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四川省新生儿葡萄糖-6-磷酸脱氢酶筛查回顾性分析 被引量:1

A Retrospective Analysis of Neonates Glucose-6-Phosphate Dehydrogenase Screening in Sichuan Province
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摘要 目的探究葡萄糖-6-磷酸脱氢酶(G6PD)筛查水平影响最大的因素,为四川省新生儿G6PD筛查切值的制定提供建议。方法研究对象为2015年1月至2018年10月四川省新生儿疾病筛查中心管辖机构出生的305536例新生儿采用荧光法检测新生儿的足跟滤纸干血斑G6PD浓度。使用多重线性回归分析新生儿出生季节、送出间隔时间、采血时间、孕周、分娩方式、户籍类型、性别、胎数、出生体重、地区对G6PD水平的影响,根据影响最大的因素以百分位数法确定切值,并将原定切值和现定切值进行比较。G6PD水平的多组比较使用独立样本克鲁斯卡尔-沃利斯检验,采用Bonferroni法校正显著性水平的事后两两比较率的比较使用卡方检验。结果经正态性检验,G6PD水平呈偏态分布。出生季节、户籍类型、性别、胎数、出生体重、地区与G6PD值成正相关送出间隔时间、采血时间、孕周、分娩方式与G6PD值成负相关。出生季节对G6PD值的影响最大(标准偏回归系数Beta=0.371)。春、夏、秋、冬季G6PD水平的多组比较差异有统计学意义(H=97561.361,P=0.000)进一步两两比较发现任意两组间差异均有统计学意义(P均=0.000)。G6PD春、夏、秋、冬季初筛阳性率比较差异有统计学意义(χ^2=73.986,P<0.05)。春、夏、秋、冬季G6PD水平第1百分位数值P1分别为3.7、3.0、3.7、5.4U/gHb,全年为3.5 U/gHb。G6PD原定切值和现定切值初筛阳性率在春、夏、秋、冬季差异均有统计学意义(χ^2=73.986,P<0.05;χ^2=97.693,P<0.05;χ^2=228.808,P<0.05;X^2=276.331,P<0.05)在全年差异亦有统计学意义(χ^2=764.721,P<0.05)。结论可根据出生季节调整G6PD截断值建议四川省新生儿G6PD筛查切值春、秋季设为3.7 U/gHb,夏季设为3.0 U/gHb,冬季设为5.4 U/gHb在减少假阳性的同时避免漏诊。 Objective To provide evidence for the neonatal glucose-6-phosphate dehydrogenase(G6PD)cutoff value in Sichuan Province based on the most influential factor for G6PD measurement.Methods From January 2015 to October 2018,heel G6PD concentrations in dried blood spot on filter paper were detected by quantitive fluorometric assay in 305,536 neonates,who were born in the jurisdictional hospitals of the Center for Neonatal Disease Screening of Sichuan Province.Multivariate logistic regression was performed to find the influential factors for G6PD measurement including season of birth,delivery interval,blood collection time,gestational week,modes of delivery,type of household registration,gender,fetus number,birth weight,and region.A G6PD cutoff value was calculated by percentile method based on the most influential factor,and is then compared with the original cutoff value.G6PD levels in multiple groups were compared using independent Kruskal-Wallis Test,and Bonferroni correction was conducted for the comparison of any two groups with significance.Rates were analyzed by chi-square test.Results Normality test showed that G6PD level was in a skewed distribution.Season of birth,type of household registration,gender,fetus number,birth weight,and region were positively correlated with G6PD level;while delivery interval,blood collection time,gestational week,and modes of delivery were negatively correlated with G6PD level.Season of birth showed biggest influence on G6PD(standardized partial regression coefficient Beta=0.371).G6PD levels were significantly different among Spring,Summer,Autumn,and Winter(H=97561.361,P=0.000),and further analysis found significant difference between any two of the seasons(P=0.000).The rates of positive G6PD preliminary screening test were significantly different among the four seasons(χ^2=73.986, P<0.05).The 1 st percentile value(P1)of G6PD in Spring,Summer,Autumn,and Winter was 3.7,3.0,3.7,and 5.4 U/gHb,respectively,and the annual average P 1 was 3.5 U/gHb.The rates of positive G6PD preliminary screening test were significantly different when comparing the use of the new and original cutoff value in each of the four seasons(χ^2=73.986, P<0.05;χ^2=97.693, P<0.05;χ^2=228.808, P<0.05;χ^2=276.331, P<0.05)as well as in annual average(χ^2=764.721, P<0.05).Conclusion The cutoff value of G6PD level could be adjusted by the season of birth,and we recommend a cutoff value of 3.7 U/gHb for both Spring and Autumn,3.0 U/gHb for Summer,and 5.4 U/gHb for Winter for neonates in Sichuan Province,to reduce false positive rate and to avoid missed diagnosis.
作者 杨丽涓 欧明才 张钰 胡琦 周婧瑶 陈雪莲 Yang Lijuan;Ou Mingcai;Zhang Yu(Department of Neonatal Disease Screening,Sichuan Provincial Hospital for Women and Children,Chengdu,Sichuan 610045,China)
出处 《四川医学》 CAS 2019年第10期981-985,共5页 Sichuan Medical Journal
基金 四川省卫计委课题资助项目(编号:110289)
关键词 新生儿疾病筛查 出生季节 葡萄糖-6-磷酸脱氢酶 切值 neonatal disease screening season of birth glucose-6-phosphate dehydrogenase cutoff value
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