血清总胆汁酸在新生儿黄疸中的临床应用

目的 本文探讨新生儿高胆红素血症时,测定其总胆汁酸(TBA)变化,了解其在新生儿黄疸诊断治疗中的意义.方法 采用全自动生化分析仪循环酶法检测87例黄疸患儿血清TBA水平.同时对其总胆红素和相关酶类进行测定.并与40例同期住院的不伴有高胆红素足月新生儿比较.结果 新生儿高胆红素血症患儿TBA明显高于对照组(P＜0.01)而相关酶类改变不明显(P＞0.05).结论 TBA测定发现当常规肝功能指标改变不明显时,血清TBA检测是一项新生儿黄疸患儿较为灵敏的肝实质损伤的指标;新生儿高胆红素患儿TBA升高,可能存在胆汁淤积,应给予适当的利胆治疗.     

血清总胆汁酸测定在新生儿黄疸中的应用

目的　探讨血清总胆汁酸 (TBA)测定对新生儿黄疸患儿肝功能损伤的诊断意义。方法　采用循环酶速率法检测 198例各类黄疸患儿血清TBA水平。结果　生理性黄疸患儿的TBA与对照组差异无显著性 ,而病理性黄疸患儿的TBA水平明显高于对照组 ,其中细菌感染组和病毒感染组的TBA有很高的异常率 ,分别为 87.5 %和 90 .4 %。结论　当常规肝功能指标改变不明显时 ,血清TBA检测是一项新生儿病理性黄疸患儿较为灵敏的肝实质损伤的指标 ;新生儿病理性黄疸患儿随其TBA的变化 ,有可能存在不同程度的胆汁淤积     

血清总胆汁酸测定在新生儿黄疸中的应用

目的探讨血清总胆汁酸(TBA)测定对新生儿黄疸患儿肝功能损伤的诊断意义.方法采用循环酶速率法检测198例各类黄疸患儿血清TBA水平.结果生理性黄疸患儿的TBA与对照组差异无显著性,而病理性黄疸患儿的TBA水平明显高于对照组,其中细菌感染组和病毒感染组的TBA有很高的异常率,分别为87.5%和90.4%.结论当常规肝功能指标改变不明显时,血清TBA检测是一项新生儿病理性黄疸患儿较为灵敏的肝实质损伤的指标;新生儿病理性黄疸患儿随其TBA的变化,有可能存在不同程度的胆汁淤积.     

血清总胆汁酸测定在新生儿溶血病中的应用

目的通过检测血清总胆汁酸(TBA)水平,探讨该指标在新生儿溶血病诊治中的变化及意义。方法采用循环酶速率法测定87例新生儿溶血病患儿TBA,以及对其他常规肝功能进行测定。同时对其中32例患儿的TBA和胆红素以出生日龄分为3组(Ⅰ组0～3d;Ⅱ组4～8d;Ⅲ组9～18d.)进行动态分析。结果①新生儿溶血病患儿组的TBA明显高于生理性黄疸对照组(P<0.01),TBA测定异常率为67.8%,ALT、AST仅分别为17.2%和39.1%。②Ⅰ组的TBA与Ⅱ、Ⅲ组比较差异均有显著性意义(P<0.01),而Ⅱ组与Ⅲ组比较无统计学意义(P>0.05)。结论新生儿溶血病时,TBA水平是一项反映肝功能损伤及胆汁淤积较为敏感的指标,TBA并不随血胆红素的下降而减低。     

血清总胆汁酸测定在新生儿溶血病中的应用

目的通过检测血清总胆汁酸(TBA)水平,探讨该指标在新生儿溶血病诊治中的变化及意义.方法采用循环酶速率法测定87例新生儿溶血病患儿TBA,以及对其他常规肝功能进行测定.同时对其中32例患儿的TBA和胆红素以出生日龄分为3组(Ⅰ组0～3d;Ⅱ组4～8d;Ⅲ组9～18d.)进行动态分析.结果①新生儿溶血病患儿组的TBA明显高于生理性黄疸对照组(P＜0.01),TBA测定异常率为67.8%,ALT、AST仅分别为17.2%和39.1%.②Ⅰ组的TBA与Ⅱ、Ⅲ组比较差异均有显著性意义(P＜0.01),而Ⅱ组与Ⅲ组比较无统计学意义(P＞0.05).结论新生儿溶血病时,TBA水平是一项反映肝功能损伤及胆汁淤积较为敏感的指标,TBA并不随血胆红素的下降而减低.     

