新生儿高胆红素血症血清神经元特异性烯醇化酶检测临床意义分析

目的通过检测新生儿高胆红素血症患儿血清神经元特异性烯醇化酶(NSE)的变化,探讨NSE早期诊断新生儿胆红素脑病的意义。方法 36名健康新生儿和96名本院新生儿室收治的高胆红素血症患者生后3-7天静脉采血检测血清胆红素和γ-GGT、NSE水平,同时做脑干听觉诱发电位(BAEP)检测,分析统计不同胆红素水平下NSE和BAEP、γ-GGT的变化。结果 NSE水平在胆红素重度升高、中度升高、轻度升高组均增高,各组间及与对照组间差异有显著性,P<0.05。BAEP异常和γ-GGT升高在轻度升高组与对照组、重度升高组与中度升高组之间差异有显著性,但在轻度升高组与中度升高组之间差异无显著性。结论血清NSE水平较BAEP及γ-GGT检测来判断新生儿胆红素脑病更早、更敏感,NSE可作为判断高胆红素血症新生儿发生脑病早期诊断指标之一。     

剖宫产儿高胆红素血症的干预及效果分析

目的 :探讨剖宫产儿术后少奶期纯母乳喂养对新生儿高胆红素血症的影响。方法 :随机将 15 2例剖宫产儿分为两组 ,母乳喂养加人工辅助 84例为实验组 ,纯母乳喂养 6 8例为对照组。对照观察排便、皮肤颜色与血清胆红素。结果 :两组在排便次数、排尽胎粪时间、血清胆红素浓度上差异有显著性 (P <0 0 1)。结论 :由于剖宫产儿出生头几天内奶汁不足 ,纯母乳喂养会导致胎粪排尽延迟 ,血清胆红素偏高 ,建议实施个体化喂养方案 ,少奶期适当施行混合喂养 ,但忌用橡皮奶头和小勺 ,以免形成乳头错觉。     

Spurious hyperbilirubinemia caused by naproxen

ObjectiveTo confirm that the naproxen metabolite O-desmethylnaproxen interferes with the Jendrassik and Grof method for total bilirubin and was a possible cause of spurious hyperbilirubinemia in a case of naproxen overdose.Design and methodsPlasma was spiked with naproxen or O-desmethylnaproxen before total and direct bilirubin analysis.ResultsO-desmethylnaproxen concentration showed a linear relationship with measured total bilirubin.ConclusionO-demethylnaproxen interferes with the total bilirubin method. Interference of glucuronide metabolites of naproxen and O-demethylnaproxen is not excluded.     

新生儿高胆红素血症病因分析

目的　了解本地区新生儿发生高胆红素血症的主要病因。方法　按全国临床检验操作规程 ,对出生后 1周内发生高胆红素血症的 2 79名患儿做葡萄糖 6磷酸脱氢酶 (G6PD)定量测定和HDN血型血清学检验。结果　在 2 79名患儿中 ,G6PD缺乏的有 5 2名 (1 8.6 4 % ) ,G6PD缺乏的男性患儿显著多于女性 (χ2 =4 .4 1P <0 .0 5 ) ;母子ABO血型不合的HDN有 77名 (2 7.6 % ) ,母 /子血型O/A(B)二种组合的患儿HDN发病率极显著多于母 /子血型A(B) /B(A) 4种组合的患儿 (χ2 =2 9.4 9P <0 .0 1 ) ;母子Rh血型不合的HDN有 1名 (0 .36 % )。结论　G6PD缺乏和母子ABO血型不合所致的HDN是本地区新生儿发生高胆红素血症的主要病因     

Unconjugated hyperbilirubinemia in young people]

Altogether 64 young patients with nonconjugated hyperbilirubinemia (NH) underwent clinico-morphological correlations to establish the nosological essence of pigment metabolism disorders revealed. 32 patients showed up the signs of chronic nonspecific hepatitis, including 7 patients with the signs of chronic aggressive hepatitis. The remainder 15 patients were found to have other inflammatory processes in the liver. Only 10 persons examined (15.6%) were diagnosed to have functional hyperbilirubinemia and 7 (10.9%) to have latent hemolytic anemia. The conclusion is made about the necessity of a comprehensive examination of young persons with NH. The morphological examination of the liver is a must to early verify the pathological process manifested by the impairment of pigment metabolism.     

MAGiC技术诊断新生儿高胆红素血症

目的 观察MAGiC技术诊断新生儿高胆红素血症(NHB)的价值。方法 前瞻性纳入33例NHB新生儿作为NHB组,以30名正常新生儿为对照组;行MAGiC序列颅脑MR扫描,记录苍白球、壳核及丘脑ROI定量值,包括T1、T2弛豫值及质子密度(PD)值,并计算苍白球/壳核定量比值。比较组间各脑区定量值及定量比值,绘制受试者工作特征曲线,计算曲线下面积(AUC)以评估诊断效能,并以Pearson相关性分析评估血清总胆红素(TSB)水平与各脑区定量值及定量比值的相关性。结果 组间各脑区T1、T2及PD值差异均无统计学意义(P均＞0.05);NHB组苍白球/壳核T1值比值、T2值比值均小于对照组(P均＜0.05)。苍白球/壳核T1值比值诊断NHB的AUC为0.79(P＜0.05);而苍白球/壳核T2值比值诊断NHB的效能低(AUC=0.63,P＞0.05)。TSB与苍白球T2值(r=－0.299,P＜0.05)、苍白球/壳核T1值比值(r=－0.480,P＜0.05)及苍白球/壳核T2值比值(r=－0.328,P＜0.05)均呈负相关。结论 以MAGiC技术获取苍白球/壳核T1值比值对于诊断NHB具有一定价值。     

False positive acetaminophen levels associated with hyperbilirubinemia

Serum acetaminophen determination is frequently necessary in patients with hepatic failure. We observed two patients (#1, #2) with elevated serum total bilirubin levels (26.5 mg/dL and 40.1 mg/dL) who had multiple false positive acetaminophen levels using the kinetic method of the GDS Diagnostics enzymatic acetaminophen assay (GDS Diagnostics, Elkhart, IN). We investigated the magnitude, threshold, and linearity of this effect using the GDS Diagnostics assay and an EMIT acetaminophen assay on two other hyperbilirubinemic patients (#3, #4) and a commercial solubilized bilirubin standard. Samples were diluted using fresh frozen plasma, and acetaminophen levels were analyzed twice using the kinetic method of the GDS Diagnostic acetaminophen assay and twice with the EMIT assay. The absence of acetaminophen in all samples was verified by gas chromatography/mass spectroscopy (GC/MS). The kinetic GDS assay resulted in a positive acetaminophen assay (cutoff for a positive result= 10 mg/L) with patient #3, patient #4, and in the bilirubin standard when the total bilirubin levels were 28.2 mg/dL, 22.5 mg/dL, and 18.3 mg/dL, respectively. One sample was interpolated to give a positive acetaminophen reading when diluted to a total bilirubin concentration of 15 mg/L. None of the samples tested with GC/MS or the EMIT assay resulted in any detectable acetaminophen. In conclusion, caution must be taken utilizing the GDS Diagnostic assay for the quantification of acetaminophen with concomitant hyperbilirubinemia. Alternatives such as EMIT or GC/MS should be employed to assess acetaminophen levels in such patients.