新生儿高胆红素血症风险预测的区域性研究  

Risk prediction of neonatal hyperbilirubinemia

作　　者：黄家虎 孙建华[1] 贝斐 王亮君 步军[1] 张国庆[1] 叶秀霞[1] 须丽清 邵志英[2] 张蕾[3] 刘丽晓 Huang Jiahu;Sun Jianhua;Bei Fei;Wang Liangjun;Bu Jun;Zhang Guoqing;Ye Xiuxia;Xu Liqing;Shao Zhiying;Zhang Lei;Liu Lixiao(Department of Neonatology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Pediatrics,Shanghai Pudong New Area Health Care Hospital for Women and Children,Shanghai 201206,China;Department of Pediatrics,Shanghai Pudong New Area People's Hospital,Shanghai 201299,China;Department of Pediatrics,Shanghai Pudong Hospital,Shanghai 201399,China.)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心新生儿科,200127 [2]上海市浦东新区妇幼保健院儿科,201206 [3]上海市浦东新区人民医院儿科,201299 [4]上海市浦东医院儿科,201399

出　　处：《中华新生儿科杂志（中英文）》2021年第5期30-34,共5页Chinese Journal of Neonatology

基　　金：浦东新区卫生和计划生育委员会卫生科技项目(PW2016D-9)。

摘　　要：目的探讨小时胆红素百分位列线图结合临床危险因素预测新生儿发生高胆红素血症风险的效能。方法选择2017年8月至2018年7月在上海市浦东新区妇幼保健院、上海市浦东新区人民医院和上海市浦东医院出生新生儿的围产期临床资料进行前瞻性研究,产科出院前每天监测经皮胆红素值(tanscutaneous bilirubin,TcB),出院后进行门诊随访和28 d电话随访,根据是否发生新生儿高胆红素血症(neonatal hyperbilirubinemia,NHB)分为NHB组和非高胆红素血症(non-hyperbilirubinemia,Non-HB)组,进行临床危险因素分析。将产科出院前TcB所处小时胆红素百分位列线图区间和临床危险因素作为预测指标,结合多因素Logistic回归分析和受试者工作特征(receiver operative characteristic,ROC)曲线评估小时胆红素值百分位列线图结合临床危险因素预测新生儿发生NHB风险的效能。结果共8664名新生儿纳入研究,发生NHB 1196例,发生率13.8%。Logistic回归分析显示,母亲血型O型、胎膜早破、男性、胎龄35~37周、皮下瘀斑/头颅血肿、母乳喂养为新生儿发生NHB的独立危险因素(P<0.05)。以小时胆红素百分位列线图、临床危险因素、小时胆红素百分位列线图结合临床危险因素预测NHB的ROC曲线下面积分别为0.874(95%CI 0.861~0.885)、0.664(95%CI 0.647~0.680)、0.891(95%CI 0.880~0.902),P均<0.05。结论小时胆红素百分位列线图结合临床危险因素能更好地预测新生儿发生NHB的风险,对于NHB的临床管理具有良好的指导意义。Objective To study the predictive value of hour-specific total serum bilirubin(TSB)nomogram combined with clinical risk factors in the risk of hyperbilirubinemia.Method Perinatal clinical data of newborns born in Shanghai Pudong New Area Health Care Hospital for Women and Children,Shanghai Pudong New Area People's Hospital and Shanghai Pudong Hospital from August 2017 to July 2018 were collected in this prospective study.Transcutaneous bilirubin(TcB)was monitored before discharge from hospital.Enrolled neonates were followed up for 28 days.The patients were assigned to neonatal hyperbilirubinemia group(NHB)and non-hyperbilirubinemia group(Non-HB)according to the occurrence of hyperbilirubinemia.The predictive value of models for the risk of hyperbilirubinemia was evaluated by receiver operating characteristic(ROC)curves and Logistic regression analysis.Result A total of 8664 newborns were included in this study,with 1196 cases of hyperbilirubinemia,with an incidence of 13.8%.Logistic regression analysis showed that maternal blood type O,premature rupture of membranes,male gender,gestational age 35~37 weeks,subcutaneous ecchymosis/cranial edema,and breastfeeding were independent risk factors for NHB(P<0.05).The area under receiver operative characteristic curve(ROC)of predischarge bilirubin risk zone only was 0.874(95%CI 0.861~0.885,P<0.05)and for all independent risk factors was 0.664(95%CI 0.647~0.680,P<0.05).The area under ROC curve was 0.891(95%CI 0.880~0.902,P<0.05)by combining predischarge bilirubin risk zone with clinical risk factors.Conclusion Predischarge bilirubin risk zone combined with clinical risk factors can reasonably predict neonatal hyperbilirubinemia well.

关 键 词：高胆红素血症 新生儿 危险因素 小时胆红素百分位列线图 风险预测 

分 类 号：R722.1[医药卫生—儿科]