结合胆红素和非结合胆红素的直接测定在高胆红素血症中的应用

目的评价结合胆红素（CBil）和非结合胆红素（UBil）的直接测定在胆汁瘀积性黄疸（CJ）、肝细胞性黄疸（HJ）和新生儿溶血性黄疽（NHJ）中的价值以及δ胆红素／总胆红素（δBil／TBil）比值对CJ患者手术疗效判断的意义。方法用Vitros 250型干式生化仪及配套干片测定18例CJ患者和20例HJ患者血浆TBil、CBil和UBil，计算δBil；13例CJ患者在行胆总管切开引流术后3d、5d、7d复测。同法测定22例NHJ患儿血浆CBil和UBil，计算新生儿总胆红素（NBil）。结果CJ组CBil／TBil比值与HJ组比较差异有统计学意义（P=0．000），而UBil／TBil比值、δBil和δBil／TBil比值2组间差异均无统计学意义（P=0．241、0．067、0．090）。6例经胆总管切开引流术治疗后排泄良好的CJ患者的TBil、CBil和UBil在术后第3d起逐渐下降，δBil缓慢下降，δBil／TBil比值由术前的0．16～0．44升至0．52～0．78。7例治疗后排泄不良的CJ患者其TBil、CBil和UBil在术后5d～7d缓慢减低，δBil变化甚微，δBil／TBil在0．20～0．46范围内波动。NHJ患儿血浆NBil、UBil及UBil／NBil比值均明显增高。结论CBil和UBil的直接测定及δBil／TBil比值对CJ、HJ和NHJ的诊断和／或鉴别诊断以及CJ患者手术疗效的判断均有很好的应用价值。

The clinical application of direct determination of conjugated bilirubin and unconjugated bilirubin in hyper bilirubinemia

Objective To study the vable of direct determination of conjugated biliruhin（CBil） and unconjugated bilirubin（UBil） in cholcstastic jaundice（ CJ） , hepatocellular jaundice （HJ） and neonate hemolytic jaundice （ NHJ ） ; to investigate the effect of the ratio of δ-hilirubin / total bilirubin （δBil/TBil）in decision on operation efficacy of patients with CJ. Methods The TBil, CBil and UBil in plasma from 18 patients with CJ and 20 patients with HJ were determined by Vitros 250 chemistly system and attached dry slides, the δBil were calculated; the all indexes in plasma from 13 patients with CJ were determirmted on 3 d, 5 d and 7 d after choledochotomy with drainage; the CBil and UBil in plasma from 22 patients with NHJ were determinated by the same method, the neonatal bilirubins（NBil） were calculated. Results There was significant difference of the ratio of CBil/TBil between CJ and HJ（ P =0. 000）, there was no significant difference of δBil, the ratio UBil/TBil and δBil/TBil between CJ and HJ（ P was 0. 241, 0. 067 and 0. 090 respectively） ; TBil, CBil and UBil in plasma from 6 bilirubin excreting well-patients with CJ had been decreasing gradually since 3d after operation, δBil was decreasing slowly, the ratio of δBil/TBil was increasing from 0. 16 -0.44（ before operation） to 0. 52 -0. 78 （ after operation ） , TBil, CBil and UBil in plasma from 7 bilirubin excreting poor-patients with CJ were deereasing slowly from 5 d to 7 d after operation, the δBil was changing a little, the ratio of δBil/TBil was 0. 20 0.46 ; NBil and UBil hi plasma from patients with NHJ as well as the ratio of UBil/NBil increased obviously. Conclusions The direct determination of CBil and UBil has high value on diagnotics and/or differential diagnotics of CJ, HJ and NHJ, the ratio of δBil/TBil is nsetul tor judging the therapeutic efficacy of CJ.