静脉注射用丙种球蛋白治疗新生儿溶血病与足月儿坏死性小肠结肠炎发病的相关性研究

Study on the correlation between the application of intravenous immunoglobulin in the treatment of hemolytic disease of the newborn and the incidence of necrotizing enterocolitis in term infants.

目的探讨静脉注射用丙种球蛋白(IVIG)治疗新生儿溶血病的临床效果及与足月儿坏死性小肠结肠炎(NEC)发病的相关性研究。方法回顾性选取2017年9月至2020年11月间于湖南省妇幼保健院进行救治的新生儿溶血病患儿80例,以治疗方式作为分组标准,其中应用IVIG治疗的患儿作为观察组,未应用IVIG治疗的患儿作为对照组。检测2组患儿住院时间、黄疸消退时间、光疗时间,血清总胆红素水平(TBIL)变化及足月后NEC发生率,采用Logistic回归分析2组患儿发生NEC的相关因素。结果观察组患儿的住院时间、黄疸消退时间及光疗时间分别为(6.23±1.32)d、(3.62±0.86)d、(34.23±0.89)h,明显低于对照组患儿[(10.29±2.31)d、(5.70±1.42)d、(42.72±2.31)h],差异均有统计学意义(P<0.05);治疗前,2组患儿的血清TBIL水平相似,治疗1、2 d后,2组患儿的血清TBIL表达水平均有下降,观察组患儿的血清TBIL水平为(209.43±12.38)、(183.59±10.62)μmol/L,明显低于对照组[(274.29±13.81)、(245.83±11.56)μmol/L],差异均有统计学意义(P<0.05)。观察组足月后NEC发生率为20.00%,高于对照组(5.00%),差异有统计学意义(P<0.05)。Logistic回归分析结果显示,小于胎龄儿和应用IVIG与足月儿NEC的发生有关(P<0.05)。结论IVIG一种具有较高疗效的新生儿溶血病法,可显著改善患儿血清TBIL水平,且足月儿NEC的发生与应用IVIG及小于胎龄儿有关。

Objective Investigate the clinical effect of intravenous immunoglobulin(IVIG)in the treatment of hemolytic disease of the newborn and its correlation with necrotizing enterocolitis(NEC)in term infants.Methods From September 2017 to November 2020,80 children with hemolytic disease of the newborn who were treated in the Hunan Maternity and Child Health Hospital were retrospectively selected,the treatment method was used as the grouping standard.The children treated with IVIG were set as the observation group,and the children not treated with IVIG were set as the control group.The hospitalization time,jaundice resolution time,phototherapy time,serum total bilirubin level(TBIL)changes and the incidence of NEC after term were detected in the two groups.Logistic regression was used to analyze the related factors of NEC in the two groups.Results The hospitalization time,jaundice resolution time,and phototherapy time of the observation group were(6.23±1.32)d,(3.62±0.86)d,and(34.23±0.89)h,respectively,which were significantly lower than those of the control group[(10.29±2.31)d,(5.70±1.42)d,(42.72±2.31)h],the differences were statistically significant(P<0.05);before treatment,the levels of serum TBIL in the two groups were similar,and after treatment 1 and 2 day,the expression level of serum TBIL in the two groups children decreased.The serum TBIL levels of the observation group were(209.43±12.38)and(183.59±10.62)μmol/L,which were significantly lower than those in the control group[(274.29±13.81)and(245.83±11.56)μmol/L],the differences were statistically significant(P<0.05).The incidence of NEC after term in the observation group was 20.00%,which was higher than(5.00%)in the control group,and the difference was statistically significant(P<0.05).The results of Logistic regression analysis showed that small for gestational age infants and the application of IVIG were related to the occurrence of NEC in term infants(P<0.05).Conclusion IVIG is a highly effective method for hemolytic disease of the newborn,which can significantly improve the level of serum TBIL in children.The occurrence of NEC in term infants is related to the application of IVIG and small for gestational age.