新生儿发生高胆红素血症危险因素分析
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摘要
目的探讨影响新生儿发生高胆红素血症的危险因素。方法 2015年5月～2018年2月我院诊治的高胆红素血症新生儿86例和同期健康新生儿86例,采用Logistic多因素分析影响新生儿发生高胆红素血症的危险因素。结果高胆红素血症新生儿出生体质量低、胎龄短和剖腹产分娩比例高,与健康新生儿比,差异显著(P<0.05);高胆红素血症新生儿血清肌红蛋白(MYO)和前白蛋白(PA)水平为(37.5±13.6) U/L和(79.9±23.5)U/L,显著低于健康新生儿【分别为(63.2±18.4) U/L和(108.6±27.3) U/L,P<0.05】,谷氨酰转肽酶(GGT)和谷草转氨酶(AST)水平分别为(141.7±45.9) U/L和(39.8±13.1) U/L,显著高于健康新生儿【分别为(113.6±39.3) U/L和(33.4±12.6) U/L,P<0.05】;多因素Logistic回归分析显示,新生儿出生体质量(OR=6.2,P=0.003)、胎龄(OR=2.8,P=0.004)、MYO(OR=3.4,P<0.001)、PA(OR=2.9,P=0.001)、GGT(OR=3.2,P=0.011)、AST(OR=3.7,P=0.024)水平和凝血功能指标为影响新生儿发生高胆红素血症的相关危险因素(P<0.05)。结论高胆红素血症新生儿存在肝功能受损,对新生儿高胆红素血症相关危险因素进行监测并及时采取措施干预将有助于降低其危害。
Objective To explore the risk factors for occurrence of hyperbilirubinemia in neonates. Methods 86 neonates with hyperbilirubinemia and another 86 healthy neonates were recruited in the Department of Neonatology in our hospital between May 2015 and February 2018,and the Logistic analysis were applied for the analysis of risk factors. Results The proportion of caesarean delivery,short gestational age and decreased body mass at birth in neonates with hyperbilirubinemia were significantly higher than in healthy neonates(P <0.05);serum level of myoglobin and prealbumin in neonates with hyperbilirubinemia were(37.5±13.6)U/L and(79.9±23.5) U/L,much lower than [(63.2±18.4)U/L and(108.6±27.3)U/L,P<0.05],serum GGT and AST levels were(141.7±45.9)U/L and(39.8±13.1)U/L,significantly higher than [113.6 ±39.3) U/L and(33.4 ±12.6) U/L,respectively,P <0.05] in the healthy neonates;multivariate Logistic regression analysis showed that body mass at birth(OR =6.2,P =0.003),gestational age(OR=2.8,P=0.004),myoglobin(OR=3.4,P<0.001),prealbumin(OR=2.9,P=0.001),GGT(OR=3.2,P=0.011),AST(OR=3.7,P=0.024)and PT were the risk factors for the occurrence of hyperbilirubinemia in neonates. Conclusion The liver function index in neonates with hyperbilirubinemia are damaged,and monitoring the risk factors related to hyperbilirubinemia and taking timely measures to intervene are helpful to reduce the incidence of untoward outcomes.
