新生儿黄疸中碳氧血红蛋白检测的临床应用研究

为探讨常见新生儿黄疸中碳氧血红蛋白(COHb)检测的临床价值,以德国800系列生化血气分析仪附加的240-血氧仪检测动脉化毛细血管血COHb,同步取静脉血检测血清总胆红素(STB).病例选自本院新生儿病房2001年7月～2002年6月收治的伴有常见黄疸原因的足月新生儿157例[新生儿溶血病75例、感染51例、晚发性母乳性黄疸31例].对照组101例为日龄匹配无病理性黄疸者,其中≤7天者52例,检测不同日龄的COHb,共测120例次.结果对照组中COHb生后5天内较高,峰值在1～2天,一周后接近成人正常水平.COHb与STB无相关性;溶血组COHb及STB均显著高于对照组(P＜0.001),感染、母乳性黄疸组COHb与对照组比较差异无显著性(P＞0.05).结果提示COHb可用于证实新生儿黄疸中有无胆红素产量的增多,有助于黄疸病因的诊断.     

高胆红素血症新生儿碳氧血红蛋白检测的意义

目的探讨高胆红素血症新生儿碳氧血红蛋白(COHb)检测的意义。方法用德国800系列生化血气分析仪附加的270-血氧仪测定189例高胆红素血症新生儿及142例日龄匹配无病理性黄疸(对照组)患儿动脉化毛细血管血COHb及静脉血血清总胆红素(STB)。新生儿溶血组予大剂量静脉用丙种免疫球蛋白治疗,2 d后测定COHb及STB水平。结果溶血组COHb及STB水平均显著高于对照组(P均<0.001);颅内出血组COHb明显高于对照组(P<0.05),STB水平显著高于对照组(P<0.001);感染、母乳性黄疸组STB水平均显著高于对照组(P均<0.001),而COHb水平与对照组比较差异无显著性(P>0.05)。新生儿溶血组大剂量静脉用丙种免疫球蛋白治疗后COHb及STB水平均显著降低(P均<0.001)。结论COHb测定可作为胆红素水平的指标,有助于高胆红素血症新生儿病因诊断及治疗指导。     

碳氧血红蛋白测定对新生儿黄疸诊断的价值

目的：探讨碳氧血红蛋白测定在新生儿黄疸诊断中的临床价值。方法：189例新生儿黄疸患儿(新生儿溶血病75例,感染52例,颅内出血32例,晚发母乳黄疸30例)及142例对照组患儿同步测定动脉化毛细血管血碳氧血红蛋白(COHb)和血清总胆红素(STB);溶血组予大剂量静脉免疫球蛋白治疗后测定COHb及STB,应用SAS6.12统计软件进行处理。结果：溶血组COHb及STB分别为(3.64±0.83)%,330.84±77.15μmol/L,显著高于对照组的(2.38±0.35)%和130.18±32.86μmol/L(P<0.01);颅内出血组COHb及STB分别为(2.48±0.53)%,184.15±29.35μmol/L,高于对照组的(2.24±0.32)%及112.11±17.45μmol/L(P<0.05);感染及母乳黄疸组STB分别为286.71±45.66μmol/L,299.15±44.14μmol/L,显著高于对照组146.23±31.26μmol/L及57.33±7.83μmol/L(P<0.01),而COHb为(2.36±0.50)%及(1.84±0.49)%与对照组(2.20±0.39)%及(1.67±0.43)%比较,差异无显著性(P>0.05)。溶血性高间胆组STB低于非溶血性高间胆组(P<0.01),而COHb显著高于后者(P<0.01)。溶血组大剂量静脉免疫球蛋白治疗前后COHb分别为(3.64±0.83)%及(2.68±0.51)%,STB分别为330.84±77.15μmol/L及230.18±42.96μmol/L,治疗前后比较差异有显著性(P<0.01)。结论：COHb测定可作为胆红素产量的指标,有助于新生儿黄疸病因诊断及指导治疗。     

