高胆红素血症患儿血清谷氨酸含量与Na^+-K^+-ATP酶活性的变化及临床意义

Changes and role of serum glutamate levels and Na^+-K^+-ATPase activities in newborns with hyperbilirubinaemia

目的了解高胆红素血症患儿血清谷氨酸(GLU)含量与Na+-K+-ATP酶活性的变化,为早期诊断脑损伤,判断预后提供依据。方法 91例高胆红素血症足月儿为高胆组(按照胆红素水平分为轻、中、重度3组),健康新生儿32例为对照组,比较两组血清谷氨酸含量与Na+-K+-ATP酶活性,并进行相关性分析;随访患儿有无听力损害和神经系统异常。结果高胆红素血症患儿血清GLU含量(61.34±11.40)μmol/L,Na+-K+-ATP酶活性(0.212±0.026)μmolPi/(mg.h),中、重度组GLU含量明显升高,Na+-K+-ATP酶活性明显降低,与血清总胆红素水平存在密切相关,且与对照组比较,差异有统计学意义(P<0.01);中、重度组TEOAE初筛,AABR初、复筛未通过例数明显增多。结论高胆红素血症患儿血清GLU含量升高,Na+-K+-ATP酶活性降低,与胆红素神经毒性有关,可能对早期预测新生儿胆红素脑病患病风险有帮助。

Objective To study the changes and clinical significance of serum glutamate concentrations and Na^＋-K^＋-ATPase activities in newborns with hyperbilirubinaemia.Methods Ninety-one newborns with hyperbilirubinaemia in varying severity and 32 controls were recruited in this study;their serum glutamate concentrations and Na^＋-K^＋-ATPase activities were detected using Beckman amino acid analyzer and colorimetry.At one time,they received hearing test and later interview.Results Serum glutamate concentrations and Na^＋-K^＋-ATPase activities were（61.34±11.40） μmol/L and（0.212±0.026） μmolPi/（mg·h）,respectively,in newborns with hyperbilirubinaemia,significautly different from those in controls（P〈0.01）,and the changes of them were closely related to total bilirubin level.The incidence of hearing disorder also increased in high bilirubin neonates.Conclusions High glutamate level and low Na^＋-K^＋-ATPase activities in newborns with hyperbilirubinaemia are possibly closely related to toxicity of bilirubin,the changes of them are likely to predict early the risk of brain disease in newborns with hyperbilirubinaemia.