表皮生长因子与足月新生儿晚发型母乳性黄疸的相关性研究
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摘要
目的：①探讨EGF与足月新生儿晚发型母乳性黄疸的关系。②探讨患儿TcB的最佳检测部位。
方法：选取我院儿科门诊就诊的晚发型母乳性黄疸患儿75例（实验组），相当日龄的正常新生儿25例（对照组），比较两组新生儿血清及母乳中EGF差异；对30例晚发型母乳性黄疸患儿停母乳72h左右，比较停母乳前后患儿血清胆红素及血清、母乳中EGF差异。采用Elisa方法检测EGF浓度。同时应用JH20-1C经皮黄疸测试仪测患儿额部及胸部TcB，前两者和均值记为额胸部TcB。不同部位TcB值与TSB值进行比较，探讨TcB的最佳检测部位及与TSB值的差异。
结果：①实验组TSB值、血清及母乳EGF浓度均高于对照组（分别是233.16±41.93μmol/L VS115.7±33.89μmol/L， P<0.01；556.37±169.5pg/ml VS493.24±159.82pg/ml，P>0.05；338.59±99.87pg/ml VS317.92±85.70pg/ml，P>0.05）。②30例配对样本停母乳后患儿TSB值、血清中EGF浓度下降，差异具有统计学意义（分别为228.82±41.07μmol/L VS159.05±48.74μmol/L，P<0.001，下降约24.8%-36.4%；502.27±188.40pg/ml VS444.81±134.18pg/ml，P<0.05）。停母乳前后母乳中EGF浓度变化无统计学意义（343.50±95.23pg/ml VS338.81±104.03pg/ml）。③TcB_额、TcB_(额胸)、TcB_胸与TSB值呈显著正相关性（相关系数分别是r_额=0.815，P<0.001；r额胸=0.812，P<0.001；r_胸=0.798，P<0.001）。④TcB_额、TcB额胸、TcB_胸值平均要高于TSB值约2.13，1.53，0.98mg/dL。胸部是TcB的最佳检测部位。
结论：EGF可能与足月新生儿晚发型母乳性黄疸的发生密切相关。胸部可以作为TcB检测最佳部位。TcB较TSB约高1-2mg/dl。在临床应用经皮胆红素诊疗时，要考虑到TcB与TSB之间的差异。
Objective: To discuss the relationship between epidermal growth factor (EGF)and late-onset breast milk jaundice and to select the optimal site of transcutaneousbilirubin measurement.
Methods: A total of75neonates with late-onset breast milkjaundice(experimental group) and25controls(normal neonates at the same days)were enrolled from the pediatric outpatient department of our hospital. Aim to findthe difference of the EGF in breast milk and serum of the two groups. A total of30neonates with late-onset breast milk jaundice had been intervented of stopping breastmilk for almost72h. Aim to find the difference of the EGF in breast milk and serumand serum total bilirubin in the neonates with stopping breast milk. Elisa method wasused to detect the concentration of EGF. At the same time,the forehead and chesttranscutaneous billirubin were measured by the transcutaneous bilirubinometer ofJH20-1C, the mean of forehead and chest transcutaneous bilirubin recorded asforehead-chest transcutaneous bilirubin.Compare the values of TcB with differentsites and TSB to select the optimal site of transcutaneous bilirubin measurement.Andfind the differences bettwen the values of TcB with different sites and TSB.
Results: The experimental group total bilirubin, serum and breast milk EGFwere higher than those in the control group. The values were233.16±41.93u mol/LVS115.7±33.89umol/L(P <0.01);556.37±169.5pg/ml VS493.24±159.82pg/ml;338.59±99.87pg/ml VS317.92±85.70pg/ml(P>0.05) respectively. In30pairedsamples after stopping breast-feeding serum total bilirubin and EGF concentrationdecreased. Serum total bilirubin was228.82±41.07umol/L VS159.05±48.74umol/L(P <0.001), dropped about24.83%-36.48%; serum EGF concentration was502.27±188.40pg/ml VS444.81±134.18pg/ml(P=0.023, P <0.05); milk EGFconcentration did not change. Breast milk EGF concentration was343.50±95.23pg/mlVS338.81±104.03pg/ml(P=0.805, P>0.05). The forehead, forehead-chest, chesttranscutaneous bilirubin measurement values were positively associated with the serum bilirubin values(r-额=0.815，P<0.001；r_(额胸)=0.812，P<0.001；r胸=0.798，P<0.001).The forehead, forehead-chest, chest transcutaneous bilirubin were higher than totalserum bilirubin, approximately2.13,0.98,1.53mg/dL, respectively. The site of chestwas the optimal site of transcutaneous bilirubin measurement.
