新生儿缺氧缺血性脑病胆红素水平的变化

目的探讨新生儿缺氧缺血性脑病胆红素的变化以及经皮测胆的准确性.方法用抽血以及经皮测胆两种方法对59例确诊为缺氧缺血性脑病的新生儿于出生第2天及第5天进行胆红素测定,并将两种方法测定结果进行比较.结果出生第2天各组间胆红素值无显著性差异,出生第5天胆红素值随着缺氧缺血性脑病程度加重明显降低,且有显著性差异(P＜0.05).经皮测胆红素值轻度175.78±45.39;中度137.02±46.24;重度95.58±42.62.抽血测胆以及经皮测胆两种方法测得结果进行比较无显著性差异(P＞0.05).结论在出生第5天中重度缺氧缺血性脑病患儿胆红素值明显低于轻度组,各组间比较有显著性差异.经皮测胆是一种准确经济的测定胆红素方法.     

新生儿缺氧缺血性脑病血清胆红素变化及其与肌酸激酶同功酶的关系

目的探讨新生儿缺氧缺血性脑病(HIE)血清总胆红素(TBil)、肌酸激酶同工酶(CK-MB)的变化及其临床意义。方法对49例(轻度组15例,中度组20例,重度组14例)HIE患儿和31例正常足月新生儿(对照组)于生后24 h及生后d4,分别测其血清TBil及CK-MB值,并进行比较。结果HIE患儿生后24 h血清胆红素水平较对照组升高,且病情越重升高越明显(P<0.01),与CK-MB呈显著正相关(r=0.48 P<0.01)。生后d4血清胆红素水平较对照组明显降低,且病情越重降低越明显(P<0.01),与CK-MB呈显著负相关(r=-0.72 P<0.01)。结论HIE患儿血清胆红索作为抗氧化剂被大量消耗,与CK-MB、病情程度有关。可作为判断病情轻重的指标之一。     

部分胃肠外营养在早产儿的临床应用

目的探讨早产儿胃肠外营养对血浆渗透压、血糖、生化及胆红素代谢、免疫功能、生长发育的影响。方法早产儿70例随机分为对照组和治疗组,在胃肠道喂养的基础上治疗组予静脉营养,对照组静滴10%葡萄糖、生理盐水和电解质;对两组进行有关指标监测。结果1.应用静脉营养后早产儿血浆渗透压、血糖、生化与输注前无显著性差异;2.两组黄疸出现时间、持续天数无显著性差异;3.治疗组血浆IgGI、gAI、gM、C3、CD4及CD4/CD8均高于对照组;4.治疗组出生体质量恢复时间、住院天数和体质量增长均优于对照组。结论胃肠外营养对血浆渗透压、生化、血糖及胆红素代谢无影响,胃肠外营养能促进早产儿体质量增长,缩短住院天数和能促进免疫功能。     

胆红素与血清CK-MB关系的临床观察及分析

目的 检测新生儿病理性黄疸时血清中肌酸激酶同工酶（CK—MB）的改变。方法 对病理性黄疸新生儿30例、生理性黄疸新生儿15例、正常新生儿10例于入院第2天测血胆红素浓度及CK—MB值。结果 生理性黄疸组和病理性黄疸组CK—MB值均增高，病理性黄疸组增高尤为明显，差异具有显著性。结论 高胆红素血症时存在胆红素对心肌的损伤，CK—MB可作为胆红素对心肌损伤的一个重要生化指标。     

Bilirubin induces apoptosis via activation of NMDA receptors in developing rat brain neurons

Increased amounts of bilirubin, the end product of heme degradation, are known to be detrimental to the central nervous system, especially in preterm newborns. In an attempt to delineate the cellular mechanisms by which unconjugated bilirubin exerts its toxic effects on neuronal cells in the developing brain, bilirubin (0.25-5 microM) was added to the extracellular medium of 6-day-old primary cultured neurons from the embryonic rat forebrain, and cell alterations were studied over the ensuing 96 h. Bilirubin decreased cell viability dose dependently with an ED(50) around 1 microM. At the dose of 0.5 microM, it triggered delayed cell death that affected 24% of the neurons. Nuclear incorporation of the fluorescent dye DAPI (4,6-diamidino-2-phenylindole) depicted the presence of apoptosis (16%). Apoptosis features were confirmed by DNA fragmentation reflected by a progressive loss of [(3)H]thymidine and sequential changes in macromolecular synthesis, as shown by the time course of [(3)H]leucine incorporation, as well as by the beneficial effects of cycloheximide and caspase inhibitors. In parallel, treatments with glutamate receptor antagonists showed that MK-801, but not NBQX, protected neurons against bilirubin neurotoxicity, suggesting a role for NMDA receptors in bilirubin effects. Coupled with previous work about glutamate toxicity in the same culture model, these data support the hypothesis that low levels of free bilirubin may promote programmed neuronal death corresponding to an apoptotic process which involves caspase activation and requires the participation of NMDA receptors, along with bilirubin-induced inhibition of protein kinase C activity.     

