高胆红素血症中检测δ胆红素的临床意义研究

高胆红素血症,包括临床常见的胆汁瘀积性黄疸、肝细胞性黄疸、溶血性黄疸以及先天性非溶血性黄疸,均是由胆红素代谢紊乱所致。血清胆红素成分分析在肝胆疾病的诊断、鉴别诊断及预后方面都有重要的临床意义。其中Bδ在疾病的鉴别诊断和预后方面有较为特殊的临床意义.     

非等量换血疗法在新生儿高胆红素血症中的应用

目的探讨非等量换血疗法治疗新生儿高胆红素血症前后血中胆红素及内环境的变化。方法18例患儿均采用桡动脉-外周静脉同步换血，采用0型红细胞＋AB型血浆，换血量150～180ml／kg，输入量比换出量多10～15ml／kg，3h左右结束。换血前后抽血送检胆红素、血气、电解质、血常规、血糖、血培养，出院前查脑干听觉诱发电位。计数资料采用t检验对比分析。结果血清胆红素换出率为50％，换血前后血红蛋白、血气等差异无显著性，电解质、血糖、白细胞计数（WBC）、血小板计数（PLT）差异具有显著性，但平均值在正常范围。结论非等量换血疗法能有效降低血中胆红素的浓度，预防胆红素脑病的发生，对内环境影响不大。     

中西医结合治疗新生儿高胆红素血症的疗效观察

我院自1996年5月至1998年5月,对住院的300例新生儿黄疸,在常规治疗的同时,采用自拟中药退黄汤口服,获得满意疗效。现报告如下。 1 临床资料 1.1 一般资料:300例新生儿黄疸均为我院新生儿科住院患儿,随机分为两组,治疗组182例,男88例,女94例,日龄在2～28天;出生体重在2600～3500克,胎龄在33周至42周。对照组118例,男62例,女56例,日龄在1～26天,出生体重在2500～3750克,胎龄在32周至43周。 1.2 主要病因:治疗组:溶血性黄疸4例均为ABO溶血,感染因素28例,围产因素54例,血管外溶血12例,红细胞增多症22例,母乳性黄疸62例,     

术后高胆红素血症的临床分析

术后高胆红素血症又称肝内胆汁淤滞或术后黄疸.1950年Caroli首先报道了14例,1973年Lamont等正式提出这一新概念.近几年来国外报道较多,国内有关专题报道很少,但临床并非少见.所以观察手术与高胆红素血症的关系,探讨胆红素升高的原因,很有必要进行深入研究,为临床诊断治疗提供依据.现就2003～2004年108例住院病例进行综合分析,报道如下.……     

新生儿高胆红素血症68例临床分析

新生儿高胆红素血症是新生儿期常见临床症状之一,尤其是早期新生儿,根据实验室测定胆红素总值和结合胆红素的浓度可分为高未结合胆红素血症、高结合胆红素血症和混合性高胆红素血症,而未结合胆红素增高常可引起胆红素脑病,严重者危及生命或损害神经系统遗留后遗症,给家庭和社会带来负担。为做好高胆红素血症的防治,减少伤残,现将2006年1月--2008年10月收治的高胆红素血症68例患儿的临床资料分析报告如下。     

经皮测胆红素在高胆红素血症患儿中的应用价值及护理

目的探讨经皮测胆红素(TCB)在高胆红素血症患儿中的应用价值及护理干预措施。方法选取2012年1月~2014年1月我科住院的240例高胆红素血症患儿为研究对象,根据随机数字表法将患儿分为观察组和对照组,各120例。观察组应用TCB技术测定血清胆红素水平。对照组应用TSB技术测定血清胆红素水平。对两组实施护理。比较分析两组灵敏度、特异度、误诊率、漏诊率及并发症发生情况和家属满意度。结果观察组灵敏度为92.36%,特异度为90.23%,误诊率为0.18%,漏诊率为1.10%。观察组感染率、静脉炎发生率显著低于对照组,家属满意率高于对照组,有显著性差异(P0.05)。结论 TCB能有效预测高胆红素血症患儿血清胆红素水平,可为患儿临床诊治方案的确立提供指导,且为无创操作,护理过程简单易行,可降低患儿静脉炎及感染发生率,提高家属满意度。     

经皮胆红素测定与早产儿高胆红素血症的相关性研究

目的 探讨经皮胆红素(TCB)测定在早产儿高胆红素血症中的临床应用价值.方法 随机选择40例早产儿(孕龄34～36+6周),在入院时和光疗(4次)后同时行TCB及血清胆红素(TSB)测定并分析两者的相关性.结果 入院时及4次光疗后TCB与TSB两者之间均呈正相关(r=0.798,r=0.813,r=0.624,r=0.339,r=0.396;均P＜0.05).结论 TCB测定方便、快捷、无创、准确,对诊断、动态监测早产儿高胆红素血症具有较好的临床应用价值.     

