网织红细胞百分比/未成熟网织红细胞指数联合胆红素与白蛋白比值对新生儿溶血病的病情评估意义  

The significance of reticulocyte percentage/immature reticulocyte fraction combined with the ratio of bilirubin to albumin in the assessment of the condition of hemolytic disease of newborns

作　　者：马海月 南晓琴[2] Ma Haiyue;Nan Xiaoqin(Faculty of Pediatrics,Shanxi Medical University,Taiyuan 030001,Shanxi Province,China;The Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,Shanxi Province,China)

机构地区：[1]山西医科大学儿科医学系,太原030001 [2]山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院),太原030032

出　　处：《中华妇幼临床医学杂志（电子版）》2024年第1期89-96,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家卫生健康委员会新生儿疾病重点实验室开放基金资助项目(NHC-XSRJB-2021-01)。

摘　　要：目的探讨网织红细胞百分比(Retic%)、未成熟网织红细胞指数(IRF)分别联合胆红素与白蛋白比值(B/A),对新生儿溶血病(HDN)患儿发生新生儿高胆红素血症(NHB)的预测价值。方法选择2020年6月至2023年12月于山西白求恩医院住院治疗的63例就诊时龄≤72 h的HDN患儿为研究对象。采用回顾性分析方法,根据生后时龄与血清总胆红素(TSB)水平在Bhutani曲线中对应的百分位区间,将患儿分为NHB高危组(n=43,对应高危区)和NHB非高危组(n=20,对应高中危、低中危及低危区)。采用多因素非条件logistic回归分析法,对本研究HDN患儿发生NHB的独立影响因素进行分析。绘制受试者工作特征(ROC)曲线,并采用曲线下面积(AUC)评估Retic%、IRF及二者分别联合B/A,对HDN患儿发生NHB的预测效果,不同预测模型之间诊断NHB效能(AUC)比较,采用DeLong检验。对入院时Retic%、IRF分别与HDN患儿就诊时龄相关性分析,采用Pearson相关分析法。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。所有患儿监护人签署临床知情同意书。结果①单因素分析结果显示:出生胎龄,入院时TSB水平、B/A、Retic%、网织红细胞(RET)计数绝对值及IRF,以及患儿母亲孕产史,为HDN患儿发生NHB的可能影响因素。②多因素非条件logistic回归分析结果显示:B/A升高(OR=2.496,95%CI:1.236~5.042,P=0.011),Retic%升高(OR=1.710,95%CI:1.088~2.688,P=0.020),IRF升高(OR=1.682,95%CI:1.176~2.407,P=0.004),均为HDN患儿发生NHB的独立危险因素。③ROC曲线分析显示:Retic%与IRF分别联合B/A,对预测HDN患儿发生NHB的ROC-AUC分别为0.790、0.906,敏感度分别为66.7%、71.4%,特异度分别为80.0%、95.0%,阳性预测值分别为86.4%、92.9%,阴性预测值分别为73.7%、81.0%。④入院时Retic%、IRF与HDN患儿就诊时龄,均呈负相关关系(r=-0.584、-0.703,均为P<0.001)。结论Retic%及IRF分别联合B/A,对就诊时龄≤72 h的HDN患儿发�Objective To investigate predictive value of reticulocyte percentage(Retic%)and immature reticulocyte fraction(IRF)in combination with the ratio of bilirubin to albumin(B/A),respectively,for the development of neonatal hyperbilirubinemia(NHB)in hemolytic disease of newborns(HDN).Methods A total of 63 aged≤72 h neonates who were hospitalized and diagnosed with HDN in neonatology department of Shanxi Bethune Hospital from June 2020 to December 2023 were selected as subjects for this study.According to the percentile intervals of postnatal hourly age and serum total bilirubin(TSB)level in the Bhutani curve,the children were divided into the NHB high-risk group(n=43,corresponding to the high-risk zone)and the NHB non-high-risk group(n=20,corresponding to the high-mid-risk zone,low-mid-risk zone,and low-risk zone)by retrospective analysis method.The independent influencing factors of NHB in children with HDN were analyzed by multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve of the subjects was plotted,and the area under the curve(AUC)was used to assess the predictive effect of Retic%,IRF,and the combined B/A of the two,respectively,on the occurrence of NHB in children with HDN,and the comparison of NHB diagnostic efficacy between different predictive models was performed using the DeLong test.The correlation between Retic%,IRF,respectively,and the age of HDN children at admission was analyzed by Pearson correlation analysis.The procedure followed in this study meets the requirements of the World Medical Association Declaration of Helsinki revised in 2013.Informed consents were obtained from all guardians of the children.Results①The results of univariate analysis showed that birth gestational age,TSB level,B/A,Retic%,absolute reticulocyte(RET)count and IRF at admission,as well as maternal pregnancy history,were the possible influencing factors for the development of NHB in children with HDN.②Multivariate unconditional logistic regression analysis showed that B/A was increas

关 键 词：网状细胞 网织红细胞百分比 幼红细胞增多症 胎儿 高胆红素血症 新生儿 未成熟网织红细胞 胆红素与白蛋白比值 婴儿 新生 

分 类 号：R722.18[医药卫生—儿科]