胆红素对烟雾损伤大鼠肺泡巨噬细胞的保护作用

目的:探讨胆红素对烟雾损伤所致肺泡巨噬细胞(AM)的保护作用,寻求防治肺气肿发生、发展的新途径。方法:将健康Wistar大鼠36只,随机分为正常对照组、肺气肿模型组和胆红素干预组。模型组及干预组采用自制大鼠实验性被动吸烟装置熏烟,连续6个月。干预组在熏烟前予以间接胆红素灌胃;模型组和对照组予以生理盐水灌胃。3组动物自由饮食饮水,6个月后处死动物,取材检测;病理形态学检查;采用支气管肺泡灌洗技术收集AM并纯化培养。观察细胞培养液上清中MDA与MO含量。结果:光镜下对照组大鼠肺组织肺泡分布较均匀;模型组大鼠肺组织肺泡普遍扩张,扩张的肺泡融合成较大的囊腔;胆红素干预组肺组织肺泡部分有扩张;模型组与对照比较MDA、MO含量升高(P<0.05);干预组与模型组比较MDA、NO含量降低(P<0.05)。结论:胆红素对于AM有一定的保护作用。     

高血压患者血清胆红素水平与脂蛋白（a）浓度的临床分析

目的研究高血压患者血清胆红素和脂蛋白（a）[Lp（a）]间的关系,探讨它们在高血压发病机理中的作用。方法78例高血压患者与70例健康对照者,抽空腹静脉血测血脂、血清胆红素。结果和健康对照组比较,高血压患者胆红素水平显著降低（P〈0.05）,脂蛋白（a）明显高于对照组（P〈0.05）,并且合并冠心病、脑梗死的高血压患者上述指标差异更为显著（P〈0.01）。进行相关分析得到胆红素与LDL和脂蛋白（a）呈负相关（P〈0.01）。结论血清胆红素水平与血压之间存在一定相关性,且高血压发病机制可能是通过LDL、Lp（a）而实现的。     

高胆红素血症新生儿光疗中不同部位经皮胆红素测定水平的比较研究

目的比较研究高胆红素血症新生儿光疗中不同部位经皮胆红素的测定水平。方法对100例高胆红素血症接受光疗的新生儿,在每次光疗前、光疗结束时、光疗结束后12 h测定其常规部位（前额正中）和遮盖部位（前额眉心）的经皮胆红素水平,并比较两部位不同时间点胆红素水平的变化。结果光疗前和光疗后12 h常规部位和遮盖部位经皮胆红素水平无显著性差异（P〉0.05）,而光疗结束时遮盖部位的经皮胆红素水平显著高于常规部位（P〈0.05）。结论采用经皮胆红素检测高胆红素血症患儿的光疗效果时,应同时检测暴露部位和遮盖部位的胆红素值加以综合分析。     

血清胆红素和血脂的综合指数对冠心病的预测价值

目的探讨血清胆红素和血脂的综合指数与冠心病的关系。方法应用冠脉造影技术将120例患者分2组：冠心病组与对照组。测定血清总胆红素（TBIL）、高密度脂蛋白胆固醇（HDLC）、低密度脂蛋白胆固醇（LDLC）、总胆固醇（TC）等指标，并计算出其综合指数：TC／（HDLC＋TBIL）和LDLC／（HDLC＋TBIL），探讨其与冠心病的关系。结果冠心病组血清TBIL及HDLC水平均明显低于对照组（均P〈0．01），TC／（HDLC＋TBIL）和LDLC／（HDLC＋TBIL）水平高于对照组（均P〈0．01）。经多变量的losistic回归分析，LDLC／（HDLC＋TBIL）比值作为冠心病独立的危险因素优于其他传统的单一指标。ROC曲线显示，LDLC／（HDLC＋TBIL）比值曲线下面积最大。结论低血清胆红素水平是冠心病的独立危险因素，血清胆红素和血脂的综合指数是冠心病一个较好的辅助预测指标。     

EFFECT OF LIGHT EXPOSURE ON GUT TRANSIT TIME IN JAUNDICED NEWBORNS

In order to elucidate the mechanism by which phototherapy induces loose stools in newborns, studies were performed on the speed of gut transit by performing the Carmine Red test on normal newborn, on jaundiced newborns before and after phototherapy. A statistically accelerated intestinal transit was observed in jaundiced newborns treated with phototherapy. The increased rate of intestinal transit produced by phototherapy is probably due to the action of the photo-decomposition derivatives of bilirubin, which are excreted during phototherapy.