原发性旁路高胆红素血症1例

1　病例报告女 ,2 2岁。14岁时无诱因下出现尿黄、肤黄、眼黄。近 2 a黄疸加深。 2 0 0 1- 11起到本院住院 2次。全身情况好 ,皮肤、巩膜黄染 ( ) ,肝肋下 1cm,脾肋下触及 ,B超脾厚 6 0 mm。Hb10 0～110 g/ L,Ret1.2 %～ 2 2 .0 % ,总胆 5 8.0～ 178.7μmol/ L,间胆5 0 .7～ 16 6 .2 μmol/ L,直胆 7.3～ 12 .5 μmol/ L,抗体筛选试验阳性 ,Coomb′s直接法阴性 ,尿胆原 16～ 131μmol/ L,尿胆红素阴性 ,尿 Rous试验阴性。骨髓增生性贫血 ,幼红细胞增多。G6 PD及 Hb分子病检查正常。游离血红蛋白增高 ,结合球蛋白缺如 ,诊为自身免疫性…     

各种胆红素对氧化酶法测定血清尿酸浓度的影响

目的　通过分析不同胆红素对尿酸(UA)氧化酶方法的干扰,探讨各种胆红素对过氧化物酶偶联Trinder反应的UA氧化酶测定方法的影响。方法　我们制备了24种含有不同浓度UA的血清,每种血清含有不同浓度的未结合胆红素(Bu)、结合胆红素(Bc)、δ胆红素(δBil),使用美国EKTACHE750XRCanalyzer生化分析仪测定各种胆红素浓度,使用日本7170全自动生化分析仪测定血清中的UA浓度。结果　来自Bc的干扰最大,当浓度为400μmol/L时,回收率只有56.4%;Bu的干扰较小,当浓度400μmol/L时,回收率仍达87.4%;δBil的干扰最小,随着血清中δBil浓度的提高,对UA测定基本无影响,回收率保持在93.4%以上。结论　Bu、Bc、δBil对UA氧化酶测定方法影响程度不同,在实际工作中应予以重视。     

酶法测定结合胆红素的方法学评价

目的评价胆红素酶法测定血清结合胆红素(CB il),并与干化学法作比较。方法在pH值5.5、120mmol/L苯二甲酸氢钾缓冲液中,胆红素氧化酶(BOD)选择性地氧化CB il,引起450 nm处吸光度(A)值下降,求得CB il浓度。加入氟化钠(NaF)和N-乙酰半胱氨酸(NAC),抑制BOD对未结合胆红素(UB il)和δ-胆红素(δB il)的氧化,消除其干扰。结果BOD法测定的线性范围达230μmol/L,批内变异系数(CV)为4.1%(低值)、1.4%(高值),批间CV为11.65%(低值)、10.26%(高值),平均回收率为97.8%。BOD法与干化学法比较,Y干化学法=1.016 0X酶法 1.603 1,r=0.990 7。结论该法能有效地抑制BOD对UB il和δB il的氧化,特异性的检测CB il,并可用于自动生化分析仪。     

血清结合胆红素的酶法测定

目的 建立用胆红素氧化酶（ＢＯＤ）作为催化剂，选择性地测定血清结合胆红素（ＣＢ）的新方法。方法 测定条件为：０．１ｍｏｌ／Ｌ甘氨酸缓冲液、ｐＨ１０．０，ＢＯＤ活性０．５～０．８Ｕ／反应管，反应时间２分钟。结果 线性至少可达到２２０μｍｏｌ／Ｌ；精密度为批内ＣＶ１．７１～３．９８％、批间ＣＶ８．０～９．７２％；正常参考值范围为０～３．１４μｍｏｌ／Ｌ；与偶氮法所测结果相关性较好。结论 本文所建立的Ｃ     

Enzymatic determination of bilirubin fractions in serum

Novel enzymatic methods using bilirubin oxidase from Myrothecium verrucaria are described for the determination of bilirubin fractions in serum. These fractions include an unconjugated form (Bu), a conjugated form (Bc), and a delta fraction of bilirubin that reacts with direct diazo reagent and is irreversibly bound to serum albumin (Bδ). The determination is based on the different reactivities of the enzyme to bilirubin fractions at different pH in the presence or absence of anionic detergent such as sodium dodecyl sulfate (SDS) or sodium cholate. Thus, in the absence of detergents, Bc and Bδ are oxidized at acidic pH, while Bc is oxidized at alkaline pH; Bu is not oxidized at either acidic or alkaline pH.

