基于倾向评分法探讨新生儿高胆红素血症换血标准相关问题

Related Issues of Exchange Transfusion Standard for Neonatal Hyperbilirubinemia Based on Propensity Score

目的:探讨目前新生儿高胆红素血症换血标准相关问题以及换血率下降的原因。方法:收集我院2011年1月至2012年12月以及2016年1月至2017年12月收治的、入院诊断为新生儿高胆红素血症且达到换血标准的近足月儿2268例,根据是否行换血疗法分为换血组和非换血组,对两组患儿所有混杂因素行倾向评分配比,比较配比后两组患儿急性胆红素脑病(ABE)相关指标,探讨换血治疗标准是否合适及换血率下降的原因。结果:我院2001-2012年新生儿换血率呈上升趋势(t=4.98,P<0.05),而2012年后换血率逐年下降(t=-8.872,P<0.05),差异有统计学意义;经过1∶1倾向评分配比后,2011-2012年有190对匹配成功,2016-2017年有65对匹配成功,且两组间混杂因素全部均衡;其中2011-2012年两组间ABE严重程度比较差异有统计学意义(P<0.05),而脑干听觉诱发电位(BAEP)、头颅MRI、听力筛查、新生儿神经行为测定(NBNA)评分比较差异无统计学意义(P>0.05)。2016-2017年两组间ABE严重程度、BAEP、头颅MRI、听力筛查、NBNA评分比较差异均无统计学意义(P>0.05)。结论:目前我国参考的黄疸换血干预标准有待进一步完善,围产医学的发展可明显降低换血率。

Objective:To investigate the related issues of exchange transfusion standard for neonatal hyperbilirubinemia based on propensity score and the causes of decline in exchange transfusion rate. Methods:A total of 2,268 newborns diagnosed with neonatal hyperbilirubinemia and met the exchange transfusion standard,who were admitted from Jan. 2011 to Dec. 2012 and from Jan. 2016 to Dec. 2016,were extracted to be divided into the exchange transfusion group and the non-exchange transfusion group according to whether to conduct exchange transfusion therapy or not. The prognostic score of all the confounding factors between two groups was recorded,and the indicators of acute bilirubin encephalopathy( ABE) between two groups were compared to explore whether the exchange transfusion standard was appropriate and the causes of the decline in exchange transfusion rate. Results:From 2001 to 2012,the exchange transfusion rate of newborns in our hospital showed an upward trend( t = 4. 98,P<0. 05),while after 2012,the rate decreased year by year( t =-8. 872,P<0. 05),and the difference was statistically significant. After the 1 ∶ 1 propensity score,190 pairs were successfully matched from 2011 to 2012,65 pairs were successfully matched from 2011 to 2012,and the confounding factors were balanced between two groups. The difference in ABE severity between two groups from 2011 to 2012 was statistically significant( P < 0. 05),while the difference in brain stem auditory evoked potential( BAEP),cranial MRI,hearing screening and neonatal behavioral neurological assessment( NBNA) score was not statistically significant( P>0. 05). There was no significant difference in ABE severity,BAEP,head MRI,hearing screening and NBNA score between two groups from 2016 to 2017( P > 0. 05). Conclusion:At present,the reference standard for exchange transfusion rate of jaundice in China still need to be further improved. The development of perinatal medicine can significantly decrease the rate of blood exchange transfusion rate.