常州地区新生儿出生后经皮胆红素水平及对高胆红素血症风险的预测  

Transcutaneous bilirubin for predicting neonatal hyperbilirubinemia in Changzhou region of China

作　　者：王瑛[1] 王金秀[1] 江华[1] 张琳[1] 刘滢[1] 丁雪晶[1] 

机构地区：[1]南京医科大学附属常州妇幼保健院新生儿科,江苏南京213003

出　　处：《上海医学》2012年第12期1043-1046,共4页Shanghai Medical Journal

基　　金：常州市卫生局重大招标资助项目(ZD201014)

摘　　要：目的预测新生儿出院后发生高胆红素血症的风险。方法选择2010年1―12月南京医科大学附属常州妇幼保健院出生的母婴同室中胎龄≥35周且出生体重≥2000g的健康近足月和足月新生儿1989例,测定其出生1周内经皮胆红素(TcB)水平。出生后168h对应最高危区域的TcB测定值作为预测指标,以小时为单位的TcB曲线图将出院前的TcB测定值转换至"危险区域",根据受试者工作特征曲线(ROC曲线)分析TcB百分位列线图预测高胆红素血症的发生风险。结果 TcB的平均峰值为(169.3±32.5)μmol/L,其中,P40、P75和P95的TcB值分别为164.2、191.5和218.9μmol/L;TcB≥220.6μmol/L占7.6%(152/1989)。TcB值随出生小时数的推移迅速升高,但变化幅度的差异并无统计学意义(P值均>0.05)。新生儿不同季度和出生后不同时间点的P95TcB值的差异均有统计学意义(F值分别为44.8和39.0,P值均<0.05)。高危区域的高胆红素血症患病率为26.6%(38/143),中高危区域为10.6%(64/603),低危区域出院后无1例新生儿的TcB值升至中高危及高危区域。出院后随访无1例患儿发生胆红素脑病。胎龄和新生儿出院前TcB值相结合预测高胆红素血症发生风险的ROC曲线下面积为0.8804(95%CI为0.8491～0.9117),小于单纯以小时TcB水平预测的0.8826(95%CI为0.8517～0.9134,P<0.05)。结论出院前对新生儿进行高胆红素血症风险评估,对及时发现和预防新生儿高胆红素血症和胆红素脑病至关重要。Objective To predict the risk of hyperb and treating neonatal hyperbilirubinemia timely. Methods rubinemia in newborns after discharge for detecting Totally 1 989 healthy infants （gestational age≥ 35 weeks and birth weight≥2 000 g） born in direct rooming-in in Changzhou Women and Children Health Hospital from January to December 2010 were enrolled in the study. Transcutaneous bilirubin （TcB） was measured within the first postnatal week. The TcB at 168 h after birth in the highest risk zone was taken as predictive indicator for hyperbilirubinemia. Hour-specific TcB nomogram was designed to predict the risk of hyperbilirubinemia. Results The average peak of TcB was （169.3±32. 5） μmol/L. The P40, P75 and P95 were 164. 2, 191. 5 and 218.9 iJmol/L, respectively. TcB level in 7.6% （152/1 989） of neonates was 220.6 μmol/L or more. TcB level was quickly increased, but the change of TcB was not significantly different （all P〉0.05）. There was significant difference in P95 TcB among different seasons and time points after birth （F = 44.8 and 39.0, all P〈0. 05）. Hyperbilirubinemia prevalence was rate 26.6% （38/143） in the high-risk zone. And it was 10.6% （64/603） in the high- and intermediate-risk zones. There was no newborn in the low-risk zone whose TcB level after discharge was elevated to the intermediate or high-risk zone. No kernicterus occurred during follow-up. The areas under the receiver operating characteristic （ROC） curves based on gestational age and bilirubin level before discharge were less than that based on hour-TcB level （0. 880 4 vs. 0. 882 6, P〈0. 05）. Conclusion It is essential to assess the risk of neonatal hyperbilirubinemia, which is vital for detecting and preventing neonatal hyperbilirubinemia and bilirubin encephalopathy timely.

关 键 词：新生儿高胆红素血症 经皮胆红素 风险评估 

分 类 号：R722.1[医药卫生—儿科]