Objective To explore the risk factors for occurrence of hyperbilirubinemia in neonates. Methods 86 neonates with hyperbilirubinemia and another 86 healthy neonates were recruited in the Department of Neonatology in our hospital between May 2015 and February 2018,and the Logistic analysis were applied for the analysis of risk factors. Results The proportion of caesarean delivery,short gestational age and decreased body mass at birth in neonates with hyperbilirubinemia were significantly higher than in healthy neonates(P <0.05);serum level of myoglobin and prealbumin in neonates with hyperbilirubinemia were(37.5±13.6)U/L and(79.9±23.5) U/L,much lower than [(63.2±18.4)U/L and(108.6±27.3)U/L,P<0.05],serum GGT and AST levels were(141.7±45.9)U/L and(39.8±13.1)U/L,significantly higher than [113.6 ±39.3) U/L and(33.4 ±12.6) U/L,respectively,P <0.05] in the healthy neonates;multivariate Logistic regression analysis showed that body mass at birth(OR =6.2,P =0.003),gestational age(OR=2.8,P=0.004),myoglobin(OR=3.4,P<0.001),prealbumin(OR=2.9,P=0.001),GGT(OR=3.2,P=0.011),AST(OR=3.7,P=0.024)and PT were the risk factors for the occurrence of hyperbilirubinemia in neonates. Conclusion The liver function index in neonates with hyperbilirubinemia are damaged,and monitoring the risk factors related to hyperbilirubinemia and taking timely measures to intervene are helpful to reduce the incidence of untoward outcomes.
引文
[1]Tufail A,Ahmad I,Arshad R,et al.Comparison of light-emitting diodelights vs fluorescent light phototherpy for the treatment of unconjugated hyperbilirubinemia in preterm infants-randomised control trial.Pediatr Int,2017,59(9):959-966.
[2]Ocon AJ,Rosenblum M,Desemone J,et al.Severe cholestatic hyperbilirubinaemia secondary to thyrotoxicosis complicated with bile cast nephropathy treated with plasma exchange and haemodialysis.BMJ Case Rep,2019,12(6):e229097.
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[4]Mikuta T,Suchacz MM,Stańczak W,et al.Mild hyperbilirubinemia as a marker of oesophageal varices in hcv-related compensated cirrhotic patients.Pol Merkur Lekarski,2019,46(275):209-212.
[5]Ivashchuk SI,Sydorchuk LP.The parameters of liver functional state as a risk factor of edematous pancreatitis development providing of genetic determination of il-4 production.Wiad Lek,2019,72(4):639-644.
[6]Lin PMF,Chow SCY,Ng SWY,et al.Acute liver failure with extreme hyperbilirubinemia secondary to endocarditis-related severe mitral and tricuspid regurgitation:a challenge and an opportunity for surgeons.J Thorac Dis,2018,10(2):1067-1071.
[7]Hu HJ,Jin YW,Zhou RX,et al.Clinical value of inflammation-based prognostic scores to predict the resectability of hyperbilirubinemia patients with potentially resectable hilar cholangiocarcinoma.J Gastrointest Surg,2019,23(3):510-517.
[8]Qosa H,Avaritt BR,Hartman NR,et al.In vitro ugt1a1 inhibition by tyrosine kinase inhibitors and association with drug-induced hyperbilirubinemia.Cancer Chemother Pharmacol,2018,82(5):795-802.
[9]陈淑芳,王六燕,俞静云,等.PA和γ-GT在新生儿高胆红素血症中的诊断价值.中国妇幼健康研究,2018,29(9):1076-1079.
[10]Erdol S,Ozgur T.Vitamin b12 deficiency associated with hyperbilirubinemia and cholestasis in infants.Pak J Med Sci,2018,34(3):714-718.
[11]Al-Omran A,Al-Abdi S,Al-Salam Z,et al.Readmission for neonatal hyperbilirubinemia in an area with a high prevalence of glucose-6-phosphate dehydrogenase deficiency:a hospitalbased retrospective study.J Neonatal Perinatal Med,2017,10(2):181-189.
[12]Jilma-Stohlawetz P,Lysy K,Belik S,et al.Interference in specialized coagulation assays affecting the protein c pathway:effects of marked haemolysis,hyperbilirubinaemia and lipaemia on chromogenic and clotting tests on two coagulation platforms.Int J Lab Hematol,2019,41(3):404-411.
[13]Yang S,Duffy JY,Johnston R,et al.Association of a delayed cord-clamping protocol with hyperbilirubinemia in term neonates.Obstet Gynecol,2019,133(4):54-761.
