肌钙蛋白在新生儿高胆红素血症心肌损伤诊断的临床价值研究

Study on the clinical value of troponin in myocardial damage of neonatal hyperbilirubinemia

目的分析肌钙蛋白对新生儿高胆红素血症的临床价值,为新生儿高胆红素血症的治疗提供科学依据。方法选择2018年2月-2019年3月四川省妇幼保健院接诊的足月高胆红素血症患儿94例(观察组)与同期足月健康新生儿94例(对照组)为研究对象。收集两组对象一般资料并对总胆红素(TBIL)、间接胆红素(IBIL)、直接胆红素(DBIL)及肌钙蛋白Ⅰ(cTnⅠ)进行检测。根据TBIL检测情况,将观察组分为轻度高胆红素血症组(轻度组)及重度高胆红素血症组(重度组);有无发生新生儿ABO溶血症,将观察组分为溶血性高胆红素血症组(溶血组)与非溶血性高胆红素血症组(非溶血组),对比各组血清指标水平。结果轻度组、重度组患儿TBIL、IBIL及cTnⅠ水平均明显高于对照组,且重度组TBIL、IBIL水平明显高于轻度组(F=1 652.030、2 150.368、1 470.795,P<0.05)。相关性分析结果显示观察组患儿治疗前后TBIL、IBIL差值与cTnⅠ差值均呈显著正相关关系(r=0.664、0.415,P<0.05)。溶血性高胆红素血症患儿TBIL、IBIL、cTnⅠ均明显高于非溶血性高胆红素血症者(t=6.924、2.029、2.490,P<0.05)。结论新生儿高胆红素血症患儿cTnⅠ水平会出现异常升高,cTnⅠ可为高胆红素血症心肌损伤诊断提供一定的参考价值。

Objective To analyze the clinical value of troponin in myocardial damage of neonatal hyperbilirubinemia,in order to provide scientific basis for the treatment of neonatal hyperbilirubinemia. Methods A total of 94 full-term infants with hyperbilirubinemia admitted to Sichuan Maternal and Child Health Hospital were enrolled in this study from February 2018 to March 2019,and 94 full-term healthy infants were selected as control group.General data of both groups were collected and the levels of total bilirubin(TBIL),indirect bilirubin(IBIL),direct bilirubin(DBIL),and troponin I(cTnⅠ) were tested.According to the TBIL test result,children in observation group were divided into two subgroups of mild hyperbilirubinemia group and severe hyperbilirubinemia group.Meanwhile,children in observation group were divided into hyperbilirubinemia group and the non-hemolytic hyperbilirubinemia group.The serum index levels of each group were compared. Results The levels of TBIL,IBIL and cTnⅠ in mild hyperbilirubinemia group and severe hyperbilirubinemia group were significantly higher than those in the control group(F=1 652.030,2 150.368,1 470.795,P<0.05).The levels of TBIL and IBIL were significantly higher in children with severe hyperbilirubinemia than those in the mild hyperbilirubinemia group(P<0.05),but there was no significant difference on cTnⅠ between mild hyperbilirubinemia group and severe hyperbilirubinemia group(P>0.05).Correlation analysis showed that there was a significant positive correlation between TBIL,IBIL and cTnⅠ before and after treatment in the observation group(r=0.664,0.415,P<0.05).The TBIL,IBIL and cTnⅠ of children with hemolytic hyperbilirubinemia were significantly higher than those of non-hemolytic hyperbilirubinemia(t=6.924,2.029,2.490,P<0.05). Conclusion The level of cTnⅠ in neonatal hyperbilirubinemia will increase abnormally,so cTnⅠ can be an indicator for the diagnosis and prognosis prediction of myocardial damage of hemolytic hyperbilirubinemia.