碳氧血红蛋白对新生儿溶血病的诊断价值

目的 探讨碳氧血红蛋白(COHb)辅助诊断新生儿溶血病的价值.方法 选择2009年10月至2010年9月本科收治的足月儿,确诊新生儿溶血病者为溶血组,存在母子血型不合和病理性黄疸但未确诊溶血病者为非溶血性黄疸组,无母子血型不合及病理性黄疸者为对照组.分别于生后5天内测定COHb、血红蛋白(Hb)、网织红细胞(Ret)和总胆红素(STB),并进行比较.建立受试者工作曲线(ROC曲线),确定COHb、Hb、Ret的曲线下面积(AUC),同时分析三者不同截断值的敏感度、特异度、阳性和阴性预测值.结果 (1)溶血组COHb、Ret和STB较非溶血性黄疸组及对照组增高,Hb降低(P均＜0.001);非溶血性黄疸组STB较对照组增高(P＜0.001),但COHb、Hb和Ret差异无统计学意义(P＞0.05).(2)COHb、Hb和Ret的AUC分别为96.0%、74.9%、85.7%,三者比较差异有统计学意叉(P＜0.05).COHb预计溶血病的最佳截断值为1.2%(敏感度86.8%、特异度91.2%、阳性预测值93.0%、阴性预测值83.9%),敏感度、特异度均优于Hb和Ret.三指标联合诊断的特异度可提高到98.2%.结论 COHb是敏感的新生儿溶血病诊断指标,与Hb和Ret联合检测,对于早期筛查和辅助诊断新生儿溶血病有重要意义.     

碳氧血红蛋白对新生儿溶血病的诊断价值

目的探讨碳氧血红蛋白（COHb）辅助诊断新生儿溶血病的价值。方法 选择2009年10月至2010年9月本科收治的足月儿,确诊新生儿溶血病者为溶血组,存在母子血型不合和病理性黄疸但未确诊溶血病者为非溶血性黄疸组,无母子血型不合及病理性黄疸者为对照组。分别于生后5天内测定COHb、血红蛋白（Hb）、网织红细胞（Ret）和总胆红素（STB）,并进行比较。建立受试者工作曲线（ROC曲线）,确定COHb、Hb、Ret的曲线下面积（AUC）,同时分析三者不同截断值的敏感度、特异度、阳性和阴性预测值。结果 （1）溶血组COHb、Ret和STB较非溶血性黄疸组及对照组增高,Hb降低（P均〈0.001）;非溶血性黄疸组STB较对照组增高（P〈0.001）,但COHb、Hb和Ret差异无统计学意义（P〉0.05）。（2）COHb、Hb和Ret的AUC分别为96.0%、74.9%、85.7%,三者比较差异有统计学意义（P〈0.05）。COHb预计溶血病的最佳截断值为1.2%（敏感度86.8%、特异度91.2%、阳性预测值93.0%、阴性预测值83.9%）,敏感度、特异度均优于Hb和Ret。三指标联合诊断的特异度可提高到98.2%。结论 COHb是敏感的新生儿溶血病诊断指标,与Hb和Ret联合检测,对于早期筛查和辅助诊断新生儿溶血病有重要意义。     

新生儿高米结合胆红素血症胆汁瘀积的检测

目的了解新生儿高未结合胆红素血症中是否存在胆汁瘀积。方法用酶法比色自动分析仪检测血清总胆汁酸(TBA),用放免法测甘胆酸(CG),检测新生儿高未结合胆红素血症120例,对照组为年龄相配无黄疸的轻症肺炎患儿。结果5组不同病因的高未结合胆红素血症其血清TBA均值与对照组比较差异均无统计学意义;感染组及综合因素组的CG值与其对照组比较,差异有显著性(P＜0.01,P＜0.02),而围生缺氧组、溶血组及母乳性黄疸组的血清CG均值,差异无显著性。结论感染及综合因素引起的新生儿高未结合胆红素血症儿提示并胆汁瘀积存在,感染可能是引起胆汁瘀积的原因。     

茵栀黄佐治新生儿高胆红素血症临床观察

我们应用茵栀黄佐治新生儿高胆红素血症获得较好疗效,报告如下. 对象和方法 一、对象 我院1995年1月至1999年3月接受治疗资料较完整的新生儿高胆100例.血清胆红素峰值均在216.4μmo1/L以上,进行随机分组.治疗组58例,男31例、女27例,日龄1～27天(平均5.1天),出生体重(3 210±480)g,胎龄(38.2±5.3)周.主要病因为新生儿缺血缺氧性脑病3例,血管外溶血9例,母乳性黄胆17例,其中早发性4例,晚发性9例,感染因素12例,围产因素18例.对照组42例,男22例,女20例,日龄1～26天(平均5.3天).出生体重(2 930±270)g,胎龄(37.8±4.8)周.主要病因为:血管外溶血3例,母乳性黄胆12例,其中早发性5例,晚发性3例,感染性因素9例,围产因素10例.两组病例日龄、胎龄、出生体重、性别及病因有可比性.     

