血管内皮钙黏蛋白结合碳氧血红蛋白预测新生儿ABO溶血病神经功能障碍的价值  

Value of vascular endothelial cadherin binding carboxyhemoglobin in predicting neurological dysfunction in newborns with ABO hemolytic disease

作　　者：孙瑶 孙鹏玲 傅彬 SUN Yao;SUN Pengling;FU Bin(Department of Pediatrics,Lishui Branch of Zhongda Hospital,Southeast University,Nanjing 211200,China)

机构地区：[1]东南大学附属中大医院溧水分院儿科,南京211200

出　　处：《国际免疫学杂志》2024年第4期378-383,共6页International Journal of Immunology

基　　金：江苏省自然科学基金项目(BK20211070)。

摘　　要：目的探讨血管内皮钙黏蛋白(vascular endothelial-cadherin, VE-Cad)结合碳氧血红蛋白(carboxyhemoglobin, COHb)对新生儿ABO溶血病神经功能障碍的预测价值。方法选择东南大学附属中大医院溧水分院2020年6月至2022年6月收治的新生儿ABO溶血病的患儿198例, 检测出生第1、3、5、7天的静脉血清中总胆红素(total bilirubin, TBil)、血红蛋白(hemoglobin, Hb)、COHb、VE-Cad水平, 患儿出生第1天新生儿神经行为测定(neonatal behavioral neurological assessment, NBNA)评分正常, 根据出生第7天的NBNA评分, 将患儿分为神经功能障碍组(NBNA评分<37分)和正常组(NBNA评分37~40分), 分析出生第1天COHb、VE-Cad及两者联合早期评估神经功能障碍发生的价值。结果神经功能障碍组和正常组在不同时间点时的TBil和Hb水平差异有统计学意义(F值分别为6.33、9.00, P值均<0.05), 神经功能障碍组和正常组出生第1、3、5、7天静脉血TBil呈现上升趋势, Hb水平呈现下降趋势(F值分别为4.13、9.63, P值均<0.05), 且神经功能障碍组出生第1、3、5、7天的平均静脉血Hb低于正常组, 平均TBil水平高于正常组(F值分别为8.24、9.00, P值均<0.05)。神经功能障碍组和正常组在不同时间点时COHb和VE-Cad水平差异有统计学意义(F值分别为15.22、15.37, P值均<0.05), 神经功能障碍组和正常组在出生第1、3、5、7天的静脉血COHb和VE-Cad水平均呈现下降趋势(F值分别为10.26、14.23, P值均<0.05), 神经功能障碍组出生第1、3、5、7天的平均COHb和VE-Cad水平均高于正常组(F值分别为11.24、13.67, P<0.05)。COHb联合VE-Cad预测新生儿ABO溶血病神经功能障碍的灵敏度为89.5%, 特异度为93.9%, 曲线下面积(area under curve, AUC)为0.897(P<0.05);两者联合的AUC数值大于COHb、VE-Cad的AUC数值(0.821, 0.802)(P<0.05)。结论 COHb联合VE-Cad早期预测新生儿ABO溶血病神经功能障碍的价值较高, 可以在临床上推广使用。Objective To investigate the predictive value of vascular endothelial cadherin(VE-Cad)binding carboxyhemoglobin(COHb)on neurological dysfunction in newborns with ABO hemolytic disease.Methods A total of 198 newborns with ABO hemolytic disease were selected from Zhongda Hospital Lishui Branch Southeast University from June 2020 to June 2022.The levels of tota lbilirubin(TBil),hemoglobin(Hb),COHb and VE-Cad in intravenous serum were detected at the 1st,3rd,5th and 7th days after birth.The neonatal behavioral neurological assessment(NBNA)score was normal on the 1st day after birth.According to the NBNA score on the 7th day of birth,the children were divided into neurological dysfunction group(NBNA score<37 points)and normal group(NBNA score 37~40 points),and the value of COHb,VE-Cad and their combination in early assessment of neurological dysfunction was analyzed on the 1st day after birth.Results The differences in TBil and Hb levels between the neurological dysfunction group and the normal group at different time points were statistically significant(F values were 6.33,9.00,both values P<0.05),with an increasing trend in venous blood TBil and a decreasing trend in Hb levels between the neurological dysfunction group and the normal group at days 1,3,5,and 7 of birth(F values were 4.13,9.63,both P<0.05),and the The mean venous blood Hb on days 1,3,5 and 7 in the neurological dysfunction group was lower than that of the normal group,and the mean TBil level was higher than that of the normal group(F values were 8.24,9.00,both values P<0.05).The differences in COHb and VE-Cad levels between the neurological dysfunction group and the normal group at different time points were statistically significant(F values were 15.22,15.37,both values P<0.05),and the venous blood COHb and VE-Cad levels of the neurological dysfunction group and the normal group showed a decreasing trend in the 1st,3rd,5th,and 7th days of life(F values were 10.26,14.23,both P values<0.05),and the mean COHb and VE-Cad levels in the neurologic dysfunct

关 键 词：血管内皮钙黏蛋白 碳氧血红蛋白 ABO溶血病 神经功能障碍 

分 类 号：R722.18[医药卫生—儿科]