中国新生儿胆红素脑病的多中心流行病学调查研究

Clinical characteristics of bilirubin encephalopathy in Chinese newborn infants-a national multicenter survey

目的通过多中心流行病学调查研究我国新生儿胆红素脑病的具体发病情况、相关高危因素及预后。方法在中华医学会儿科分会新生儿学组成员单位进行回顾性调查，以出院诊断胆红素脑病或核黄疸的患儿为研究对象，记录患儿一般情况、围产期高危因素、伴随疾病、胆红素峰值水平、治疗情况、临床转归等内容。结果2009年1月至12月，33家医院中的28家共报告348例新生儿胆红素脑病或核黄疸病例，仅5家（15．2％）未收治相关患儿。患儿平均出生体重（3112．44±599．6）g，平均胎龄（38．3±2．3）周，其中足月儿291例（83．6％），34-36周的晚期早产儿40例（11．5％），34周以下的早产儿11例（3．2％），另有6例（1．7％）胎龄不详。其中男婴250例，占71．8％，女婴98例，占28．2％。平均人院日龄为（7．34-5．4）d，其中在出生7d以内入院的247例（71．0％），14d以后入院的24例（6．9％）。348例入院后测得的胆红素峰值为（478．1±175．8）μmol／L，其中300例（86．2％）伴发其他疾病，常见的包括细菌感染（52．6％）、ABO溶血（29．9％）、围产期窒息（10．1％）等，其中109例（31．3％）伴有两种或两种以上疾病。住院期间131例（37．6％）患儿接受了换血治疗，白蛋白和静脉用丙种球蛋白的应用也很常见。随访223例（64．1％），失访125例失访率为35．9％，住院和随访期间共死亡36例，占随访患儿的16．1％。病死组除住院时间明显短于存活组（P〈0．05）外，其他资料差异无统计学意义（P〉0．05）。少数民族患儿以回族和壮族为主，G6PD缺乏症所占比例显著高于汉族患儿（P〈0．05），其余临床特点和汉族患儿无异。结论新生儿胆红素脑病在我国并不少见。制定符合我国国情的高胆红素血症干预指南，及早识别并干预高胆红素血症及其高危因素具有十分重要的意义。

Objective Bilirubin encephalopathy continued to be reported worldwide. This muhicenter study was conducted to explore the clinical characteristics, comorbidities and prognosis of bilirubin encephalopathy in China. Methods The survey was conducted in 33 level m hospitals. Clinical charts of infants with diagnosis of bilirubin encephalopathy or kernicterus at discharge were reviewed. The data were collected by a detaild questionnaire and analyzed. Results From January to December in 2009, 348 cases of bilirubin encephalopathy were reported from 28 hospitals. The mean birth weight was （3112.4 ±599. 6） grams, mean gestational age was （38.3 ±2. 3） weeks; 291 （83.6%） cases were term infants, 40 （ 11.5% ） cases were late-preterm infants, and 11 （3.2%） cases were early preterm infants. After admission, the highest bilirubin level was （478. 1 ± 175.8） μmol/L. Of all the 348 cases, the age at admission was （7. 3 ±5.4） days; 247 （71.0%） cases were admitted before 7 days of age, 24 （6. 9% ） cases were admitted after 14 days of age. Most of the cases （86. 2% ） were complicated with other conditions, including bacterial infection （52. 6% ） , ABO incompatibility （29.9%）, and perinatal asphyxia （10. 1% ）. A total of 131 infants （37.6%） underwent an exchange transfusion. Use of albumin, intravenous immunoglobulin was also common （68.7% and 44. 0% respectively）. A total of 52 cases were of minority ethnic groups, with significantly higher rate of G6PD deficiency than Han ethnicity cases. During the hospitalization and follow up, 36 infants died, and 125 infants （ 35.9% ） were lost to follow up. Conclusions Bilirubin encephalopathy is still not rare in China, the establishment of a population-based reporting system and prevention of kernicterus remain a high priority among public health institutions.