病理性黄疸对新生儿心肌的影响

目的 探讨病理性黄疸对新生儿心肌组织的影响.方法 以2005年1-11月本科住院的38例病理性黄疸新生儿为研究对象,同期32例生理性黄疸新生儿为对照组.检测二组新生儿总血清胆红素(采用钒酸盐法)、心肌酶(采用酶学速率法)、心肌肌钙蛋白(cTnI)(采用化学发光免疫分析法)、心脏超声心动图及心电图,同时观察临床表现,组间比较采用t检验,相关性分析采用Pearson分析.结果 1.二组新生儿血清AST、LDH、羟丁酸脱氢酶(HBDH)、CK水平均增高,磷酸肌酸激酶同工酶(CK-MB)水平与临床标准相符,CK-MB/CK ＜6%.二组之间血清心肌各酶、cTnI无显著差异(Pa>0.05).2.观察组恢复期血清LDH、HBDH明显降低,与急性期比较差异显著(Pa<0.05),AST、CK、CK-MB与急性期比较均无显著差异(Pa>0.05).3.急性期血清胆红素与心肌酶、cTnI均无明显相关(Pa＞0.05).4.二组新生儿心脏超声心动图及心电图均无明显异常改变,临床无明显心肌受损症状及体征.结论 新生儿病理性黄疸对心肌无明显损害.对早期新生儿诊断心肌损伤仅依据其心肌酶谱、cTnI值增高是不够的,还要根据新生儿临床表现及心脏彩超、心电图改变,并结合新生儿日龄全面分析,综合判断.

Effect of Pathological Jaundice on Neonatal Myocardium

Objective To explore the effect of pathological jaundice on neonatal myocardium and its clinical significance.Methods Thirty-eight hospitalized neonates with pathological jaundice were selected as study subjects,admitted between Jan.and Nov.in 2005,synchronization 32 neonates with physiological jaundice for control group.The blood serum,bilirubin,myocard enzyme,cardiac troponin-I(cTnI)were detected,and heart echocardiogram and echocardiogram(ECG)were performed,at the same time,clinical manifestations were observed.Results 1.Serum levels of aspartate aminotransferase(AST),lactate dehydrogenase(LDH),hydroxybutyrate dehydrogenase(HBDH),creatine kinase(CK)in 2 groups were all higher,children commonly used clinical standerd,but the level of mbisoenzyme of creatine kinase(CK-MB)conform to frequently used clinical standard,CK-MB/CK < 6%.Between 2 groups,each blood serum myocard enzymes,cTnI had no significant deviation(Pa>0.05).2.Recovery phase of observation group blood serum LDH,HBDH manifest degradle,compared to acute stage had significant deviation(Pa<0.05),AST,CK,CK-MB compared to acute stage all had no significant deviation(Pa>0.05).3.Acute phase serum bilirubin with each myocard enzymes and cTnI had no conspicuous linear corrlativity(Pa> 0.05).4.Echocardiogram and ECG of 2 groups of neonates showed no apparent abnormality,without myocardical impaired manifestations and signs clinically.Conclusions Neonatal pathological jaundice have no obviously damage to myocardium.To diagnosis earlier neonate myocardial damage,only according to the increase of myocardial enzymogram,cTnI value are insufficient,also on the basis of neonatal clinical manifestation and the change of echocardiogram,ECG,as well as combine neonate day age to mnti-analysis,and comprehend judgement.