The first approach is based on measuring the decreased absorbance of bilirubin colour at 450 nm caused by the enzymatic oxidation. Total bilirubin is measured at pH 8.0 in the presence of SDS. Direct bilirubin is measured at pH 3.7 and Bc is measured at pH 10.0 in the absence of SDS, respectively.

The second approach is made by coupling the diazo reaction with the enzyme reaction. Total and direct bilirubin are determined by a conventional diazo method without prior treatment by the enzyme. Bδ is determined with a direct diazo method after the serum sample is treated at pH 10.0 by the enzyme to oxidize the Bc fraction. The precision and the accuracy of these methods were compared with a precision and the accuracy of these methods were compared with a diazo method, an HPLC method and a slice method, and good results were obtained.     

Zinc salts precipitate unconjugated bilirubin in vitro and inhibit enterohepatic cycling of bilirubin in hamsters

BACKGROUND: We have evidence for enterohepatic cycling of bilirubin experimentally and in vivo in humans. This study was designed to investigate whether Zn salts might inhibit such cycling of bilirubin. MATERIALS AND METHODS: Micellar bile salt solutions with unconjugated bilirubin were prepared, appropriate concentrations of Zn salts were added, and unconjugated bilirubin precipitation was measured. Hamsters and Wistar rats were fed a chow diet or a chow diet enriched with 1% ZnSO4, and bilirubin secretion rates were monitored. RESULTS: Unconjugated bilirubin was precipitated maximally (90%) after a 10-min incubation with 5 mM Zn salts in the pH range of 6.8-9.0. In control hamsters, total bilirubin secretion rates into bile were 36.0 +/- 2.8 nmol h(-1) 100g(-1) body weight, whereas they were 25.0 +/- 3.3 nmol h-1 100(-1) g in the ZnSO4 group (P < 0.05). CONCLUSIONS: Zn salts that flocculate at physiological pH adsorb unconjugated bilirubin almost completely from unsaturated micellar BS solutions. In addition, Zn salts administered orally suppress biliary bilirubin secretion rates in hamsters. These findings suggest that the administration of Zn salts may inhibit the enterohepatic cycling of unconjugated bilirubin in humans who are predisposed to pigment gallstone formation due to diet, disease or drugs.     

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.     

脑出血患者颅内血肿中血红素加氧酶1和非结合胆红素的含量变化及其与迟发性脑水肿的关系研究

目的研究脑出血患者颅内血肿中的血红素加氧酶1(HO-1)和非结合胆红素(UCB)的含量变化,探讨脑出血后迟发性脑水肿的病理机制。方法选择脑出血行颅内血肿微创清除术患者30例(脑出血组),同时选择健康体检者20例(对照组);用酶联免疫吸附测定(ELISA)法和钒酸盐氧化法检测对照组和脑出血组第1天、第3天和第6天颅内血肿中的HO-1和UCB含量,并应用多田公式计算术后第6天血肿周围脑水肿的体积。结果脑出血组第1天颅内血肿中HO-1的含量(13.96±4.83)μg/L和UCB的含量(11.34±2.96)μmol/L均较对照组(3.53±2.07)μg/L、(7.13±2.74)μmol/L明显增高(P<0.01);并且脑出血组第3天HO-1、UCB(25.60±7.13)μg/L、(28.45±7.69)μmol/L均达到高峰,第6天(18.77±5.39)μg/L,(20.18±4.75)μmol/L有所下降,与第1天比较差异均有统计学意义(P<0.01)。并且第6天HO-1和UCB的含量与脑水肿的体积均呈正相关(r值分别为0.453、0.525,均P<0.05)。结论HO-1和UCB可能在脑出血后迟发性脑...     

基线非结合胆红素对肥胖人群早期生活方式减重达标的切点预测

目的 探究基线非结合胆红素（unconjugated bilirubin, UBiL）对肥胖人群生活方式减重3个月后减重达标的切点预测。方法 选取进行体重管理的单纯性肥胖人群314例,采用生活方式减重,通过记录基线及3个月后体重,计算体重减轻百分比,将体重减轻百分比超过10%定义为减重成功,从而分为达标组和未达标组。采用二元logistic回归分析减重达标的影响因素,采用受试者工作特征(ROC)曲线分析UBiL预测减重达标的敏感度和特异度。结果 UBiL为女性减重是否达标的影响因素。ROC 曲线下面积为0.747（95%CI 0.622, 0.871),在最适切点UBiL为9.50 μmol/L时,约登指数为0.416,敏感度和特异度分别为52.4%、89.2%。结论 UBiL对于预测女性生活方式减重3个月后是否达标具有较高的特异性。当UBiL小于9.50 μmol/L时,我们建议尽早在生活方式减重的基础上加用药物、减重手术等其他减重方式。