丙种球蛋白联合蓝紫光治疗溶血性黄疸新生儿的疗效分析

Effect of intravenous immunoglobulin combined with blue-purle light therapy on newborns with hemolytic jaundice

目的探讨丙种球蛋白联合蓝紫光对溶血性黄疸新生儿的疗效及其对血清胆红素水平和心脑功能的影响。方法前瞻性选取2018年8月至2023年3月延安大学咸阳医院接收的78例溶血性黄疸新生儿为研究对象,按随机数字表法分为观察组和对照组,各39例。对照组患儿男21例、女18例,胎龄(39.45±1.55)周,接受蓝紫光治疗;观察组患儿男22例、女17例,胎龄(39.52±1.60)周,接受静脉注射丙种球蛋白(剂量为1 g/kg)联合蓝紫光治疗。7 d为1个治疗周期,持续至总胆红素降至安全水平。对比两组患儿临床疗效、血清胆红素(总胆红素、直接胆红素、间接胆红素)水平、神经和心肌损伤指标[S100钙结合蛋白B(S100B)、神经元特异性烯醇化酶(NSE)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)]水平、胆红素致神经功能障碍量表(BIND)评分和新生儿神经行为测定(NBNA)评分。采用t检验、χ^(2)检验。结果治疗后,观察组治疗总有效率为94.87%(37/39),高于对照组的79.48%(31/39),差异有统计学意义(χ^(2)=4.129,P=0.042);观察组总胆红素、直接胆红素、间接胆红素、S100B、NSE、CK和CK-MB水平均低于对照组,差异均有统计学意义(均P<0.05);观察组的BIND评分低于对照组[(0.25±0.05)分比(0.38±0.09)分],NBNA评分高于对照组[(38.78±1.53)分比(37.12±1.17)分],差异均有统计学意义(t=8.564、5.845,均P<0.001)。结论丙种球蛋白联合蓝紫光治疗溶血性黄疸新生儿疗效显著,能降低胆红素水平,改善和保护新生儿的神经系统发育和心脏功能。

Objective To investigate the efficacy of intravenous immunoglobulin combined with blue-purle light therapy in the treatment of neonatal hemolytic jaundice and its effects on serum bilirubin level and cardiac and cerebral function.Methods A total of 78 newborns with hemolytic jaundice admitted to Xianyang Hospital of Yan'an University from August 2018 to March 2023 were prospectively selected and were divided into an observation group and a control group by the random number table method,with 39 newborns in each group.In the control group,21 boys and 18 girls,with a gestational age of(39.45±1.55)weeks,received blue-purle light therapy.In the observation group,22 boys and 17 girls,with a gestational age of(39.52±1.60)weeks,received intravenous immunoglobulin(1 g/kg)combined with blue-purle light therapy.Both groups were treated for 7 days until the total bilirubin dropped to a safe level.The clinical efficacy,serum bilirubin(total bilirubin,direct bilirubin,and indirect bilirubin)levels,levels of neurological and myocardial injury markers[S100 calcium-binding protein B(S100B),neuron-specific enolase(NSE),creatine kinase(CK),and creatine kinase isoenzyme(CK-MB)],Bilirubin-Induced Neurological Dysfunction (BIND) score, and Neonatal Behavioral Neurological Assessment (NBNA) score were compared between groups. t test and χ^(2) test were used. Results After treatment, the total effective rate of the observation group was 94.87% (37/39), which was higher than that of the control group [79.48% (31/39)], with a statistically significant difference (χ^(2)=4.129, P=0.042). The levels of total bilirubin, direct bilirubin, indirect bilirubin, S100B, NSE, CK, and CK-MB in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). The BIND score in the observation group was lower than that in the control group [(0.25±0.05) points vs. (0.38± 0.09) points], but the NBNA score was higher than that in the control group [(38.78±1.53) points vs. (37.12±1.17) points], with statistically significant differences (t=8.564 and 5.845, both P<0.001). Conclusion Intravenous immunoglobulin combined with blue-purle light therapy is significantly effective in the treatment of neonatal hemolytic jaundice, capable of reducing the bilirubin level and protecting the cardiac function in infants.