摘要
亚洲新生儿严重高胆红素血症发生率比白种人高。笔者用病例对照研究来调查已知的8个危险因素[母乳喂养、ABO溶血、早产、感染、头颅血肿、窒息、葡萄糖-6-磷酸脱氢酶(G6PD)缺乏、变异的鸟苷二磷酸-葡萄苷酸基转移酶1A1(UGT1A1)基因]及在台湾地区新生儿严重高胆红素血症中一个可疑的危险因素[有机阴离子输送物2(OATP2)基因]对该病的影响。病例组由72例血清胆红素水平≥342μmol/L的新生儿组成,对照组由医院内血清胆红素水平【256.5μmol/L 的100例新生儿组成。
The incidence of severe neonatal hyperbilirubinemia is higher in Asians than in whites. A case-control study was designed to investigate the effects of eight known risk factors [breast feeding, ABO incompatibility, premature birth, infection , cephalohe matoma , asphyxia , glucose- 6 -phosphate dehydrogenase (G6PD) deficiency, and variant UDP-glucuronosyltransferase 1A1 (UGT1A1) gene] and a suspicious analog [organic anion transporter 2 (OATP 2) gene] on severe hyperbilirubinemia in Taiwan Residents neonates. The 72 study subjects and 100 hospital control subjects consisted of neonates with peak serumbilirubin levels ≥342 μM and < 256. 5 μM, respectively. The PCR-restriction fragment length polymorphism method was applied to detect the UGT1A1, OATP 2, and G6PD genes. The results of multivariate logistic regressions, adjusted for covariates, revealed odds ratios (ORs) of 4. 64 [95% confidence interval (CI): 2.25-9.57; p <0.001], 3.36 (95% CI: 1.54-7.35; p = 0.002), and 3. 02 (95% CI: 1.30-6. 99; p = 0. 010) for neonates who were fed with breast milk, and carry the variant UGT1A1 gene at nucleotide 211 and the variant OATP 2 gene at nucleotide 388, respectively. The ORs, adjusted for covariates, for the other six risk factors were not statistically significant. The ORs in neonates who had one, two, and three significant risk factors were 8. 46 (95% CI: 2.75-34.48; p <0. 001), 22.0 (95%CI: 5.50- 88.0; p < 0.001), and 88.0 (95% CI: 12.50-642.50; p < 0.001), respectively. In conclusion, neonates who carry the 211 and 388 variants in the UGT1A1 and OATP 2 genes, respectively, as well as feed with breastmilk are at high risk to develop severe hyperbilirubinemia.