妊娠期肝内胆汁淤积症产妇与新生儿高胆红素血症的关系

目的 探讨妊娠期肝内胆汁淤积症(ICP)产妇总胆汁酸(TBA)、总胆红素(TBIL)、直接胆红素(DBIL)水平与新生儿高胆红素血症的关系。方法 选取2020年3月至2021年10月在本院就诊的100例ICP产妇为研究对象,进行回顾性分析,根据ICP孕妇分娩后新生儿是否发生高胆红素血症分为高胆红素血症组(n=45)及无高胆红素血症组(n=55)。两组产妇均行肝功能指标检测,比较两组一般资料及血清TBA、DBIL及TBIL水平;ICP产妇分娩后新生儿发生高胆红素血症的危险因素采取多因素Logistic回归性分析明确;分析ICP产妇TBA、TBIL、DBIL水平与新生儿高胆红素血症的相关性。结果 新生儿高胆红素血症组剖宫产占比及产妇TBA、TBIL、DBIL水平显著高于无高胆红素血症组(P<0.05);经Logistic分析,剖宫产、产妇TBA≥14.54μmol/L、TBIL≥18.63μmol/L、DBIL≥12.70μmol/L是ICP产妇分娩后新生儿发生高胆红素血症的危险因素(P<0.05);经相关性分析,新生儿高胆红素血症发生与ICP产妇TBA、TBIL、DBIL水平...     

新生儿高胆红素血症患儿胆汁淤积状况分析

目的探讨新生儿高胆红素血症时患儿胆汁酸的变化及胆汁淤积的情况及其临床意义。方法用酶法比色自动分析仪测定120例高胆红素患儿血清总胆汁酸(TBA)的水平,并与40例年龄相匹配的同期住院的不伴有高胆红素血症的足月新生儿比较;测定高胆红素患儿黄疸消退前后TBA的变化。结果新生儿高胆红素血症患儿TBA水平较不伴有高胆红素血症的足月新生儿高,有非常显著性差异(P0.01);黄疸治疗消退后TBA较治疗前增高,与总胆红素水平呈负相关。结论新生儿高胆红素血症患儿存在胆汁淤积;诊断胆汁淤积,血TBA较胆红素更准确;提示新生儿高胆红素血症患儿应给予适当的利胆治疗。     

新生儿高胆红素血症患者总胆汁酸测定及临床意义

血清总胆汁酸（TBA）是胆固醇在肝脏分解以及肠肝中的一组代谢产物，其生成和代谢与肝脏有十分密切系。血清中胆汁酸的水平是反映肝实质性损伤的重要指标时对检测胆汁瘀积症也具有很高的灵敏度和特异性犤１犦。儿高胆红素血症临床发病率较高，主要是由于感染、缺氧乳及肝细胞对胆红素排泄功能障碍等多种因素引起。为解新生儿高胆红素血症时血清TBA浓度的变化，更好了胆红素血症时新生儿肝功能状态，对我院２００１年５月～年５月收治的６０例高胆红素血症患儿进行空腹血清TB测定，现将结果报告如下。１对象与方法１．１对象高胆红素血症…     

