血清胆红素水平对新生儿神经功能及免疫功能的影响

The Effect of the Serum Bilirubin Level on the Neonatal Neurological Function and Immune Function

目的探讨新生儿血清胆红素水平对神经功能及免疫功能的影响。方法将100例新生儿黄疸患儿按照其治疗前血清总胆红素(total serum bilirubin,TSB)水平的高低分为轻度组(n=33)、中度组(n=36)和重度组(n=31);另选30例健康新生儿作为正常对照组。比较各组血清TSB/白蛋白(B/A)比值、S-100B蛋白、神经元特异性烯醇化酶(NSE)、免疫球蛋白(IgG、IgA、IgM)水平及外周血T淋巴细胞亚群(CD4^+、CD4^+/CD8^+)的差异,并分析TSB与其他各指标的相关性。结果与正常对照组比较,轻、中、重度组患儿血清B/A比值、S-100B蛋白和NSE水平均显著升高,差异有统计学意义(P<0.05);血清IgG、IgA、IgM水平及外周血CD4^+细胞百分比、CD4^+/CD8^+比值均显著降低,差异有统计学意义(P<0.05);随着血清TSB水平的升高,血清B/A比值、S-100B蛋白和NSE水平逐渐升高,血清IgG、IgA、IgM水平及外周血CD4^+细胞百分比、CD4^+/CD8^+比值逐渐降低,且轻、中、重度组间比较,差异有统计学意义(P<0.05);新生儿血清TSB水平与B/A比值、S-100B蛋白及NSE水平呈正相关(P<0.05);与血清IgG、IgA、IgM水平及外周血CD4^+细胞百分比、CD4^+/CD8^+比值呈负相关(P<0.05)。结论新生儿血清胆红素升高可导致一定程度的神经毒性和免疫功能损害,且胆红素水平越高,神经功能和免疫功能损害越严重。

Objective To study the effect of the serum bilirubin level on the neurological function and immune function in neonates.Methods The100cases with neonatal jaundice were divided into the mild group(n=33),moderate group(n=36)and severe group(n=31)according to the levels of their serum total bilirubin(TSB)before treatment.Another30healthy neonates were selected into the normal control group.The ratio of TSB to albumin(B/A),the levels of serum S-100B protein,neuron specific enolase(NSE)and immunoglobulin(IgG,IgA and IgM)and the changes of peripheral blood T lymphocyte subsets(CD4+and CD4+/CD8+)in each group were compared respectively,and the correlation between TSB and the other indexes was analyzed.Results Compared with the normal control group,the ratio of B/A and the levels of serum S-100B and NSE in the mild,moderate and severe groups were significantly increased(P<0.05),while the levels of serum IgG,IgA and IgM,the percentage of CD4+cells and the ratio of CD4+/CD8+in those groups were significantly decreased(P<0.05).With the increase of the serum TSB level,the ratio of B/A and the levels of serum S-100B and NSE gradually increased while the levels of serum IgG,IgA and IgM,the percentage of CD4+cells and the ratio of CD4+/CD8+gradually decreased,and the differences among the mild,moderate and severe groups were statistically significant(P<0.05).In the neonates,the serum TSB level was correlated positively with the ratio of B/A and the levels of serum S-100B and NSE(P<0.05),while it was correlated negatively with the levels of serum IgG,IgA and IgM,the percentage of CD4+cells and the ratio of CD4+/CD8+(P<0.05).Conclusion The neonatal hyperbilirubinemia could lead to a certain degree of neurotoxicity and immune impairment and the higher levels of bilirubin would cause the greater impairment of the neurological and immune function.