蓝光联用中药治疗新生儿高胆红素血症的效果评价

目的评价蓝光联用中药治疗新生儿高胆红素血症的效果。方法60例新生儿高胆红素血症患者随机分为对照组和观察组,对照组采用常规蓝光治疗,观察组在此基础上,联用茵栀黄注射液治疗。结束后对两组患者的临床效果进行比较。结果观察组和对照组治疗前血清总胆红素（TBiL）和未结合胆红素（IBil）差异不显著（P〉0．05）,但治疗后观察组TBiL为（125．40±24．50）μmol／L,明显低于对照组（158．20±29．60）μmol／L,具有显著差异（t=4．6755,P〈0．01）;治疗后观察组IBiL为（91．10±11．50）μmol／L,明显低于对照组（97．90±12．30）μmol／L,具有显著差异（t=2．2119,P〈0．05）。观察组在治疗后1-3d黄疸消退,对照组在治疗后5—7d黄疸消退。治疗期间两组均未见不良反应。结论蓝光联用茵栀黄注射液治疗新生儿高胆红素血症效果好,而且安全,建议临床进一步推广。     

Changes in the liver function tests during the attacks of familial mediterranean fever

The present study aims to investigate whether or not FMF patients display abnormal liver functions during attack periods. About 41 consecutive FMF patients with attacks were enrolled on this study. Bilirubin levels, liver transaminases, erythrocyte sedimentation rate and C-reactive protein (C-RP) levels were determined within the first 72 h after the onset of attacks. This procedure could be performed on only 28 of these 41 FMF patients, 4 weeks after the attack of the patients’ had completely disappeared. As for the disease control group, 44 patients were determined to be eligible for the study. Another 31 healthy individuals were also included. Hyperbilirubinemia was determined in 11 of the 41 patients (26.8%) with FMF. The number of FMF patients with hyperbilirubinemia was significantly higher than in DC and HC (P < 0.001, P = 0.03, respectively). Levels of liver transaminases slightly increased in four patients with FMF during the attack and two of these four patients had also mild hyperbilirubinemia. A significant correlation was found between C-RP levels and total and unconjugated bilirubin levels in FMF patients with attack (r = 0.43, P = 0.01; r = 0.40, P = 0.02, respectively). In conclusion, mild hyperbilirubinemia may occur in one-fourth of the patients with FMF during the attack period.     

新生儿脐血免疫血清学检验结果与新生儿高胆红素血症发生率关系探讨

目的:探讨脐血免疫血清学检验结果IgG抗-A+B与新生儿高胆红素血症发生率的关系。方法:对392例O型血母亲分娩的A或B型血新生儿进行脐血免疫血清学检验,并按是否存在IgG抗-A+B进行分组,调查其高胆红素血症的发生率。结果:①在抗体释放试验阳性的新生儿中,红细胞凝集的程度与高胆红素发生率有极显著的相关性(P<0.01)。②新生儿血液中存在的IgG抗-A+B与高胆红素血症发生率无显著的相关性(P>0.05),③新生儿血液中存在的游离抗体与高胆红素血症发生率有极显著的相关性(P<0.01)。结论:脐血免疫血清学检验结果对预判新生儿发生高胆红素血症有一定的临床意义。     