新生儿病理性黄疸肝功能的检测分析

目的分析新生儿病理性黄疸的肝功能指标变化,探讨胆红素沉积对肝功能的影响。方法采用重氮法检测185例病理性黄疸患儿血清总胆红素(TBIL)、直接胆红素(DBIL)的含量;速率法分析患儿丙氨酸转移酶(ALT)、天门冬氨酸转移酶(AST)的活性;免疫金标法测试患儿的乙型肝炎病毒表面抗原(HB-sAg)。结果病理性黄疸组患儿血清的TBIL、DBIL、ALT、AST均比对照组明显升高(P<0.001,P<0.05,P<0.01,P<0.01)。不同日龄患儿的肝功能指标存在着一定程度的差异。生理性和病理性黄疸两组患儿的HBsAg均为阴性。结论检测新生儿黄疸的肝功能指标,对于及时诊断新生儿高胆红素血症,降低新生儿胆红素脑病的发病率、致残率,具有重要意义。     

新生儿高胆红素血症患儿胆汁淤积状况分析

目的探讨新生儿高胆红素血症时患儿胆汁酸的变化及胆汁淤积的情况及其临床意义。方法用酶法比色自动分析仪测定120例高胆红素患儿血清总胆汁酸（TBA）的水平,并与40例年龄相匹配的同期住院的不伴有高胆红素血症的足月新生儿比较;测定高胆红素患儿黄疸消退前后TBA的变化。结果新生儿高胆红素血症患儿TBA水平较不伴有高胆红素血症的足月新生儿高,有非常显著性差异（P〈0.01）;黄疸治疗消退后TBA较治疗前增高,与总胆红素水平呈负相关。结论新生儿高胆红素血症患儿存在胆汁淤积;诊断胆汁淤积,血TBA较胆红素更准确;提示新生儿高胆红素血症患儿应给予适当的利胆治疗。     

The influence of hemolysis, turbidity and icterus on the measurements of CK-MB, troponin I and myoglobin.

To decide on the acceptability of a specimen for the measurement of serum CK-MB, troponin I and myoglobin, we investigated the influence of hemolysis, turbidity, and icterus on those tests by adding arbitrarily made interferents. A total of 16 cases each for CK-MB and troponin I, and 18 cases for myoglobin tests were studied to verify the effects of hemolysis, turbidity, and unconjugated hyperbilirubinemia. A total of 16 cases were studied to clarify the effects of the conjugated hyperbilirubinemia. We graded the severity of hemolysis, turbidity, and icterus as mild, moderate, and severe after adding hemolysate, Intralipos (20% soybean oil), and unconjugated or conjugated bilirubin to sera. ACS180SE automated chemiluminescence system was used to measure CK-MB, troponin I, and myoglobin. CK-MB and troponin I were affected by any degree of hemolysis, turbidity, unconjugated hyperbilirubinemia, and conjugated hyperbilirubinemia, while myoglobin was affected only by severe unconjugated hyperbilirubinemia and conjugated hyperbilirubinemia in the samples with concentration higher than reference range, resulting in concentration level lower than baseline. In conclusion, the results of cardiac markers should be carefully interpreted when the specimens are hemolyzed, turbid or icteric.     

Measurement of bilirubin-protein conjugates in serum and application to human and rat sera

Evidence suggests that the esterified bilirubins in serum of patients with conjugated hyperbilirubinemia can react with serum protein, predominantly albumin, producing bilirubin-protein conjugates. To specifically measure this pigment fraction, we now have developed an assay that requires neither sample preincubation nor special equipment and is based on (1) selective removal of the bilirubins that are reversibly bound to serum protein by using organic solvent extraction, and (2) subsequent measurement of the bilirubin-protein conjugates in the denatured protein pellet by a diazo method. The accuracy of the bilirubin-protein conjugate assay was verified by determining the individual recoveries of the various pigment fractions known to occur in patient serum samples. Near-complete removal (approximately 97%) of unconjugated bilirubin and its various monoesterified and diesterified bilirubins from the serum proteins was demonstrated, with quantitative recovery of total serum protein (greater than 99%) and of bilirubin-protein conjugates (greater than or equal to 95%; tested with purified bilirubin-albumin conjugate). The assay has a demonstrated linearity for bilirubin-protein conjugate concentrations between 3 mumol/L and 170 mumol/L, is precise (total and within-day coefficient of variation, assessed over a 12-month period, less than or equal to 5%), and is essentially free of interference by hemoglobin (for hemoglobin concentrations up to 5.0 gm/L). A fair linear correlation (r = 0.975) was found between the bilirubin-protein conjugate assay results and the values for diazo-positive pigment in serum that is not accounted for by unconjugated bilirubin and its esters. Bilirubin-protein conjugates were found only in sera of patients and rats with conjugated hyperbilirubinemia, not in those with unconjugated hyperbilirubinemia.     

