脐血胆红素对ABO溶血病足月儿高胆红素血症的预测价值  

Predictive value of cord blood bilirubin level for subsequent neonatal hyperbilirubinemia in ABO hemolytic term infants

作　　者：黄丽萍[1] 贲晓明[1] 

机构地区：[1]同济大学附属第一妇婴保健院新生儿科,上海200040

出　　处：《中华围产医学杂志》2015年第1期20-23,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的 研究脐血胆红素水平预测ABO溶血病足月儿发生高胆红素血症的价值.方法 回顾性分析同济大学附属第一妇婴保健院新生儿科2011年8月1日至2012年7月31日收治的292例足月ABO溶血病患儿的脐血胆红素水平.比较发生高胆红素血症（高胆组,34例）和未发生高胆红素血症（非高胆组,258例）患儿的临床特征.采用配对f检验、x2检验和Spearman相关分析对数据进行分析.构建受试者工作特性（receiver operating characteristic,ROC）曲线,分析脐血胆红素水平预测高胆红素血症的准确度及界值（cut-off point）. 结果 高胆组34例患儿平均脐血胆红素水平为（52.4±13.2） μmol/L,明显高于非高胆组的（35.0±8.0） μmol/L（t=7.540,P=0.001）.脐血胆红素水平与高胆红素血症发生率明显相关（x^2=113.715,P＜0.001; rs=7.19,P＜0.001）.新生儿脐血胆红素水平为50μmol/L时,发生黄疸的阳性预测值为0.683,阴性预测值为0.959,敏感性为0.690,特异性为0.958,ROC曲线下面积为0.882 （95％CI：0.873-0.891,P＜0.001）.结论 脐血胆红素水平可作为预测ABO溶血病足月儿发生黄疸及预测黄疸程度的有效指标.Objective To evaluate the predictive value of cord blood bilirubin levels for subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease.Methods A total of 292 term newborns with ABO hemolytic disease admitted from August 1,2011 to July 31,2012 were enrolled.Cord blood bilirubin levels were analyzed and the clinical characteristics of the neonatal hyperbilirubinemia group （n=34） and non-hyperbilirubinemia group （n=258） were compared.A receiver operating characteristic （ROC） curve analysis was performed to identify the predictive value of the occurrence and cut-off point of hyperbilirubinemia in term infants with ABO hemolytic disease.Paired-t-test,Chi-square test and Spearman correlation were used for statistical analysis.Results Of the 292 term infants with ABO hemolytic disease,34 cases had hyperbilirubinemia,with an incidence of 11.6%.Cord blood bilirubin levels were significantly associated with the presence of hyperbilirubinemia.The mean cord blood bilirubin level in infants who developed hyperbilirubinemia was （52.4± 13.2） μ mol/L,and was （35.0±8.0） μ mol/L for those who did not develop hyperbilirubinemia （t=7.540,P=-0.001）.When cord blood bilirubin concentration increased,the incidence of hyperbilirubinemia gradually increased （x^2=113.715,P〈0.001; rs=7.19,P〈0.001）.The ROC area under the curve of 0.882 （standard error 0.005,95%CI：0.873-0.891,P〈0.001） was significant in predicting neonatal hyperbilirubinemia by cord blood bilirubin,and the occurrence of hyperbilirubinemia increased with increasing cord blood bilirubin level.Neonatal cord blood total bilirubin ≥ 50 μ mol/L predicted hyperbilirubinemia,and the positive predictive value was 0.683,negative predictive value was 0.959,sensitivity was 0.690 and specificity was 0.958.Conclusions Cord blood bilirubin level is useful in predicting subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease.

关 键 词：ABO血型系统 血型不合 高胆红素血症 新生儿 胆红素 胎血 

分 类 号：R722.17[医药卫生—儿科]