不同严重程度高胆红素血症新生儿血清AST、CK-MB、LDH、BUN、TBiL水平的表达及临床意义

Expression and clinical significance of AST,CK-MB,LDH,BUN and TBiL levels in neonates with different severity of hyperbilirubinemia

目的探讨不同严重程度高胆红素血症新生儿血清总胆红素(TBiL)、谷草转氨酶(AST)、血尿素氮(BUN)、肌酸激酶同工酶(CKMB)及乳酸脱氢酶(LDH)水平的表达及临床意义,旨在为临床高胆红素血症新生儿的诊治以及预后评估提供参考。方法选择2020年4月-2021年4月在郑州市某医院就诊的65例高胆红素血症新生儿作为观察组,选择同期行实验室指标检测的63例健康新生儿作为对照组。观察组患儿根据血清TBiL水平分为重度(TBiL水平>342μmol/L)8例,中度(257~342μmol/L)21例,轻度(TBiL水平<257μmol/L)36例。所有研究对象均进行实验室检测,指标包括AST、CKMB、LDH、BUN、TBiL。对比2组研究对象血清相关实验室检测指标:观察组、对照组的AST、CKMB、LDH、BUN、TBiL水平。对比治疗前后24 h轻度、中度、重度患儿AST、CKMB、LDH、BUN、TBiL水平。对比不同病情患儿预后情况,即统计治疗过程中的并发症发生率。结果观察组研究对象AST、CKMB、LDH、TBiL水平均高于对照组,差异均有统计学意义(P<0.05)。2组研究对象BUN水平比较,差异无统计学意义(P>0.05)。治疗前,中、轻度患儿AST、CKMB、LDH、TBiL水平均低于重度组,轻度组患儿AST、CKMB、LDH、TBiL水平均低于中度组,差异均有统计学意义(P<0.05)。治疗后,3组患儿AST、CKMB、LDH、TBiL水平均低于治疗前,差异均有统计学意义(P<0.05)。中、轻度组患儿AST、CKMB、LDH、TBiL水平均低于重度组,轻度组患儿AST、CKMB、LDH、TBiL水平均低于中度组,差异均有统计学意义(P<0.05)。中、轻度组患儿并发症发生率低于重度组,差异有统计学意义(P<0.05)。轻、中度组患儿并发症发生率比较,差异无统计学意义(P>0.05)。结论AST、CK-MB、LDH、TBiL联合检测可用于评判高胆红素血症新生儿的病情严重程度,并可指导临床治疗,改善预后质量,值得临床推广。

Objective To investigate the expression and clinical significance of serum total bilirubin(TBiL),aspartate aminotransferase(AST),blood urea nitrogen(BUN),creatine kinase myocardial band(CKMB)and lactate dehydrogenase(LDH)levels in neonates with different severity of hyperbilirubinemia,with the aim of providing reference for the diagnosis and treatment as well as prognostic assessment of neonates with hyperbilirubinemia in clinical practice.Methods Sixty-five neonates with hyperbilirubinemia attending a hospital in Zhengzhou from April 2020 to April 2021 were selected as the observation group,and 63 healthy neonates with laboratory indexes tested at the same period were selected as the control group.The children in the observation group were divided into 8 cases with severe(TBiL level>342μmol/L),21 cases with moderate(257~342μmol/L),and 36 cases with mild(TBiL level<257μmol/L)hyperbilirubinemia according to the severity of the disease.All study subjects underwent laboratory tests,and the indexes included AST,CKMB,LDH,BUN,and TBiL.Serum-related laboratory test indexes were compared between the 2 groups:AST,CKMB,LDH,BUN,and TBiL levels were recorded in the observation and control groups.The levels of AST,CKMB,LDH,BUN and TBiL in children with mild,moderate and severe disease were compared before and after 24 h of treatment.The prognosis of children with different conditions was compared,the incidence of complications during the treatment was counted.Results The levels of AST,CKMB,LDH,and TBiL in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The differences were not statistically significant(P>0.05)when comparing the BUN levels in the 2 groups.Before treatment,the levels of AST,CKMB,LDH,and TBiL were lower in the moderate and mild groups than in the severe group,and the higher of AST,CKMB,LDH,and TBiL were lower in the mild group than in the moderate group,and the differences were all statistically significant(P<0.05).After treatment,the levels of AST,CKMB,LDH and TBiL of children in the three groups were lower than those before treatment,and the differences were all statistically significant(P<0.05).The levels of AST,CKMB,LDH and TBiL of children in the moderate and mild groups were lower than those in the severe group,and the levels of AST,CKMB,LDH and TBiL of children in the mild group were lower than those in the moderate group,and the differences were all statistically significant(P<0.05).The complication rates of children in the moderate and mild groups were lower than those in the severe group,and the differences were statistically significant(P<0.05).There was no statistically significant difference between the complication rates of children in the mild and moderate groups(P>0.05).Conclusion The combined test of AST,CK-MB,LDH and TBiL is effective in the clinical management of neonates with hyperbilirubinemia,which can effectively identify the severity of the disease,guide clinical treatment and improve the quality of prognosis,and is worthy of clinical promotion.