新生儿溶血病患儿碳氧血红蛋白检测的临床应用研究

Clinical evaluation of measuring the carboxyhemoglobin in hemolytic disease of the newborn

目的 探讨新生儿溶血病中碳氧血红蛋白 (COHb)检测的临床意义。方法 以德国产80 0系列生化血气分析仪附加的 2 70 血氧仪检测动脉化毛细血管血COHb ,以COHb占总血红蛋白的百分比 ( % )表示。同步取静脉血检测血清总胆红素 (STB)。病例选自新生儿病房收治的母子血型不合溶血病 (溶血组 ) 75例 (其中ABO溶血病 71例 ,Rh溶血病 4例 )。对照组 4 0例为日龄匹配无病理性黄疸者。 结果 ( 1)溶血组与对照组比较 ,COHb :[3 7± 0 8与 2 4± 0 4 ) % (t =9 3,P <0 0 0 1) ];STB :[( 333 8± 130 6与 130 6± 76 2 ) μmol/L(t =10 0 ,P <0 0 0 1) ],差异均有非常显著性。 ( 2 )ABO溶血病 :生后 1～ 2dCOHb达 ( 3 5± 0 5 ) % ,已明显增高 ;STB并不高 ,为 ( 184± 4 5 8)μmol/L ,两者无相关性 (r =- 0 1,P =0 7) ;但随黄疸加重STB≥ 2 5 7μmol/L时两者呈正相关 (r =0 5 ,P <0 0 0 1) ;胆红素脑病者COHb均 >3 7%。 ( 3) 6 1例直接Coombs试验 ( + )及 10例 ( - )两组的COHb均增高 ,差异无显著性 [( 3 7± 0 9与 3 6± 0 6 ) % (t =0 5 ,P =0 6 ) ]。 ( 4 ) 31例静脉注射大剂量免疫球蛋白 (IVIG) 1g/ (kg·d) ,仅用 1d ;2 5例予小剂量IVIG 4 0 0mg/ (kg·d) ,连用 3d 。

Objective To evaluate the clinical significance of the level of carboxyhemoglobin (COHb) in hemolytic disease of the newborn. Methods Capillary blood COHb were detected by 270 CO oximeter in 75 term birth infants of hemolytic disease of the newborn. Serum total bilirubin (STB) was measured at the same time. Forty cases without pathological jaundice in the same age were selected as control group. Results (1) Compared with the control group, both COHb [(3 7±0 8 vs 2 4±0 4)%] and STB [(333 8±130 6 vs 130 6±76 2) μmol/L] were much higher in hemolytic disease of the newborn ( P<0.001 ). (2) In ABO hemolytic disease, the levels of COHb (3 5±0 5)% showed obviously higher in the first 1～2 days of age, while the levels of STB (184 5±45 8) μmol/L did not increase coordinately. Only when STB was more than 257 μmol/L, the COHb had Positive correlation with STB ( r=0.5,P<0.001 ); It was found in all cases of bilirubin encephalopathy that COHb was more than 3 7%. (3) COHb showed no statistical difference between direct Coombs test (+) and (-) groups of ABO hemolytic disease [(3 7±0 9 vs 3 6±0 6)%( t=0 5,P =0 6)].(4)IVIG were used in different doses for ABO hemolytic disease; 1 g/(kg·d)×1 d vs 400 mg/(kg·d)×3 d, the former dose was more effective in decreasing COHb than the latter dose ( P=0.001 ). Conclusion The high levels of COHb indicate an increased production of bilirubin in neonatal jaundice, especially in hemolytic diseases of the newborn; it can be used to assist the diagnosis of ABO hemolytic disease when the direct Coombs test is negative; the increasing of COHb is more sensitive than that of STB in the early stage of ABO hemolytic disease; if COHb >3.7%,bilirubin encephalopathy should be pard more attention to happen; the high dose of IVIG can decrease COHb and STB more effectively.