Conclusion: Epidermal growth factor maybe related to the occurrence of lateonset breast milk jaundice. Chest could be as the optimal site of transcutaneousbilirubin measurement. TcB is about1-2mg/dl higher than TSB. In the clinicalapplication of percutaneous diagnosis and treatment, we should consider thedifference between TcB and TSB.
方法：选取我院儿科门诊就诊的晚发型母乳性黄疸患儿75例（实验组），相当日龄的正常新生儿25例（对照组），比较两组新生儿血清及母乳中EGF差异；对30例晚发型母乳性黄疸患儿停母乳72h左右，比较停母乳前后患儿血清胆红素及血清、母乳中EGF差异。采用Elisa方法检测EGF浓度。同时应用JH20-1C经皮黄疸测试仪测患儿额部及胸部TcB，前两者和均值记为额胸部TcB。不同部位TcB值与TSB值进行比较，探讨TcB的最佳检测部位及与TSB值的差异。
结果：①实验组TSB值、血清及母乳EGF浓度均高于对照组（分别是233.16±41.93μmol/L VS115.7±33.89μmol/L， P<0.01；556.37±169.5pg/ml VS493.24±159.82pg/ml，P>0.05；338.59±99.87pg/ml VS317.92±85.70pg/ml，P>0.05）。②30例配对样本停母乳后患儿TSB值、血清中EGF浓度下降，差异具有统计学意义（分别为228.82±41.07μmol/L VS159.05±48.74μmol/L，P<0.001，下降约24.8%-36.4%；502.27±188.40pg/ml VS444.81±134.18pg/ml，P<0.05）。停母乳前后母乳中EGF浓度变化无统计学意义（343.50±95.23pg/ml VS338.81±104.03pg/ml）。③TcB_额、TcB_(额胸)、TcB_胸与TSB值呈显著正相关性（相关系数分别是r_额=0.815，P<0.001；r额胸=0.812，P<0.001；r_胸=0.798，P<0.001）。④TcB_额、TcB额胸、TcB_胸值平均要高于TSB值约2.13，1.53，0.98mg/dL。胸部是TcB的最佳检测部位。
结论：EGF可能与足月新生儿晚发型母乳性黄疸的发生密切相关。胸部可以作为TcB检测最佳部位。TcB较TSB约高1-2mg/dl。在临床应用经皮胆红素诊疗时，要考虑到TcB与TSB之间的差异。
Objective: To discuss the relationship between epidermal growth factor (EGF)and late-onset breast milk jaundice and to select the optimal site of transcutaneousbilirubin measurement.
Methods: A total of75neonates with late-onset breast milkjaundice(experimental group) and25controls(normal neonates at the same days)were enrolled from the pediatric outpatient department of our hospital. Aim to findthe difference of the EGF in breast milk and serum of the two groups. A total of30neonates with late-onset breast milk jaundice had been intervented of stopping breastmilk for almost72h. Aim to find the difference of the EGF in breast milk and serumand serum total bilirubin in the neonates with stopping breast milk. Elisa method wasused to detect the concentration of EGF. At the same time,the forehead and chesttranscutaneous billirubin were measured by the transcutaneous bilirubinometer ofJH20-1C, the mean of forehead and chest transcutaneous bilirubin recorded asforehead-chest transcutaneous bilirubin.Compare the values of TcB with differentsites and TSB to select the optimal site of transcutaneous bilirubin measurement.Andfind the differences bettwen the values of TcB with different sites and TSB.
