新生儿胆红素脑病的早期诊断及神经损伤的综合评价  

Early diagnosis of neonatal bilirubin encephalopathy and comprehensive evaluation of nerve injury

作　　者：张健[1] 郑洪[1] 刘光辉[1] 孙路璐[1] 

机构地区：[1]安徽省立儿童医院新生儿科,安徽合肥230051

出　　处：《中国妇幼健康研究》2014年第2期184-186,共3页Chinese Journal of Woman and Child Health Research

基　　金：安徽省卫生厅科研资助项目(2010C086)

摘　　要：目的分析高胆红素血症患儿脑脊液未结合胆红素(UCB)在诊断胆红素脑病时的敏感性和特异性。方法通过对36例高胆红素血症患儿进行脑脊液UCB、血清胆红素UCB、头颅核磁共振(MRI)、脑干听觉诱发电位(BAEP)及新生儿心理行为测定(NBNA),综合评价胆红素脑病患儿早期的神经损伤情况及诊断的敏感指标。结果胆红素脑病患儿脑脊液UCB为(13.85±5.10)μmol/L,显著高于非胆红素脑病组的(6.12±4.55)μmol/L,差异有统计学意义(t=6.888,P<0.01);ROC曲线分析显示脑脊液UCB诊断胆红素脑病的曲线下面积(0.910)大于血清UCB面积(0.690),临界值为9.50μmol/L时,其灵敏度为89.0%,特异度为91.2%,均高于血清UCB;胆红素脑病患儿头颅磁共振苍白球T1WI高信号发生率(77.8%),显著高于非胆红素脑病组(7.9%),差异有统计学意义(x^2=37.088,P<0.01);BAEP异常率(80.6%)显著高于非胆红素脑病组(18.4%),差异有统计学意义(x^2=28.569,P<0.01);其NBNA评分(34.0±2.4)低于非胆红素脑病组(36.6±2.3),差异有统计学意义(t=-4.759,P<0.01)。结论脑脊液UCB可作为新生儿胆红素脑病早期诊断的敏感指标,胆红素脑病患儿早期神经损伤发生率高,需早期干预及定期随访。Objective To analyze the sensitivity and specificity of unconjugated bilirubin （ UCB） in neonates with hyperbilirubinemia in the diagnosis of bilirubin encephalopathy .Methods UCB in cerebrospinal fluid （CSF）, UCB in serum bilirubin, MRI, BAEP and NBNA of 36 neonates with hyperbilirubinemia were detected to evaluate the nerve injury and sensitive index of diagnosis in neonates with bilirubin encephalopathy.Results The level of CSF UCB in neonates with bilirubin encephalopathy was higher than that of controls （13.85 ±5.10μmol/L vs 6.12 ±4.55μmol/L）, and the difference was statistically significant （t=6.888,P〈0.01）.The area under curve of CSF UCB （0.910） was larger than that of serum UCB （0.690） by ROC curve.When the cutoff value was 9.50μmol/L, the sensitivity was 89.0%and the specificity was 91.2%, which were higher than those of serum UCB .The incidence of MRI high signal of globus pallidus in T 1WI （77.8%） was significantly higher than that of the controls （7.9%） （χ2 =37.088, P〈0.01）.The abnormal rate of BAEP was 80.6%, which was significantly higher than that of the controls （18.4%） （χ2 =28.569, P＆lt;0.01）.But the NBNA score was lower in than in controls （34.0 ±2.4 vs 36.6 ±2.3）, and the difference was significant （t =-4.759, P 〈0.01）.Conclusion CSF UCB can be considered as a sensitive index in the diagnosis of neonatal bilirubin encephalopathy .Neonates with bilirubin encephalopathy have high incidence of nerve injury at early stage , which needs early intervention and regular follow-up.

关 键 词：新生儿 胆红素脑病 早期诊断 神经损伤 

分 类 号：R722[医药卫生—儿科]