安徽省淮南地区正常足月新生儿生后7d内胆红素水平动态变化

Dynamic measurement of total serum bilirubin of healthy term newborns during the first post-natal week： an experience from the Huainan region of Anhui province

目的 通过动态检测正常足月新生儿血清总胆红素（TSB）,确定淮南地区正常足月新生儿生后7 d内血清总胆红素变化范围,为新生儿黄疸干预提供理论根据.方法 对收集的淮南地区1 257例符合纳入标准的正常足月新生儿用微量法测定生后第1～7天血清总胆红素值,计算各时间点第25、50、75、95百分位值,观察其高峰值（PSB）及高峰出现时间.随机抽取50例新生儿血清标本,用生化法测定血清总胆红素值,并同步以微量法测定胆红素值,计算末梢微量血胆红素值与静脉血总胆红素值之间的相关系数、检验其统计学意义,并得出直线回归方程;统计入选50例新生儿不同皮肤黄染范围相对应的静脉血总胆红素值,得出皮肤黄染不同范围相对应的胆红素估计值.结果 1 257例正常足月新生儿生后第1～7天血清胆红素值的第25、50、75、95百分位值分别是：第1天58.64 μmol/L、72.51 iμmol/L、102.44 μmol/L、120.35 μmol/L,第2天105.41 μmol/L、119.72 μmol/L、150.18 μmol/L、185.30 μmol/L,第3天128.85 μmol/L、157.95 μmol/L、191.22 μmol/L、227.61 μmol/L,第4天160.24 μmol/L、191.40 μmol/L、216.65 μmol/L、277.49 μmol/L,第5天164.26 μmol/L、179.51 μmol/L、209.88μmol/L、263.74μmol/L,第6天131.87 μmol/L、172.73 μmol/L、195.57 μmol/L、231.26μmol/L,第7天118.94 μmol/L、157.57 μmol/L、204.83 μmol/L、223.84 μmol/L.PSB为294.46 μmol/L,高峰出现在第4天;微量法与生化法有良好的相关性（微量法与生化法r=0.948,t=21.067）;皮肤黄染在头面部其血清总胆红素值为（112.3±6.2）μmol/L,到胸部为（165.1 ±26.7） μmol/L,到腹部为（214.0 ±30.8） μmol/L,到膝、肘为（268.5±28.2） μmol/L,到手、足心为＞271.7 μmol/L.结论 安徽省淮南地区正常足月新生儿生后l～7d血清总胆红素的变化范围为120.35～223.84 μmol/L、高峰值为294.46 μmol/L,出现在第4天;以微量法检测新生儿血清胆红素结果准确可靠;通过目测皮肤黄染范围,初步估计其胆红素值,不失为一种简便易行的方法.

Objective To determine the range of total serum bilirubin（TSB） of healthy term newborns dur- ing the first post natal week in Huainan region of Anhui province and provide the theoretical basis for the neonatal jaundice intervention in this region. Methods The bilirubin analyzer for capillary blood was used to measure TSB level of 1257 healthy term newborns during the first post natal week, P25, P50, P75 and P95 were recorded at every time point,the peak serum bilirubin（PSB） and the time it appeared was observed. 50 blood samples were randomly selected and the TSB level was measured by the routine laboratory method, at the same time, the serum bilirubin lev- el was measured by bilirubin analyzer for capillary blood. Then, the linear correlation coefficient of capillary blood bilirubin level and TSB level was calculated and statistically analyzed, and at last got the linear regression model. The newborns＇skin xanthochromia coverage scales and TSB levels were recorded in order to get the corresponding TSB lev- el in terms of xanthochromia coverage. Results In this study, the serum bilirubin P25, P P75 and P95 of 1 257 healthy term newborns were 58. 64μmol/L, 72.51μmo]/L L, 102. 44μmol/L, 120.35 μ mol/L, respectively in the first day, 2nd day 105. 41μmol/L, 119. 72μmol/L, 150. 18μmoL/L, 185. 30μmol/L, 3rd day 128. 85μmol/L, 157.95μmol/L, 191. 221xmol/L, 227. 61μmoL/L, 4th day 160. 24μmol/L, 191. 40μmol/L, 216. 65μmol/L, 277.491xmol/L,5th day 164.26μmol/L, 179. 511xmol/L,209.88p, mol/L,263.74μmol/L,6th day 131.87μmol/L, 172. 73μmol/L, 195. 57μmoL/L,231. 261μmol/L,and the 7th day 118.94txmol/L, 157.57μmol/L, 204.83μmol/L, 223. 84μmol/L,with PSB 294.46μoL/L appeared at the fourth day. The correlationship was existed between the capillary blood bilirubin measurement and the routine laboratory method （r = 0. 948 ,t = 21. 067）. The TSB level was （ 112.3 ,＋ 6.2 ） Ixmol/Lwhenthexanthochromiawas on the head, （ 165.1 _＋ 26.7 ） p, mol/Lonthe chest, （214.0 ＋30.8） p, mol/L on the belly, （268.5 -＋28.2）Ixmol/L on the knee or elbow,and 〉271.7txmol/L on the palm or sole of the foot. Conclusion The TSB variation rang is 120.35 ~ 223. 841xmol/L within 7 days after their birth in Huain- an region of Anhui province, capillary blood bilirubin is reliable in measuring serum bilirubin level of newborns ; visual assessment of xanthochromia coverage is also an easy and feasible way of estimating serum bilirubin level initially.