思密达治疗新生儿高胆红素血症45例

新生儿高胆红素血症是新生儿常见疾病 ,在医院设备所限无法用光疗的情况下 ,给予茵栀黄退黄及保肝等综合治疗 ,但疗效不十分满意。思密达用于治疗新生儿母乳性黄疸文献中已有报道[1] 。我们用思密达口服辅助治疗新生儿高胆红素血症 ,疗效满意 ,现报告如下。资料与方法一、对象　 1999年 3月～ 2 0 0 2年 12月我院收治的 4 5例新生儿高胆红素血症 ,日龄均 <2 8d ,均符合病理性黄疸诊断标准[2 ] 。总胆红素 <342 .0 μmol/L(2 0mg/dl) ,未成熟儿总胆红素 <2 5 6 .5 μmol/L(15mg/dl)。感染性黄疸 14例 ,头颅血肿 8例 ,母乳性黄疸 13例 ,溶血…     

茵栀黄佐治新生儿高胆红素血症临床观察

我们应用茵栀黄佐治新生儿高胆红素血症获得较好疗效 ,报告如下。对象和方法一、对象我院 1 995年 1月至 1 999年 3月接受治疗资料较完整的新生儿高胆 1 0 0例。血清胆红素峰值均在 2 1 6 4μｍｏｌ Ｌ以上 ,进行随机分组。治疗组 5 8例 ,男 31例、女 2 7例 ,日龄 1～2 7天 (平均 5 1天 ) ,出生体重 ( 32 1 0±480 )ｇ,胎龄 ( 38 2± 5 3)周。主要病因为新生儿缺血缺氧性脑病 3例 ,血管外溶血 9例 ,母乳性黄胆 1 7例 ,其中早发性 4例 ,晚发性 9例 ,感染因素 1 2例 ,围产因素 1 8例。对照组42例 ,男 2 2例 ,女 2 0例 ,日龄 1～ 2 6天 (平…     

新生儿口服高丽参的毒副作用

目的探讨新生儿口服高丽参后的毒副作用。方法选择口服高丽参的新生儿67例,分为无黄疸组和并母乳性黄疸组。观察其临床表现,检查血、尿常规、血生化、凝血系统及脑CT等。选取同期未服高丽参母乳性黄疸新生儿43例作为对照。结果新生儿口服高丽参主要表现为胃肠功能障碍腹胀、呕吐、呕血或(和)便血、精神疲乏或爱哭闹,并母乳性黄疸组血液直接胆红素、间接胆红素增高,但与对照组比较无显著差异(P>0.05)。血小板数升高50例(占74.6%)。死亡1例,表现为中毒性脑病、中枢性呼吸衰竭、药物性肝损害、代谢性酸中毒。结论新生儿口服高丽参后毒副作用较明显,严重中毒可死亡。新生儿应慎用高丽参,以免产生不良反应。     

Breast milk beta-glucuronidase and exaggerated jaundice in the early neonatal period.

Breast-feeding is associated with jaundice in the early neonatal period. Previous work has shown levels of the enzyme beta-glucuronidase in maternal breast milk to be related to infant serum bilirubin on postnatal day 21. Our aim was to establish if there was a correlation between the level of breast milk beta-glucuronidase and the degree of early (first week) neonatal hyperbilirubinaemia. A study of 55 mother and baby pairs showed that breast milk beta-glucuronidase levels had no relationship with the level of infant serum bilirubin between postnatal days 3 and 6. Breast milk beta-glucuronidase does not directly account for the early neonatal jaundice seen in breast-fed babies.     

Neonatal Jaundice and Fatty Acid Composition of the Maternal Diet

ABSTRACT. The role of serum fatty acid composition in neonatal jaundice was studied by comparing the incidence of jaundice among 332 newborn infants receiving breast milk from mothers on a diet with either a low (0.1, n =145) or a high (1.5, n =187) polyunsaturated to saturated fatty acid (P/S) ratio. The diet was started immediately after delivery. The composition of fatty acids in the breast milk and sera of the mothers and in the sera of the newborns was evaluated from a random sample of 15 mother-newborn pairs on the control diet (low P/S ratio) and 19 pairs on the experimental diet. Five days after delivery the relative amounts of fatty acids, especially that of linoleate, in the sera of the mothers differed significantly depending on the diet. Differences were also observed in breast milk samples taken three, four or five days after delivery and in the sera of the newborns sampled at the age of four or five days. Nine of the 145 newborn infants (6.2 %) in the control group had to be treated with light therapy compared with 12 out of 187 (6.4 %) of the newborn infants in the experimental group (high P/S ratio). Serum bilirubin concentrations were 142.5 μmol/l (SD 65.8) and 140.7 μmol/l (SD 73.5) in the experimental and control groups, respectively, at the age of five days. It appears that the changes in the composition of serum fatty acids reached in this study had no effect on the neonatal jaundice.     

