血清总胆红素/白蛋白比值对ABO新生儿溶血病并发败血症早期诊断价值研究  

The value of serum total bilirubin/albumin ratio in early diagnosis of ABO hemolytic disease complicated with sepsis

作　　者：姚倩 刘磊[1] 张杏杏 张文娟 YAO Qian;LIU Lei;ZHANG Xingxing;ZHANG Wenjuan(Department of Blood Transfusion,Fuyang People’s Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]阜阳市人民医院输血科,安徽阜阳236000

出　　处：《中国优生与遗传杂志》2023年第2期301-306,共6页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨血清总胆红素/血清白蛋白比值(B/A)对ABO新生儿溶血病(ABO-HDN)并发败血症早期诊断价值。方法选取2019年3月至2022年5月阜阳市人民医院收治的100例ABO-HDN并发败血症患儿作为观察组,另选择同期于阜阳市人民医院就诊的单纯ABO-HDN患儿100例作为对照组,对比两组临床资料,采用LASSO回归模型及Logistic回归分析ABO-HDN患儿并发败血症的独立危险因素,并建立列线图预测模型。结果与对照组新生儿比较,观察组早产比例、母亲孕期使用抗菌药物比例、母亲孕期使用激素药物比例、白细胞计数、中性粒细胞比值、C反应蛋白(CRP)、降钙素原(PCT)、总胆红素(TSB)及总胆红素/白蛋白(B/A)均较对照组显著增加(P<0.05),而出生体质量及体质量≥出生体质量比例较对照组显著降低(P<0.05)。母亲孕后期使用抗菌药物、CRP、PCT、TSB及B/A均为ABO-HDN患儿并发败血症的独立危险因素(P<0.05)。平滑曲线拟合结果显示,ABO-HDN患儿B/A与并发败血症呈线性正相关关系,当B/A>10.52时,B/A每增加2个单位,患儿并发败血症的风险增加17%(OR=0.80,95%CI:0.68~0.94,P<0.05)。依据独立影响因素构建的列线图预测模型具有较高的区分度、准确性和临床适用性。结论B/A值异常变化与ABO-HDN患儿并发败血症密切相关,结合母亲孕后期使用抗菌药物、CRP、PCT、TSB等变量构建的列线图风险预测模型具有良好的预测效能,可为临床医师诊断新生儿败血症提供参考。Objective To explore the value of serum total bilirubin/serum albumin ratio(B/A)in early diagnosis of ABO hemolytic disease of newborn(ABO-HDN)complicated with sepsis.Methods Select 100 children with ABO-HDN complicated with sepsis treated in Fuyang People’s Hospital from March 2019 to May 2022 as the observation group,and select 100 children with simple ABO-HDN treated in Fuyang People’s Hospital in the same period as the control group.Compare the clinical data of the two groups,use lasso regression model and logistic regression to analyze the independent risk factors of ABO-HDN children complicated with sepsis,and the nomogram prediction model was established.Results Compared with the control group,the proportion of preterm birth,the proportion of antibiotics used by the mother during pregnancy,the proportion of hormone drugs used by the mother during pregnancy,the white blood cell count,the neutrophil ratio,the C-reactive protein(CRP),procalcitonin(PCT),total bilirubin(TSB)and total bilirubin/albumin(B/A)in the observation group were remarkably higher than those in the control group(P<0.05),but the birth weight and the proportion of body weight≥birth weight in the control group were markedly lower(P<0.05).The use of antibiotics,CRP,PCT,TSB and B/A were all independent risk factors of sepsis in children with ABO-HDN(P<0.05).Smooth curve fitting results showed that there was a linear positive correlation between B/A and sepsis in children with ABO-HDN.When B/A>10.52,every 2 units of B/A increased,the risk of sepsis in children increased by 17%(OR=0.80,95%CI:0.68~0.94,P<0.05).The nomogram prediction model based on independent influencing factors has high discrimination,accuracy and clinical applicability.Conclusion The abnormal change of B/A value is closely related to sepsis in children with ABO-HDN.The nomogram risk prediction model constructed by combining the use of antibiotics,CRP,PCT,TSB and other variables in the late pregnancy of the mother has good prediction efficiency and can provide reference fo

关 键 词：ABO溶血病 败血症 总胆红素 白蛋白 诊断 

分 类 号：R722.18[医药卫生—儿科]