胆红素-尿苷二磷酸葡萄糖醛酸基转移酶G71R基因型对广西地区新生儿黄疸程度的影响

目的 探讨胆红素-尿苷二磷酸葡萄糖醛酸基转移酶1A1(UGT 1A1)基因突变对广西新生儿黄疸的影响.方法 收集73例高胆红素血症新生儿及31例健康新生儿外周血,应用突变特异性扩增系统(amplification refractory mutation system,ARMS)法及直接测序法对所有新生儿行UGT1A1基因G71R突变检测,分析胆红素脑病发生率,胆红素峰值及总胆红素(total serum bilirubin,TSB)>20 mg/dl的机会比.结果 (1)本研究人群G71R等位基因频率为0.1915,病例组为0.2329,健康对照组为0.097,病例组的G71R等位基因频率显著高于健康对照组(P<0.05).(2)G71R纯合子的胆红素脑病发病率及72 h的TSB浓度(28.57%,23.12±4.58 mg/dl)均高于野生型组(0%,17.68±2.69 mg/dl),差异有统计学意义(P<0.001).(3)G71R纯合子组中5例的TSB>20 mg/dl,G71R纯合子TSB>20 mg/dl的机会比(odds ratio,OR)为7.955,总体机会比95%可信区间(confidence interval,CI)为(1.349,46.899).结论 G71R突变与本地新生儿黄疸的发病存在相关性.G71R纯合子的胆红素脑病发病率及生后72 h的TSB较对照组及野生型增高.G71R纯合子发生TSB>20 mg/dl的危险性是野生型的7.955倍.     

蓝光照射治疗新生儿高胆红素血症的疗效和对甲状腺功能的影响

目的探讨蓝光疗法治疗新生儿高胆红素血症对甲状腺功能的影响。方法新生儿高胆红素血症50例,按蓝光照射时间不同分为：治疗8h组（治疗组A）25例,治疗12h以上（治疗组B）25例,同时选取正常足月儿30例为对照组,观察2组治疗前后高胆红素血症的含量和蓝光照射对甲状腺功能的影响。结果双面蓝光治疗新生儿高胆红素血症显效28．0％,有效54．0％,无效18。0％,总有效率为82．0％;光疗后血清胆红素（190±29）μmol／L明显低于光疗前（264±25）μmol／L,差异有统计学意义（P〈0．0．5）;光疗后发生皮疹16．0％、发热12．0％、腹泻8．0％、精神疲乏8．0％、哺乳能力下降8．0％、皮肤损伤12．0％;光疗前后甲状腺功能指标变化差异无统计学意义（P〉0．05）。结论蓝光照射治疗新生儿黄疸安全有效,对甲状腺功能无影响,对甲状腺不必采取特殊保护措施。     

Bone mineral densities in individuals with Gilbert’s syndrome: A cross-sectional,case-control pilot study

BACKGROUND

Unconjugated bilirubin inhibits osteoblastic proliferative activity in vitro, raising the possibility that Gilbert’s syndrome (GS) patients are at increased risk of osteoporosis.

OBJECTIVES

To compare bone mineral density (BMD), serum parathyroid hormone (PTH), C-telopeptide (CTX) and osteocalcin levels in GS subjects versus matched controls in a cross-sectional, case-control study.

METHODS

BMD determinations were obtained with central dual-energy x-ray absorptiometry. Serum PTH, CTX and osteocalcin levels were measured by enzyme immunoassay.

RESULTS

A total of 17 GS and 30 control subjects were studied. Overall, there were no significant differences in BMD, PTH, CTX or osteocalcin levels between the two groups. However, when older (older than 40 years of age) and younger (40 years of age and younger) cohorts were considered separately, the older GS cohort had significantly decreased total hip BMD, T scores and Z scores, and femoral neck BMD, T scores and Z scores (P<0.005 for each parameter, respectively) compared with older control subjects. Serum osteocalcin levels were lower in the older versus younger GS cohort (P=0.006). An inverse correlation existed between all subjects’ serum unconjugated bilirubin levels and total body BMD determinations (r=−0.42; P=0.04). On univariate analysis, the association between serum unconjugated bilirubin and total body BMD was not significant (P=0.066), nor was serum unconjugated bilirubin identified as a risk factor for low BMD when entered into multivariate analyses.

CONCLUSIONS

The results of the present pilot study warrant further research involving larger numbers of subjects and longitudinal measurements to determine whether GS is associated with decreased BMD, particularly in older GS subjects.     