Neonatal jaundice and fatty acid composition of the maternal diet

The role of serum fatty acid composition in neonatal jaundice was studied by comparing the incidence of jaundice among 332 newborn infants receiving breast milk from mothers on a diet with either a low (0.1, n = 145) or a high (1.5, n = 187) polyunsaturated to saturated fatty acid (P/S) ratio. The diet was started immediately after delivery. The composition of fatty acids in the breast milk and sera of the mothers and in the sera of the newborns was evaluated from a random sample of 15 mother-newborn pairs on the control diet (low P/S ratio) and 19 pairs on the experimental diet. Five days after delivery the relative amounts of fatty acids, especially that of linoleate, in the sera of the mothers differed significantly depending on the diet. Differences were also observed in breast milk samples taken three, four or five days after delivery and in the sera of the newborns sampled at the age of four or five days. Nine of the 145 newborn infants (6.2%) in the control group had to be treated with light therapy compared with 12 out of 187 (6.4%) of the newborn infants in the experimental group (high P/S ratio). Serum bilirubin concentrations were 142.5 mumol/l (SD 65.8) and 140.7 mumol/l (SD 73.5) in the experimental and control groups, respectively, at the age of five days. It appears that the changes in the composition of serum fatty acids reached in this study had no effect on the neonatal jaundice.     

人乳脂肪酸组分与新生儿母乳性黄疸的相关性分析

目的 探讨人乳中不同脂肪酸组分与新生儿母乳性黄疸（BMJ）的相关性。方法 选取2016年10月至2017年10月入住该院新生儿重症监护室,临床诊断为晚发性母乳性黄疸的足月儿作为BMJ组,同期入住月子会所的无黄疸或无病理性黄疸健康新生儿为对照组,每组30例。分别收集两组新生儿的临床资料（包括性别、出生方式、喂养方式、胎龄、出生体重、胎次、产次及总胆红素峰值）及其母亲乳汁,使用MIRIS母乳分析仪检测人乳脂肪、蛋白质、碳水化合物等宏量营养素含量和热卡,采用气相色谱法分析母乳中不同脂肪酸组分含量。结果 对照组人乳各种宏量营养素组分均高于BMJ组,其中脂肪、干物质和热卡差异有统计学意义（P<0.05）。另测得母乳脂肪酸共25种,其中饱和脂肪酸9种,单不饱和脂肪酸6种,多不饱和脂肪酸10种。比较两组不同脂肪酸百分含量发现,BMJ组人乳中C15：0、C16：0、C17：0、C18：0、C20：0、C18：1n9t、C20：1n9、C18：3n6、C22：2、C22：6n3（DHA）等10种长链脂肪酸百分含量均低于对照组,3种脂肪酸C10：0、C12：0、C14：0百分含量均高于对照组（P<0.05）。结论 部分人乳宏量营养素及脂肪酸组分可能与新生儿母乳性黄疸发生机制有关。     

In the eye of the beholder: how accurate is clinical estimation of jaundice in newborns?

AIM: Hour-specific serum total bilirubin (STB) percentiles have proved useful in predicting which babies will develop significant neonatal hyperbilirubinemia (NHB) requiring intervention. This study investigated whether this assessment could be performed visually instead of by blood test. The aim was to evaluate the ability of experienced clinicians to determine accurately the level of clinical jaundice in neonates by visual means. METHODS: Four neonatologists were asked to estimate the level of bilirubin in a group of 283 term clinically jaundiced infants before discharge from the nursery on day 3 of life. Their clinical estimation was compared with actual measurement of STB from samples drawn simultaneously. RESULTS: Clinical estimation of STB had a high correlation to actual serum bilirubin levels (Pearson's correlation coefficient = 0.682, p < 0.001). CONCLUSION: Clinical impression of jaundice by the eye of an experienced clinician is a reliable method to assess newborns for significant NHB and may diminish the need for universal serum sampling.     

