湖南省郴州地区血清总胆红素大于或等于427.5μmol/L足月儿高胆红素血症临床分析

Clinical analysis of hyperbilirubinemia in full-term infants with total serum bilirubin ≥427.5 μmol/L in Chenzhou area

目的探讨湖南省郴州地区血清总胆红素(TSB)≥427.5μmol/L足月儿高胆红素血症的主要病因和临床特点。方法回顾性分析2015年5月至2016年10月湖南省郴州市第一人民医院收治的130例TSB≥427.5μmol/L足月高胆红素血症患儿的临床资料。根据入院时TSB值分为极重度高胆红素血症(EHB)组(427.5μmol/L≤TSB<513.0μmol/L,70例)和危险性高胆红素血症(HHB)组(TSB≥513.0μmol/L,60例)。结果两组患儿出生胎龄、体质量及日龄、性别、清蛋白等比较,差异均无统计学意义(P>0.05);HHB组患儿入院时TSB、非结合胆红素、TSB与清蛋白比值(B/A)、急性胆红素脑病(ABE)发生率、换血治疗比例、换血治疗后TSB、换血治疗前后TSB差值均明显高于EHB组,差异均有统计学意义(P<0.05)。130例患儿黄疸主要病因:葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏症47例(36.2%),ABO溶血病13例(10.0%),感染性疾病12例(9.2%)。EHB组患儿无一例死亡;HHB组患儿中死亡4例,放弃治疗1例。入院时TSB、B/A值预测ABE的受试者工作特征曲线下面积分别为0.844 2、0.823 4,均大于0.500 0,差异有统计学意义(P<0.05)。TSB=519.0μmol/L、B/A=9.9时约登指数最大,入院时TSB、B/A值均与ABE显著相关(r=0.603、0.572,P<0.05)。结论TSB≥427.5μmol/L尤其是大于或等于513.0μmol/L时ABE发病率和新生儿病死率均随TSB值增加而增加。TSB、B/A均是预测ABE的良好指标。

Objective To investigate the main causes and clinical features of full-term infants with hyperbilirubinemia[total serum bilirubin（TSB）≥427.5 μmol/L] in Chenzhou area. Methods The clinical data in 130 full-term infants with hyperbilirubinemia（TSB≥427.5 μmol/L） hospitalized in our hospital from May 2015 to October 2016 were retrospectively analyzed.The patients were divided into the extreme severe hyperbilibrubinemia group（EHB group,427.5 μmol/L≤TSB513.0 μmol/L,n=70） and hazardous hyperbilirubinemia group（HHB group,TSB≥513 μmol/L,n=60） according to the TSB value at admission.Results The gestational age,body mass,day-old,sex and albumin had no statistical difference between the two groups（P〈0.05）.The TSB level at admission,unconjugated bilirubin（TSB） and B/A ratio,occurrence rate of acute bilirubin encephalopathy（ABE）,proportion of blood exchange transfusion, TSB after blood exchange transfusion and TSB difference value before and after blood exchange transfusion in the HHB group were significantly higher than those in the EHB group,the differences were statistically significant（P〈0.05）. Among 130 cases of jaundice,the main causes included G-6-PD deficiency in 47 cases（36.2%）,ABO hemolytic diseases in 13 cases（10.0%） and infectious diseases in 12 cases（9.2%）. No case died in the EHB group,while 4 cases died and 1 case gave up treatment in the HHB group. The areas under the receiver operating characteristic（ROC） curve of TSB and B/A at admission for predicting ABE were 0.844 2 and 0.823 4 respectively,all0.500 0,the difference was statistically significant（P〈0.05）. When TSB=519.0 μmol/L and B/A =9.9,the Youden index was maximal. TSB and B/A value at admission had significant correlation with ABE（r=0.603,0.572,P〈0.05）. Conclusion When TSB ≥427.5 μmol/L, especially ≥513.0 μmol/L,the incidence rate of ABE and neonatal mortality rate are increased with the TSB increase. TSB and B/A ratio are good indicators for predicting ABE. Therefore strengthening the monitoring of bilirubin during perinatal period and combining clinical risk factors with TSB level can improve the accuracy for predicting neonatal hyperbilirubinemia,and timely conducts the intervention for reducing the incidence rate and mortality rate of ABE.