蓝光治疗对新生儿红细胞葡萄糖-6-磷酸脱氢酶缺乏症所致高胆红素血症患儿溶血反应的影响

Effects of Phototherapy on the hemolytic reaction of neonatal hyperbilirubinemia induced by glucose-6-phosphate dehydrogenase deficiency

目的研究蓝光治疗对新生儿红细胞葡萄糖-6-磷酸脱氢酶（G-6-PD）缺乏症所致高胆红素血症患儿溶血反应的影响。方法选择2013年2~12月,广东省肇庆市妇幼保健院收治的59例G-6-PD缺乏症患儿为研究对象。根据入院顺序号随机将其分为G-6-PD缺乏接受蓝光治疗＋综合治疗组（研究组,n=34）和G-6-PD缺乏仅接受综合治疗,未接受蓝光治疗组（对照组,n=25）。研究组与对照组患儿的性别构成比、日龄、喂养方式及分娩方式等比较,差异均无统计学意义（P〉0.05）。本研究遵循的程序符合广东省肇庆市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书。分别比较两组患儿治疗前、后及两组患儿治疗48h后红细胞计数、血红蛋白（Hb）水平及其变化情况。结果研究组和对照组患儿治疗前出生体质量、总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）、红细胞计数、Hb水平比较,差异均无统计学意义（P〉0.05）。研究组及对照组患儿接受治疗后,TBIL、DBIL、IBIL、红细胞计数、Hb水平均较治疗前降低,并且差异均有统计学意义（P〈0.05）。此外,研究组患儿接受蓝光治疗48h后红细胞计数及Hb水平明显低于对照组,并且差异均有统计学意义（P〈0.05）。结论蓝光治疗虽是治疗G-6-PD缺乏所致新生儿高胆红素血症的有效方法,但同时亦可加重G-6-PD缺乏所致新生儿高胆红素血症患儿溶血反应。

Objective To discuss the effects of phototherapy on the hemolytic reaction of neonatal hyperbilirubinemia caused by glucose-6-phosphate dehydrogenase （G-6-PD） deficiency. Methods From February to December 2013, a total of 59 neonates with G-6-PD deficiency were included into this study. According to the order of hospitalization, they were divided into study group （received phototherapy and comprehensive treatment, n： 34） and control group （comprehensive treatment only, n： 25）. There were no significant differences between two groups in the aspects of gender constituent ratio, age, feeding modes and delivery modes （P 〉 0. 05）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Haoqing Maternity ＆ Child Care Hospital. Informed consent was obtained from the parents of each participate. The change of red blood count and hemoglobin （Hb） and blood serum bilirubin levels were observed and analyzed between two groups before and after 48 hours of phototherapy. Results There were no significant differences between two groups in the aspects of birth weight, total bilirubin （TBIL）, direct bilirubin （DBIL）, indirect bilirubin （IBIL）, red blood count, and Hb （P〉0.05）. The levels of TBIL, DBIL, IBIL, red blood cell count, and Hb of 48 hours post-treatment significant declined than those of prereatment in both two groups （P〈0.05）. The number of red blood cell count and Hb of study group were significantly lower than those of control group at 48 hours after the treatment （P〈 0.05）. Conehlsions Phototherapy is an effective treatment method of neonatal hyperbilirubinemia induced by G-6-PD deficiency, but phototherapy also could aggravate the hemolytic reaction.