新生儿高胆红素血症的风险预测

摘要

Objective To investigate accuracy and practicality of the transcutaneous bilirubin (TCB) measurement in neonatal bilirubinemia assessment. Methods Four hundred concomitant assays were performed (transcutaneous or in plasma) , and the correlation and level of agreement between them were calculated. An assessment was also performed to study the influence of birth weight, gestational age and postnatal age. Results The mild jaundice were 200 cases, moderate and severe jaundice were 200 cases. The linear correlation coefficient was 0.932 (P = 0.0001) in cases with total serum bilirubin (TSB) < 257 μmol/L. The linear correlation coefficient was 0.282 (P = 0.004) in cases with TSB ≥ 257 μmol/L. Calculation showed a high correlation between TCB and TSB. No influence of birth weight, gestational age and postnatal age was observed on total bilirubin. Conclusions TSB assay can be substituted by TCB assay when total bilirubin is less than 257 μmol/L. TCB can be extended and practical in the management of neonatal hyper-bilirubinemia.%目的 探讨一种无创性、按每小时计的经皮胆红素(TeB)百分位列线图,以预测新生儿高胆红素血症的发生风险.方法 选择2010年1月至2010年3月出生、胎龄≥35周且出生体质量≥2 000 g的健康新生儿679例,测定其出生后152 h内的TcB值.将出生后68 h内对应最高危区域的胆红素测定值作为预测指标,利用以小时为单位的胆红素曲线图评估其高胆红素血症的危险度,利用诊断试验特征曲线(ROC曲线)分析胆红素百分位列线图预测高胆红素血症的发生风险.结果 将679例新生儿7 482个对应不同小时龄的TeB值纳入分析.42例新生儿出生后68 h内的胆红素水平处于高危区,预测高胆红素血症的灵敏度为34.52%,特异度为97.82%;212例新生儿胆红素水平处于高危区和中高危区,预测高胆红素血症的灵敏度为80.95%.特异度为75.80%;213例新生儿胆红素水平处于低危区,预测高胆红素血症的灵敏度为98.81%,特异度为35.63%.以TcB百分位列线图危险区域表示的出院前胆红素水平预测高胆红素血症发生风险的ROC曲线下面积(AUC)为0.846;胎龄与出生68 h内的胆红素水平结合预测高胆红素血症发生风险的ROC曲线下面积(AUC)为0.857;出生后前3 d的生理性体质量下降与出院前胆红素水平结合预测高胆红素血症发生风险的AUC为0.859.结论 根据新生儿出院前胆红素水平结合胎龄、出生后前3天的生理性体质量下降能简单而准确地预测新生儿高胆红素血症的发生风险.