高胆红素血症对新生儿心肌的影响

Influence of hyperbilirubinemia on myocardial enzymes in newborns

目的探讨高胆红素血症对新生儿心肌的影响。方法选择2010年3月至2012年3月在广西梧州市妇幼保健院住院的高胆红素血症新生儿137例作为高胆红素组,同时选择50例同期出生的足月生理性黄疸新生儿为对照组,测定血清总胆红素(TBIL)、心肌酶谱(CK、CK-MB、LDH、HBDH),肌钙蛋白Ⅰ(cTnI)、心电图QT离散度(QTd)。结果与对照组相比,高胆红素新生儿心肌酶及cTnI均显著升高,QTd显著增加,差异具有统计学意义(t值分别为37.066_((CK))、13.028_((CKMB))、22.150_((HBDH))、39.554_((LDH))、4.317_((cTnI))、4.423_((QTd)),均P<0.05);与轻度高胆红素血症组相比,重度高胆红素血症组新生儿心肌酶及cTnI均显著升高,QTd显著增加,差异有统计学意义(t值分别为29.736_((CK))、18.352_((CKMB))、35.142_((HBDH))、31.351_((LDH))、4.517_((cTnI))、6.353_((QTd)),均P<0.05)。结论高胆红素血症可引起新生儿心肌损害,心肌损害程度与胆红素水平有关。心肌酶谱(CK、CKMB、LDH、HBDH)、cTnI及QTd可作为临床诊断和治疗高胆红素血症新生儿心肌损害的指标,具有一定的实用价值。

Objective To explore the influence of hyperbilirubinemia on myocardial enzyme in newborns. Methods From March 2010 to March 2012 137 cases of newborns with hyperbilirubinemia hospitalized in Guangxi Wuzhou Maternity and Child Health Care Hospital were selected in high bilirubin group, and 50 normal newborns with physiologic jaundice born at the same period were recruited as controls. Serum total bilirubin （TBIL）, myocardial enzyme spectrum （CK, CK-MB, LDH, HBDH）, eTnI, QTd of two groups were measured. Results Compared with the control group, myocardial enzymes, eTnI and QTd of the high bilirubin group were significantly elevated, and the differences were statistically significant （ t value was 37. 066（cK） , 13. 028（CK_MB） , 22. 150（HBDH） , 39. 554（LDH） , 4. 317（cTnI） and 4. 423（QTd） , respectively, all P 〈 0.05）. Compared with the cases with mild high hilirubin, myocardial enzymes, cTnI and QTd of the cases with severe high bilirubin were significantly elevated, and the differences were statistically significant （t value was 29. 736（cK） , 18. 352〈CK_MB） , 35. 142（HBDH）, 31. 351 （LDH）, 4. 517（ cTnI）, and 6. 353 （QTD）, respectively, all P 〈 0.05 ）. Conclusion High blood bilirubin may cause neonatal myocardial damage, which is related to the bilirubin level. Myocardial enzyme spectrum （CK, CK-MB, LDH, HBDH） , cTnl and QTd may indicate myocardial damage in newborns with hyperbilirubinemia, and can be used as clinic＇al diagnostic indicators, which have certain practical value.