特异度为97.82%;212例新生儿胆红素水平处于高危区和中高危区,预测高胆红素血症的灵敏度为80.95%,特异度为75.80%;213例新生儿胆红素水平处于低危区,预测高胆红素血症的灵敏度为98.81%,特异度为35.63%。以TcB百分位列线图危险区域表示的出院前胆红素水平预测高胆红素血症发生风险的ROC曲线下面积(AUC)为0.846;胎龄与出生68 h内的胆红素水平结合预测高胆红素血症发生风险的ROC曲线下面积(AUC)为0.857;出生后前3 d的生理性体质量下降与出院前胆红素水平结合预测高胆红素血症发生风险的AUC为0.859。结论根据新生儿出院前胆红素水平结合胎龄、出生后前3天的生理性体质量下降能简单而准确地预测新生儿高胆红素血症的发生风险。

Objective To probe the noninvasive and hourly transcutaneous bilirubin（TcB）nomogram of newborns in Changzhou region and assess its predictive ability to screen risks of sequent hyperbilirubinemia.Methods TcB was measured for 679 healthy infants（gestational age ≥ 35 weeks and birth weight ≥ 2 000 g）from birth to 7 days.We designed the hour-specific bilirubin nomogram with these data.Newborns were divided into 4 groups based on the predischarge bilirubin risk zone.Results Six hundreds and seventy-nine infant with 7 482 hour-specific bilirubin data were enrolled into the study.Forty-two infants were in the high-risk zone（sensitivity 34.52%,specificity 97.82%）.Two hundrend and twelve infants were in the high-risk and intermediate-risk zone（sensitivity 80.95%,specificity 75.80%）.Two hundreds and thirteen infants were in the low-risk zone（sensitivity 98.81%,specificity 35.63%）.The receiver operating characteristic（ROC）curves were drawn to assess the predictive abilities of the predischarge bilirubin level and prediction models that were combined with gestational age and weight losses.The area under the ROC curve of predischarge bilirubin level was 0.846.The area under the ROC curve of the combination of predischarge bilirubin level and gestational age was 0.857.The area under the ROC curve of the combination of predischarge bilirubin level and weight losses was 0.859.Conclusions The infant＇s risk of developing significant hyperbilirubinemia can be simply and accurately assessed according to the infant＇s predischarge bilirubin level,gestational age and weight loss.