Jaundice in the adult patient

Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders. Organizing the differential diagnosis by prehepatic, intrahepatic, and posthepatic causes may help make the work-up more manageable. Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin. Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. The conjugated (direct) bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders. Posthepatic disorders also can cause conjugated hyperbilirubinemia. Gallstone formation is the most common and benign posthepatic process that causes jaundice; however, the differential diagnosis also includes serious conditions such as biliary tract infection, pancreatitis, and malignancies. The laboratory work-up should begin with a urine test for bilirubin, which indicates that conjugated hyperbilirubinemia is present. If the complete blood count and initial tests for liver function and infectious hepatitis are unrevealing, the work-up typically proceeds to abdominal imaging by ultrasonography or computed tomographic scanning. In a few instances, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis.     

新生儿黄疸期血清总胆汁酸测定的临床价值

目的通过检测血清总胆汁酸（TBA）水平，探讨其在新生儿黄疸诊断治疗中的意义。方法采用日立7060全自动生化分析仪对40例新生儿血清总胆红素（TBIL）和血清TBA进行定量测定。结果高胆红素组新生儿血清TBA测定值较30例对照组明显增高，差异有统计学意义（P〈0．01），并与黄疸程度呈正比。结论血清TBA测定在新生儿黄疸实验室诊断中具有较好的特异性和灵敏性，可为临床提供诊断和治疗依据。     

A practical approach to neonatal jaundice

Kernicterus and neurologic sequelae caused by severe neonatal hyperbilirubinemia are preventable conditions. A structured and practical approach to the identification and care of infants with jaundice can facilitate prevention, thus decreasing rates of morbidity and mortality. Primary prevention includes ensuring adequate feeding, with breastfed infants having eight to 12 feedings per 24 hours. Secondary prevention is achieved by vigilant monitoring of neonatal jaundice, identifying infants at risk of severe hyperbilirubinemia, and ensuring timely outpatient follow-up within 24 to 72 hours of discharge. Total serum bilirubin or transcutaneous bilirubin levels should be routinely monitored in all newborns, and these measurements must be plotted on a nomogram according to the infant's age in hours. The resultant low-, intermediate-, or high-risk zones, in addition to the infant's risk factors, can guide timing of postdischarge follow-up. Another nomogram that consists of age in hours, risk factors, and total bilirubin levels can provide guidance on when to initiate phototherapy. If the infant requires phototherapy or if the bilirubin level is increasing rapidly, further work-up is indicated.     

Serum concentrations of unconjugated and conjugated cholic acid in portal venous and systemic venous blood of fasting man

The fasting concentrations of unconjugated and conjugated cholic acid were determined in the peripheral venous serum of 15 healthy subjects, eight patients with ileal resection and six patients with known bacterial overgrowth of the upper small intestine. In addition, the estimated hepatic uptake of unconjugated and conjugated cholic acid was determined in 15 gallstone patients undergoing cholecystectomy. A highly accurate and specific mass-fragmentographic technique with high sensitivity was used. The proportion of unconjugated cholic acid averaged 34% in the healthy subjects. The estimated fractional hepatic uptake of unconjugated cholic acid was lower than that of conjugated cholic acid, 71% and 87%, respectively (means). Patients with ileal resection had an increased proportion of unconjugated cholic acid in their peripheral venous serum, 49% (mean). The patients with bacterial overgrowth of the upper small intestine also displayed a high proportion of unconjugated cholic acid, 63% (mean). It is suggested that determination of the proportion of unconjugated cholic acid in peripheral venous blood may possibly be used for detection of bacterial contamination of the upper small intestine.     