Results: The experimental group total bilirubin, serum and breast milk EGFwere higher than those in the control group. The values were233.16±41.93u mol/LVS115.7±33.89umol/L(P <0.01);556.37±169.5pg/ml VS493.24±159.82pg/ml;338.59±99.87pg/ml VS317.92±85.70pg/ml(P>0.05) respectively. In30pairedsamples after stopping breast-feeding serum total bilirubin and EGF concentrationdecreased. Serum total bilirubin was228.82±41.07umol/L VS159.05±48.74umol/L(P <0.001), dropped about24.83%-36.48%; serum EGF concentration was502.27±188.40pg/ml VS444.81±134.18pg/ml(P=0.023, P <0.05); milk EGFconcentration did not change. Breast milk EGF concentration was343.50±95.23pg/mlVS338.81±104.03pg/ml(P=0.805, P>0.05). The forehead, forehead-chest, chesttranscutaneous bilirubin measurement values were positively associated with the serum bilirubin values(r-额=0.815，P<0.001；r_(额胸)=0.812，P<0.001；r胸=0.798，P<0.001).The forehead, forehead-chest, chest transcutaneous bilirubin were higher than totalserum bilirubin, approximately2.13,0.98,1.53mg/dL, respectively. The site of chestwas the optimal site of transcutaneous bilirubin measurement.
Conclusion: Epidermal growth factor maybe related to the occurrence of lateonset breast milk jaundice. Chest could be as the optimal site of transcutaneousbilirubin measurement. TcB is about1-2mg/dl higher than TSB. In the clinicalapplication of percutaneous diagnosis and treatment, we should consider thedifference between TcB and TSB.
引文
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[1] Basu, Das, Bhattacharya. et al. A new look on neonatal jaundice[J]. J Indian Med Assoc,2002Sep;100(9):556-60,574.
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[9] Yau KI, Chien CH, Fong LL. et al. Breast milk beta-glucuronidase in breast milk jaundice[J].J Formos Med Assoc,1992Mar;91(3):287-93.
[10] Ince Z, Coban A, Peker I. et al. Breast milk beta-glucuronidase and prolonged jaundice in theneonate[J]. Acta Paediatr,1995Mar;84(3):237-9.
[11] Yigit S, Ciliv G, Aygun C. et al. Breast milk beta-glucuronidase levels inhyperbilirubinemia[J]. Turk J Pediatr,2001Apr-Jun;43(2):118-20.
[12]陈洪敏，候红梅，李雅雯.母乳性黄疸与母乳中β-葡萄糖醛酸苷酶的关系[J].江苏医药，2008，34(1)：856.
[13] MartiU, Burwen SJ, JonesAL. Biological effects of epidermal growth factor, with emphasison the gastrointestinal tract and liver: an update [J]. Hepatology,1989,9(1):126-138.
[14] Shinohara H, Williams CS, Yakabe T, Koldovsky O1996Epidermal growth factor delaysgastric emptying and small intestinal transit in suckling rats[J]. Pediatr Res,39:281–286
[15] Kumral A, Ozkan H, Duman N, et al.Breast Milk Jaundice Correlates With High Levels ofEpidermal Growth Factor[J]. Pediatric Research,2009;66:218-221
[16] XIAO Xin，XIONG Aihua，CHEN Xin，et al.Epidermal growth factor concenatrations inhuman milk,cow’s milk and cow’s milk-based infant formulas[J].Chinese Mekical Journal,2002;115(3):451-454
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[19] Kilic I, Koseler A, Cakaloz I. et al. Screening for G71R mutation of theUDP-glucuronosyltransferase1(UGT1A1) gene in neonates with pathologic and prolongedhyperbilirubinemia in Turkey[J]. Int J Clin Pharmacol Ther,2010Aug;48(8):504-8.
[20] Fujiwara R, Nguyen N, Chen S. et al. Developmental hyperbilirubinemia and CNS toxicityin mice humanized with the UDP glucuronosyltransferase1(UGT1) locus[J]. Proc Natl AcadSci U S A,2010Mar16;107(11):5024-9. Epub2010Mar1.
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[2]邵肖梅,叶鸿帽,丘小汕，等.实用新生儿学[M].第4版.北京：人民卫生出版社,2011,277-279.
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