Cotrimoxazole and neonatal kernicterus: a review

Abstract

Sulfamethoxazole (SMX) and trimethoprim (TMP) individually and a combination known as cotrimoxazole (SMX-TMP) are widely used for the treatment of protozoan and bacterial infections. SMX-TMP is also one of the widely used antibiotics administered orally in neonates, along with gentamicin injection, for treating pneumonia and sepsis by home-based healthcare providers in Asian countries. Although the use of this drug has successfully reduced neonate mortality, there is a concern for it causing neurotoxicity. Previous clinical studies with sulfisoxazole have demonstrated occurrence of kernicterus in neonates. This sulfonamide is thought to displace bilirubin from its albumin-binding sites in plasma leading to an elevation of plasma bilirubin, which crosses the blood–brain barrier, reaches central neurons to cause kernicterus. We performed an extensive review of clinical and animal studies with cotrimoxazole, which showed no reported incidences of kernicterus with SMX-TMP use in neonates. EndNote, BasicBiosis, Embase, PubMed and Toxline database searches were conducted using specific keywords yielding 74 full-length articles relevant to the review. This review has taken into account various factors, including the disease itself, direct effects of the drug and its metabolism through conjugation and acetylation through a thorough review of the literature to examine the potentials of SMX-TMP to cause kernicterus in neonates. SMX-TMP in oral doses administered to neonates for 7–10 days is unlikely to cause kernicterus. Also, this review recommends warranting the need of future studies using animal models and clinical studies in humans to address SMX-TMP toxicity.     

Evaluation of maternal knowledge level about neonatal jaundice

Objective: To evaluate the knowledge of mothers on neonatal jaundice. Methods: This study was conducted on 161 mothers who had given birth to healthy newborns at Izmir Aegean Gynecology and Obstetrics Hospital between January 2010 and April 2010. A questionnaire was used to assess the mothers’ knowledge on neonatal jaundice. Knowledge was evaluated as “sufficient” or “insufficient” based on responses. Sufficiently informed mothers were compared with insufficiently informed group for the knowledge level about neonatal jaundice. Results: The rate of insufficiently informed mothers was 53.6%. Logistic regression analysis showed that education level and having a previous offspring with jaundice were independent variables affecting the mothers’ knowledge level. Low education level was found to increase the probability of the mothers’ knowledge level to be insufficient by 2.1 folds (OR 2.1, 95% CI 1.3–3.4; p?=?0.003). Being informed beforehand by a previous offspring with jaundice increased the probability of the mothers’ knowledge to be sufficient by twofolds (OR 2, 95% CI 1.1–3.7; p?=?0.03). Conclusion: It is found that the mothers’ knowledge about neonatal jaundice is insufficient. Maternal education level and having a previous offspring with jaundice are major factors affecting the knowledge of the mothers on hyperbilirubinemia.     

Auditory nerve and brain stem responses in homozygous jaundiced gunn rats

Summary In humans, functional evidence based on recording cochlear microphonic, auditory nerve, and brain stem responses has shown that the site of lesion in hearing loss following neonatal hyperbilirubinemia is the auditory nerve (with sparing of the hair cells). Structural damage to the central nervous system (CNS) including the cochlear nuclei has been demonstrated in adult, homozygous Gunn rats which develop hyperbilirubinemia shortly after birth. In an attempt to use the Gunn rat as an experimental model for bilirubin-induced CNS damage, auditory nerve and brain stem responses (ABR) were recorded in jaundiced (homozygous) and non-jaundiced (heterozygous) Gunn rats and in Sabra (Wistar) rats. All of the rats including the jaundiced Gunn rats had normal ABR and responded behaviorally to sound stimuli. These results suggest that the adult jaundiced Gunn rat retains auditory function and in this way differs from human patients in whom neonatal jaundice has lead to hearing loss. Therefore, the adult homozygous Gunn rat probably cannot serve as a model for hearing loss due to hyperbilirubinemia.