游离胆红素预测新生儿胆红素脑病的研究进展  

Usefulness of the unbound serum bilirubin for predicting neonatal bilirubin encephalopathy

作　　者：李建瑜(综述) 李薇(审校)[1] Li Jianyu;Li Wei(Department of Neonatology,Jinan University Medical College affiliated Dongguan Hospital,Dongguan 523900,China)

机构地区：[1]暨南大学医学院附属东莞医院新生儿科,东莞523900

出　　处：《国际儿科学杂志》2019年第8期575-579,共5页International Journal of Pediatrics

摘　　要：胆红素脑病迄今仍是新生儿学界面临的挑战之一。近年欧美发生率为1/100 000~1/40 000,国内发生率高达1.13‰。当前新生儿高胆红素血症诊疗指南以血清总胆红素(total serum bilirubin,TSB)水平结合胎龄、出生体重、日龄及危险因素制定,并以TSB作为光疗和换血的主要指标,有局限性。因为只有血清游离胆红素(unbound serum bilirubin,UB)能穿透血脑屏障和神经细胞膜产生神经毒性,故监测UB水平至关重要。由于直接检测UB难度很大,学者们曾提出检测TSB同时加查血清白蛋白(serum albumin,SA)、TSB/SA比值、TSB/SA摩尔比、SA与TSB亲和力,以间接评估UB水平,但临床实用价值有限。此前直接检测血清UB的氧化酶法、改良过氧化酶法、荧光光度计法的准确性迄今未获公认,亦未在临床常规应用。新近Martelanc等首创高效液相色谱法直接检测UB,精确度达到pmol/L水平。这一最新进展为检测新生儿UB提供了借鉴。但预测新生儿胆红素脑病的UB阈值,还有待进一步研究。该文对UB在预测胆红素脑病的重要作用、预测新生儿胆红素脑病的实验学参数及目前直接检测UB的方法学进行综述。Bilirubin encephalopathy is still one of the challenges for neonatal society.In recent years, the incidence in Europe and North America is 1/100 000~1/40 000, while it is 1.13‰ in China.The current guideline for neonatal hyperbilirubinemia is based on total serum bilirubin(TSB), combined with gestational age, birth weight, age and risk factors.TSB is used as a main index for phototherapy and exchange transfusion.However, only unbound serum bilirubin(UB)can cross blood brain barrier and neuron membrane to cause neurotoxicity, so it is important to monitor UB.In view of the difficulties to measure UB directly, it has been proposed to measure serum albumin(SA), the TSB/SA ratio, TSB/SA molar ratio and the affinity of SA for TSB in addition to monitor TSB, but their clinical practice value is limited.Previously, the methods for direct detection of UB such as oxidase method, modified peroxidase method and photometric method have not been accepted nor routinely used.Recently Martelanc has piloted to use high performance liquid chromatography to directly measure UB with precision up to pmol/L.This recent progress offers reference for measuring UB in neonates, but the threshold of UB predicting bilirubin encephalopathy needs to be further studied.This article will review the important role of UB in predicting bilirubin encephalopathy, predicting experimental parameters of neonatal bilirubin encephalopathy, current methodologies for direct detection of UB.

关 键 词：胆红素脑病 新生儿 游离胆红素 检测 高效液相色谱 

分 类 号：R722.17[医药卫生—儿科]