足月显性黄疸新生儿 TcB 与血清 TSB 测定的比较

目的：评估应用BiliCheck 设备新生儿经皮胆红素（ TcB）测定的准确度。方法分别使用直接分光设备和Bili-Check设备进行测定,获得血清总胆红素（TSB）值和TcB值,以TSB为参考标准,使用Stata／SE 12．0（StataCorp LP,美国）统计方案对数据进行分析,考察健康足月显性黄疸新生儿TcB测定的准确度,并重新评估新生儿黄疸指南。结果获得222例新生儿368对TSB／TcB样本,TSB平均值为225．4±25．4μmol／L,TcB平均值为237．9±21．0μmol／L。两者之间相关性较差（ Pearson相关系数为0．439;Lin一致性系数为0．377（95％置信区间为0．301～0．453,P＜0．001）。 Bland-Altman分析表明,TcB的测定高估了TSB值（均数差为12．5±24．9μmol／L）,95％一致性范围较宽（－36．2μmol／L～61．3μmol／L）。结论应用BiliCheck设备测定足月显性黄疸新生儿,TcB值与TSB值之间的相关性较差,在预测实际TSB水平方面往往不够准确,可能增加了新生儿需要光疗的几率。

A comparison between transcutaneous bilirubin and total serum bilirubin measurement in full-term neonates with visible jaundice

Objective To evaluate the accuracy of BiliCheck device used for measuring the levels of transcutaneous bilirubin ( TcB) in full-term neonates with visible jaundice .Methods The levels of total serum bilirubin ( TSB ) and TcB were measured by using direct spectrophotometric device and BiliCheck device , respectively .TSB was set as the reference standard .The data was analyzed by using Stata/SE 12.0 (StataCorp LP, U.S.A.) statistical programme so as to evaluate the accuracy of TcB measurement in full-term neonates with visible jaundice and to re-evaluate the guideline for jaundice in neonates .Results A total of 368 pairs of TSB/TcB samples were collected from 222 cases of neonates.The mean value of TSB and TcB was 225.4 ±25.4μmol/L and 237.9 ±21.0μmol/L, respectively. The correlation between them was poor [Pearson’s correlation coefficient was 0.439; Lin’s concordance coefficient was 0.377 (95%confidence interval ranged from 0.301 to 0.453,P<0.001].The Bland-Altman analysis demonstrated that TcB measurements tended to overestimate the value of TSB (mean difference was 12.5 ±24.9 μmol/L).The 95% limits of agreement were relatively wide (-36.2-61.3 μmol/L).Conclusion When using BiliCheck device to measure the levels of TcB and TSB in full-term neonates with visible jaundice, the correlation between TcB and TSB is poor .Thus, imprecise results are often obtained when using BiliCheck device to predict the actual level of TSB .To some extent , it has increased the possibility of requiring phototherapy during treatment .