Analysis of conjugated and unconjugated bile acids in serum and jejunal fluid of normal subjects

A reliable method is described for the determination of conjugated and unconjugated bile acids in serum and jejunal fluid. Bile acids are extracted using reverse-phase octadecylsilane bonded silica cartridges and are separated into their unconjugated and conjugated fractions using the lipophilic anion exchanger diethylaminohydroxypropyl Sephadex LH-20 (DEAP-LH-20). The conjugated fraction can be separated into a glycine and a taurine fraction, using the same anion exchanger. The bile acids are measured using a hydroxysteroid dehydrogenase-fluorimetric assay for serum and a hydroxysteroid dehydrogenase-photometric assay for jejunal fluid. The normal fasting serum value of total 3 alpha-hydroxy bile acids amounts to 3.5 +/- 2.8 mumol/l (mean +/- SD, range 1.4-10.8, n = 22). The corresponding unconjugated bile acid fraction amounts to 39.9 +/- 11.2% (range 20.7-64.6%) of total bile acids. The concentration of conjugated bile acids became significantly elevated 30, and 60 min after a standard meal, whereas that of unconjugated bile acids remained unchanged. In jejunal fluid only conjugated bile acids are found, as well in fasting subjects as postprandial, 30 or 60 min after a standard meal.     

Evaluation of a kinetic method for simultaneous determination of conjugated and unconjugated bilirubin.

This paper describes a fast kinetic method for the simultaneous determination of unconjugated and conjugated bilirugin in the same reaction solution. A stopped-flow mixing system with a stabilized photometer and small computer is used to mix sample and reagent rapidly and to record 250 data points during a 700-ms reaction time, and a regression program is used to resolve these kinetic data into the concentrations of unconjugated and conjugated bilirubin. Data are reported for synthetic single and two-component samples and for serum samples. Kinetic results for synthetic mixtures and serum samples are compared with results obtained by a conventional two-step procedure. Regression equations show good linearity between kinetically determined absorbance changes and concentration, good agreement between taken and found values for total, unconjugated, and conjugated bilirubin for synthetic samples in human serum albumin, and a good correlation between kinetic and equilibrium results for these species in sera. Regression slopes for kinetic vs. equilibrium assay results for total, unconjugated, and conjugated bilirubins in sera were 1.01 +/- 0.05, 1.04 +/- 0.03 and 0.91 +/- 0.04, respectively, with intercepts of 6.6,--2.7, and 3.8 micromol/liter, and standard errors of estimate of 28, 14, and 20 micromol/liter. These data reflect uncertainties in both the kinetic and equilibrium methods.     

The Use of an Albumin-Enhanced Indirect Antiglobulin System to Detect Immune Anti-A and Anti-D in the Serum of the Newborn

A case of hemolytic disease of the newborn is presented. Immune anti-A and anti-D were detected in the serum of the mother and the infant. The use of the albumin-enhanced antiglobulin system proved effective in detecting anti-A and anti-D in the infant's serum after all other systems had failed. The need for caution in inferring ABO incompatibility alone in the presence of a strongly reactive direct Coombs test is illustrated.     

新生儿高未结合胆红素血症340例临床病因分析及治疗

目的：探讨新生儿高未结合胆红素血症病因构成、发生规律及防治。方法：对340例新生儿高未结合胆红素血症进行病因综合分析。结果：（1）病因以感染因素占首位,其次是溶血因素及围产因素;（2）病因与发病时间的关系：溶血因素及围产因素均发生在日龄〈3d内,发病日龄〉3d以感染因素为主,还有母乳性黄疸。结论：早期新生儿高未结合胆红素血症以溶血因素及围产因素为主,中晚期新生儿高未结合胆红素血症则以感染因素为主。故加强围生期保健,加强预防及抗感染,减少孕期及产时并发症的发生可有效减少新生儿黄疸的发生。