[14]Tabatabaee RS,Golmohammadi H,Ahmadi SH.Easy diagnosis of jaundice:a smartphone-based nanosensor bioplatform using photoluminescent bacterial nanopaper for point-of-care diagnosis of hyperbilirubinemia.ACS Sens,2019,4(4):1063-1071.
[15]王军梅,毛桂平,赵海举.新生儿高胆红素血症患儿胆红素的变化与继发性血小板增多症及凝血异常的临床研究.中国优生与遗传杂志,2018,26(4):61-63.
[16]Alkén J,Hakansson S,Ekéus C,et al.Rates of extreme neonatal hyperbilirubinemia and kernicterus in children and adherence to national guidelines for screening,diagnosis,and treatment in sweden.JAMA Netw Open,2019,2(3):e190858.
[17]Piwowarczyk P,Kutnik P,Potrec-Studzińska B,et al.Hemoadsorption in isolated conjugated hyperbilirubinemia after extracorporeal membrane oxygenation support.cholestasis of sepsis:a case report and review of the literature on differential causes of jaundice in icu patient.Int J Artif Organs,2019,42(5):263-268.
[18]张三红.新生儿高胆红素血症胆红素峰值与β2-微球蛋白、胱抑素C和尿素氮及血肌酐的相关性分析.中国全科医学,2017,20(1):136-138.
[19]van der Geest BAM,de Graaf JP,Bertens LCM,et al.Screening and treatment to reduce severe hyperbilirubinaemia in infants in primary care(starship):a factorial stepped-wedge cluster randomised controlled trial protocol.BMJ Open,2019,9(4):e028270.
[20]杨敏,卢明芹.肝细胞性黄疸的诊断与治疗.实用肝脏病杂志,2018,21(2):160-162.
[21]Itoh S1,Okada H1,Kuboi T,et al.Phototherapy for neonatal hyperbilirubinemia.Pediatr Int,2017,59(9):959-966.
[22]Shi X,Aronson S,Khan AS,et al.A novel ugt1a1 gene mutation causing severe unconjugated hyperbilirubinemia:a case report.BMC·Pediatr,2019,19(1):173.
[23]Ezetendu C,Jarden A,Hamzah M,et al.Bivalirudin anticoagulation for an infant with hyperbilirubinemia and elevated plasma-free hemoglobin on ecmo.J Extra Corpor Technol,2019,51(1):26-28.
[2]Ocon AJ,Rosenblum M,Desemone J,et al.Severe cholestatic hyperbilirubinaemia secondary to thyrotoxicosis complicated with bile cast nephropathy treated with plasma exchange and haemodialysis.BMJ Case Rep,2019,12(6):e229097.
[3]Xi Y,Wang L,Zhang P,et al.A novel mutation in spta1 identified by whole exome sequencing in a chinese family for hereditary elliptocytosis presenting with hyperbilirubinemia:a case report.Medicine(Baltimore),2019,98(22):e15800.
[4]Mikuta T,Suchacz MM,Stańczak W,et al.Mild hyperbilirubinemia as a marker of oesophageal varices in hcv-related compensated cirrhotic patients.Pol Merkur Lekarski,2019,46(275):209-212.
[5]Ivashchuk SI,Sydorchuk LP.The parameters of liver functional state as a risk factor of edematous pancreatitis development providing of genetic determination of il-4 production.Wiad Lek,2019,72(4):639-644.
[6]Lin PMF,Chow SCY,Ng SWY,et al.Acute liver failure with extreme hyperbilirubinemia secondary to endocarditis-related severe mitral and tricuspid regurgitation:a challenge and an opportunity for surgeons.J Thorac Dis,2018,10(2):1067-1071.
[7]Hu HJ,Jin YW,Zhou RX,et al.Clinical value of inflammation-based prognostic scores to predict the resectability of hyperbilirubinemia patients with potentially resectable hilar cholangiocarcinoma.J Gastrointest Surg,2019,23(3):510-517.