Transcutaneous bilirubinometry: a noninvasive tool for studying newborn jaundiced rats before and after exposure to light

The homozygous Gunn rat is the most frequently used animal model for the study of neonatal jaundice. We evaluated the applicability of noninvasive transcutaneous bilirubin (TcB) measurements as an index of serum total bilirubin (STB) levels in neonatal rats by comparison to invasive STB measurements. TcB measurements were made during the first 96 h of life with the Model 101 Minolta/Air-Shields Jaundice Meter (JM) and SpectRx BiliCheck System (BC). Measurements with both devices displayed parallel TcB profiles, rapidly rising within 24 h, increasing during the next 6 h, then leveling off after 30 h. Linear regressions for the JM (n = 60) were as follows: STB (mg/dL) = 0.79 (JM) - 0.01 (units, r = 0.95, head); STB (mg/dL) = 0.82 (JM) + 1.51 (units, r = 0.95, upper back); and STB (mg/dL) = 0.74 (JM) + 1.60 (units, r = 0.91, lower back). Mean bias +/- imprecision were as follows: -0.02 +/- 3.99 mg/dL, -0.01 +/- 3.90, and 0.01 +/- 4.28 at the head, upper back, and lower back, respectively. For the BC, only lower back measurements were taken, and the regression was as follows: STB (mg/dL) = 0.77 (BC) + 1.65 mg/dL, (r = 0.93, n = 29) with a mean bias +/- imprecision of -1.08 +/- 3.08 mg/dL. When pups were exposed to light, correlations remained strong but intercepts increased. These results demonstrate that noninvasive TcB measurements correlate highly with STB in the Gunn rat during the first 96 h of life and after exposure to light. We conclude that JM measurements at the head and BC at the lower back reflect STB most reliably and consistently. Thus, in addition to being a useful tool for evaluating jaundice in human neonates, TcB methodology can be used successfully for the noninvasive monitoring of jaundice in neonatal Gunn rats pre- and postlight exposure.     

人乳脂肪酸组分与新生儿母乳性黄疸的相关性分析

目的 探讨人乳中不同脂肪酸组分与新生儿母乳性黄疸（BMJ）的相关性。方法 选取2016年10月至2017年10月入住该院新生儿重症监护室，临床诊断为晚发性母乳性黄疸的足月儿作为BMJ组，同期入住月子会所的无黄疸或无病理性黄疸健康新生儿为对照组，每组30例。分别收集两组新生儿的临床资料（包括性别、出生方式、喂养方式、胎龄、出生体重、胎次、产次及总胆红素峰值）及其母亲乳汁，使用MIRIS母乳分析仪检测人乳脂肪、蛋白质、碳水化合物等宏量营养素含量和热卡，采用气相色谱法分析母乳中不同脂肪酸组分含量。结果 对照组人乳各种宏量营养素组分均高于BMJ组，其中脂肪、干物质和热卡差异有统计学意义（P<0.05）。另测得母乳脂肪酸共25种，其中饱和脂肪酸9种，单不饱和脂肪酸6种，多不饱和脂肪酸10种。比较两组不同脂肪酸百分含量发现，BMJ组人乳中C15：0、C16：0、C17：0、C18：0、C20：0、C18：1n9t、C20：1n9、C18：3n6、C22：2、C22：6n3（DHA）等10种长链脂肪酸百分含量均低于对照组，3种脂肪酸C10：0、C12：0、C14：0百分含量均高于对照组（P<0.05）。结论 部分人乳宏量营养素及脂肪酸组分可能与新生儿母乳性黄疸发生机制有关。     

新生猪溶血性黄疸模型的制备与验证

目的 建立新生猪溶血性黄疸动物模型,以进一步研究新生儿溶血性黄疸的病理生理。方法 7日龄纯种大约克白猪分成实验组和对照组,每组各6只。并采用免疫新西兰大白兔的方法 制备兔抗猪红细胞抗体,分离兔抗猪红细胞血清。实验组静脉注射兔抗猪红细胞血清5mL,对照组注射5mL生理盐水。两组均每6h采血送检血常规及肝功能。结果 实验组注射兔抗猪红细胞血清18h后血清胆红素水平高于对照组(64±30μmol/Lvs20±4μmol/L,PP12/L,低于对照组[(5.09±0.44)×1012/L](P12/L]和HB(87±3g)进一步降低,低于对照组[(5.11±0.39)×1012/L,97±6g](P结论 新生猪溶血性黄疸模型较好地模拟了人类溶血性黄疸的病理过程,为更进一步研究新生儿溶血病提供了良好的生物物质基础。