直接抗球蛋白试验和总胆红素与白蛋白比值联合检测在ABO新生儿溶血病导致的严重高胆红素血症中的临床意义

Clinical value of combination detection of direct antiglobulin test and ratio of total bilirubin to albumin in severe hyperbilirubinemia caused by ABO hemolytic disease of the newborn

目的探讨直接抗球蛋白试验(DAT)和总胆红素与白蛋白比值(B/A)联合检测在ABO新生儿溶血病(ABO-HDN)所致严重高胆红素血症中的临床应用。方法选择2020年6月~2021年12月,在武汉儿童医院住院的确诊为ABO-HDN的患儿,根据峰值总胆红素水平将研究对象分为高危组和低危组,分析DAT、B/A以及联合检测DAT和B/A对ABO-HDN导致的严重高胆红素血症的预测价值。结果在270例研究对象中,69例DAT阳性,二元Logistic的结果显示,总胆红素峰值(OR 0.970;95%CI 0.962~0.987)、B/A(OR 6.152;95%CI 3.593~10.535)、DAT(±)(OR 0.106;95%CI 0.018~0.646)、DAT(1+)(OR 0.280;95%CI 0.116~0.674)、DAT(2+)(OR 0.152;95%CI 0.049~0.472)与高胆红素血症的严重程度显著独立相关(P_(均)<0.05),受试者工作特征(ROC)曲线分析DAT、B/A预测ABO-HDN导致的严重高胆红素血症的最佳截值为±和8.84,DAT、B/A以及联合检测DAT和B/A的曲线下面积(AUC)分别为0.621、0.740和0.750。结论DAT和B/A可作为ABO-HDN高胆红素血症严重程度的预测指标,联合检测DAT和B/A可进一步提高预测价值。

Objective To study clinical applications of direct antiglobulin test(DAT)and ratio of total bilirubin to albumin(B/A)in newborns with severe hyperbilirubinemia resulting from ABO hemolytic disease of the newborn(ABO-HDN).Methods The neonates diagnosed with ABO-HDN in Wuhan Children's Hospital from June 2020 to December 2021 were grouped into the high-risk group and the low-risk group based on the peak value of total bilirubin of individuals.The correlations of DAT and B/A with severe hyperbilirubinemia caused by ABO-HDN were singly or conjointly analyzed between groups.Results Among 270 patients,69 were confirmed positive in the DAT assay.The optimum cutoff values of receiver operating characteristic curve(ROC)for correlations of DAT and B/A with severe hyperbilirubinemia caused by ABO-HDN were±and 8.84.Binary logistic regression analysis showed that the peak values of total bilirubin(OR 0.970;95%CI 0.962~0.987),B/A(OR 6.152;95%CI 3.593~10.535),DAT(±)(OR 0.106;95%CI 0.018~0.646),DAT(1+)(OR 0.280;95%CI 0.116~0.674),and DAT(2+)(OR 0.152;95%CI 0.049~0.472)were significantly and independently correlated with the severity of hyperbilirubinemia(P<0.05).Areas under the curve(AUC)of ROC for correlations of DAT,B/A and both of them with severe hyperbilirubinemia were 0.621,0.740 and 0.750,respectively.Conclusion DAT or B/A seems to be a competent predictor of severe hyperbilirubinemia caused by ABO-HDN,which could be enhanced when the two indicators are combined.