新生儿黄疸经皮胆红素与血清胆红素测定标准的比较研究

Comparative Study of the Standard for Transcutaneous Bilirubin and Serum Bilirubin Determination in Neonatal Jaundice

目的:本研究旨在比较新生儿黄疸中经皮胆红素(TCB)与血清胆红素(TSB)测定的准确性和一致性,并探讨建立标准化TCB测定流程的必要性。方法:共纳入188例足月新生儿,根据TSB水平分为高危、中危和低危三组。使用Dröger JM-103经皮胆红素检测仪,在额头、胸口和肩胛骨进行TCB测定,与RocheCobasc311全自动生化分析仪测得的TSB值进行比较。采用SPSS26.0软件进行单因素ANOVA和独立样本t检验。结果:三个测定部位的TCB值与TSB值之间有一定的差异,但是差异均未达到统计学意义(P﹥0.05),表明TCB测定的结果与TSB测定具有较好的一致性。在不同危险等级组中,TCB值在中危和低危组中偏高,而在高危组中偏低,其中高危组与TSB值的差异具有统计学意义(P﹤0.05)。光疗后,高危组的TCB值显著增加(P﹤0.001)。结论:TCB测定是一种准确且一致的新生儿黄疸检测方法,尤其适用于初步黄疸筛查和监测。不同测定部位的TCB值差异不显著,建议额头作为首选测量部位。治疗措施对TCB值有影响。应建立标准化TCB测定流程,以提高新生儿黄疸管理的准确性和效率。

Objective:The aim of this study was to compare the accuracy and consistency of transcutaneous bilirubin(TCB)and serum bilirubin(TSB)determination in neonatal jaundice,and to discuss the necessity of establishing a standardized TCB determination procedure.Methods:A total of 188 full-term neonates were included and divided into high risk,medium risk and low risk groups according to TSB level.TCB measurements were performed on the forehead,chest and scapula using the Dräger JM-103 percutaneous bilirubin detector,and TSB values were compared with those obtained by the Roche Cobas c 311 automatic biochemical analyzer.The SPSS 26.0 software was used for single factor ANOVA and independent sample t test.Results:There were some differences between TCB and TSB values in the three test sites,but the differences did not reach statistical significance(P>0.05),indicating that the TCB results were in good agreement with the TSB results.In different risk groups,the TCB value was higher in the medium-risk and low-risk groups,but lower in the high-risk group,and the difference between the high-risk group and the TSB value was statistically significant(P﹤0.05).After phototherapy,the TCB value of the high-risk group was significantly increased(P﹤0.001).Conclusion:TCB assay is an accurate and consistent method for detecting neonatal jaundice,especially for preliminary screening and monitoring of jaundice.There was no significant difference in TCB values between different sites,so the forehead was recommended as the first choice.The significant increase of TCB value in high-risk group neonates after receiving phototherapy suggests that treatment measures have an impact on TCB value,so attention should be paid to it in clinical application.A standardized TCB measurement procedure should be established to improve the accuracy and efficiency of neonatal jaundice management.