丙种球蛋白治疗ABO溶血病患儿的胆红素阈值分析

Analysis of bilirubin thresholds of using gamma globulin for treating ABO hemolytic disease

目的比较不同胆红素水平的ABO溶血病患儿应用丙种球蛋白(IVIG)治疗的临床疗效,探讨丙种球蛋白治疗ABO溶血病患儿的胆红素阈值。方法选择2011年1月至2013年8月期间我院收治的ABO溶血病患儿102例,按照数字随机法将其分为A组与B组,每组51例。A组在胆红素指标位于Bhutani曲线的75百分位时应用IVIG治疗,B组患儿在胆红素指标位于Bhutani曲线的95百分位时应用IVIG治疗。观察两组间住院率、住院费用、疗效等方面的差异。结果 A组IVIG应用率为81.31%,住院费用为(3 689±985)元,B组IVIG应用率为58.82%,住院费用为(3 241±1 126)元,A组采用IVIG治疗率和住院费用明显高于B组,两组比较差异均具有统计学意义(P<0.05);所有患儿均未采取血白蛋白治疗,两组患儿的总光疗时间、胆红素降低程度、住院时间比较差异增多无统计学意义(P>0.05);两组患儿在出生42 d、入院、出院时的Hb值比较差异均无统计学意义(P>0.05)。结论 ABO溶血病患儿胆红素指标在Bhutani曲线中的95百分位和75百分位时应用IVIG治疗疗效相当,但以胆红素指标在Bhutani曲线中的95百分位作为治疗阈值时IVIG治疗病例更少,住院费用更低。

Objective To observe the effects of gamma globulin （MG） in the treatment of patients of ABO hemolytic disease with different levels of bilirubin, and to study the threshold of bilirubin. Methods One hundred and two patients of ABO hemolytic disease treated in our hospital from January 2011 to August 2013 were enrolled in the study, which were randomly divided into group A and group B, with 51 patients in each group. Group A applied MG when bilirubin index was located at 75% points of the Bhutani curve, while group B applied IVIG at 95% points. The admission rate, hospitalization expenses, curative effect were compared between the two groups. Results The ap- plication rate of MG, the hospitalization expenses was 81.31%, （3 689＋985） RMB in group A, significantly higher than 58.82%, （3 2414-1126） RMB in group B （P〈0.05）. In this study, all the patients .did not received blood albumin for treatment. The two groups showed no statistically significant difference in total phototherapy time, decrease in bili- rubin level, and hospitalization time （P〉0.05）. The two groups also showed no statistically significant difference in Hb in 42 d after born, at admission and discharge （P〉0.05）. Conclusion The effect of MG treatment is similar when bil- irubin index is at 95% points and 75% points of Bhutani curve, but the cases of IVIG treatment is less and hospitaliza- tion expense is lower at 95% points.