[8]Qosa H,Avaritt BR,Hartman NR,et al.In vitro ugt1a1 inhibition by tyrosine kinase inhibitors and association with drug-induced hyperbilirubinemia.Cancer Chemother Pharmacol,2018,82(5):795-802.
[9]陈淑芳,王六燕,俞静云,等.PA和γ-GT在新生儿高胆红素血症中的诊断价值.中国妇幼健康研究,2018,29(9):1076-1079.
[10]Erdol S,Ozgur T.Vitamin b12 deficiency associated with hyperbilirubinemia and cholestasis in infants.Pak J Med Sci,2018,34(3):714-718.
[11]Al-Omran A,Al-Abdi S,Al-Salam Z,et al.Readmission for neonatal hyperbilirubinemia in an area with a high prevalence of glucose-6-phosphate dehydrogenase deficiency:a hospitalbased retrospective study.J Neonatal Perinatal Med,2017,10(2):181-189.
[12]Jilma-Stohlawetz P,Lysy K,Belik S,et al.Interference in specialized coagulation assays affecting the protein c pathway:effects of marked haemolysis,hyperbilirubinaemia and lipaemia on chromogenic and clotting tests on two coagulation platforms.Int J Lab Hematol,2019,41(3):404-411.
[13]Yang S,Duffy JY,Johnston R,et al.Association of a delayed cord-clamping protocol with hyperbilirubinemia in term neonates.Obstet Gynecol,2019,133(4):54-761.
[14]Tabatabaee RS,Golmohammadi H,Ahmadi SH.Easy diagnosis of jaundice:a smartphone-based nanosensor bioplatform using photoluminescent bacterial nanopaper for point-of-care diagnosis of hyperbilirubinemia.ACS Sens,2019,4(4):1063-1071.
[15]王军梅,毛桂平,赵海举.新生儿高胆红素血症患儿胆红素的变化与继发性血小板增多症及凝血异常的临床研究.中国优生与遗传杂志,2018,26(4):61-63.
[16]Alkén J,Hakansson S,Ekéus C,et al.Rates of extreme neonatal hyperbilirubinemia and kernicterus in children and adherence to national guidelines for screening,diagnosis,and treatment in sweden.JAMA Netw Open,2019,2(3):e190858.
[17]Piwowarczyk P,Kutnik P,Potrec-Studzińska B,et al.Hemoadsorption in isolated conjugated hyperbilirubinemia after extracorporeal membrane oxygenation support.cholestasis of sepsis:a case report and review of the literature on differential causes of jaundice in icu patient.Int J Artif Organs,2019,42(5):263-268.
[18]张三红.新生儿高胆红素血症胆红素峰值与β2-微球蛋白、胱抑素C和尿素氮及血肌酐的相关性分析.中国全科医学,2017,20(1):136-138.
[19]van der Geest BAM,de Graaf JP,Bertens LCM,et al.Screening and treatment to reduce severe hyperbilirubinaemia in infants in primary care(starship):a factorial stepped-wedge cluster randomised controlled trial protocol.BMJ Open,2019,9(4):e028270.
[20]杨敏,卢明芹.肝细胞性黄疸的诊断与治疗.实用肝脏病杂志,2018,21(2):160-162.
[21]Itoh S1,Okada H1,Kuboi T,et al.Phototherapy for neonatal hyperbilirubinemia.Pediatr Int,2017,59(9):959-966.
[22]Shi X,Aronson S,Khan AS,et al.A novel ugt1a1 gene mutation causing severe unconjugated hyperbilirubinemia:a case report.BMC·Pediatr,2019,19(1):173.
[23]Ezetendu C,Jarden A,Hamzah M,et al.Bivalirudin anticoagulation for an infant with hyperbilirubinemia and elevated plasma-free hemoglobin on ecmo.J Extra Corpor Technol,2019,51(1):26-28.