碳氧血红蛋白在新生儿ABO溶血病中的诊断价值

目的探讨碳氧血红蛋白（COHb）在新生）LABO溶血病辅助诊断中的临床价值。方法选取2013年2月至2015年1月新生儿病房收治的病理性黄疸患儿为观察对象，确诊为新生）IoABO溶血症患儿为ABO溶血组，不能确诊为溶血病的病理性黄疸患儿为非溶血性黄疸组，采取同期住院的无病理性黄疸患儿为对照组。比较三组患者生后7d内总胆红素（STB）上升速度、COHb、网织红细胞（Ret）和血红蛋白（Hb）。分析三组STB上升速度与COHb的相关性。建立受试者工作曲线（ROC曲线），确定COHb、RetTJkHb的曲线下面积（AUC），同时分析三者的最佳截断值及联合诊断的敏感度、特异度、阳性预测值和阴性预测值。结果ABO溶血组患）LSTB上升速度、COHb和Ret较非溶血性黄疸组及对照组增高，Hb降低（P均〈0．001）；非溶血性黄疸组STB上升速度较对照组增高（P〈0．001），但COHb、Ret和Hb差异无统计学意义（P〉0．05）。生后7d内COHb诊断新生）~ABO溶血病的最佳截断值为≥1．35％，曲线下面积为0．971，敏感度91．3％、特异度90．5％，敏感度、特异度均比Hb和Ret明显升高。三指标联合诊断的敏感度和特异度可分别提高至95．7％和93．3％。结论COHb是新生）LABO溶血病辅助诊断的敏感指标，与Ret和Hb联合检测，对早期辅助诊断、及时干预和指导治疗有重要价值。

Objective To discuss the clinical significance of earboxyhemoglobin （ COHb ） in neonatal ABO incompatibility. Methods Full- term infants diagnosed serologically with ABO HDN in our department from February 2013 to January 2015 were categorized as hemolytic group. Infants with pathologic jaundice but without ABO HDN were categorized as non-hemolytic jaundice group, while those without pathologic jaundice were studied as control. Serum total bilirubin （ STB ） increasing speed, COHb level, reticulocyte （ Ret ） count and hemoglobin （ Hb ） were measured within seven days after birth and compared within the three groups.Correlation with STB increasing speed and COHb was analyzed.Area under the receiver operating characteristic （ ROC ） curve （ AUC ） and optimum sensitivity, specificity and predictive values for COHb, Ret and Hb were evaluated. Results In hemolytic group, STB increasing speed, COHb and Ret were significantly higher and Hb were lower than that of non- hemolytic jaundice group and control group （ P〈0.001 ） , but they had no statistical difference between non-hemolytic jaundice group and control group except STB increasing speed.The cut-off value of COHb within 7 days after birth was 1.35%, AUC was 0.971, sensitivity was 91.3%, specificity was 90.5%, sensitivity and specificity were higher than Ret and Hb. Multi-biomakers detection showed that the sensitivity and specificity could be raised to 95.7% and 93.3%. Conelusions COHb is a sensitive adjunctive marker for detecting ABO HDN.If combined with Ret and Hb detection, the diagnostic efficacy can be improved, which makes COHb an important role in early diagnosis and intervention guiding.