内蒙古地区新生儿急性胆红素脑病的影响因素及预测指标的多中心研究  

Influencing factors and predictive indicators for neonatal acute bilirubin encephalopathy in Inner Mongolia:a multicenter study

作　　者：许玉红 刘春枝[1] 王爱琼[2] 李婷 张晓梅 曲艳杰[4] 李宏颖[5] 付黎明 谢华 李晓红 高萌[9] 召拉 Xu Yuhong;Liu Chunzhi;Wang Aiqiong;Li Ting;Zhang Xiaomei;Qu Yanjie;Li Hongying;Fu Liming;Xie Hua;Li Xiaohong;Gao Meng;Zhao La(Department of Neonatology,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Department of Neonatology,Ordos Central Hospital,Ordos 017000,China;Department of Neonatology,People's Hospital of Inner Mongolia Autonomous Region,Hohhot 010017,China;Department of Neonatology,the Fourth Hospital of Baotou,Baotou 014030,China;Department of Pediatrics,Tongliao Hospital,Tongliao 028000,China;Department of Pediatrics,Maternal and Child Health Hospital of Hohhot,Hohhot 010020,China;Department of Pediatrics,the Affiliated Hospital of Chifeng University,Chifeng 024005,China;Department of Pediatrics,Manzhouli People's Hospital,Manzhouli 021400,China;Department of Neonatology,Chifeng Hospital,Chifeng 024000,China)

机构地区：[1]内蒙古医科大学附属医院新生儿科,呼和浩特010050 [2]鄂尔多斯市中心医院新生儿科,鄂尔多斯017000 [3]内蒙古自治区人民医院新生儿科,呼和浩特010017 [4]包头市第四医院新生儿科,包头014030 [5]通辽市医院儿科,通辽028000 [6]呼和浩特市妇幼保健院儿科,呼和浩特010020 [7]赤峰学院附属医院儿科,赤峰024005 [8]满洲里市人民医院儿科,满洲里021400 [9]赤峰市医院新生儿科,赤峰024000

出　　处：《中华围产医学杂志》2024年第12期1035-1041,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨重度高胆红素血症并发急性胆红素脑病(acute bilirubin encephalopathy,ABE)的危险因素,以及血清总胆红素(total serum bilirubin,TSB)和胆红素(bilirubin,B)/白蛋白(albumin,A)比值预测ABE的价值。方法回顾性收集2020年1月1日至2021年12月31日期间内蒙古医科大学附属医院、鄂尔多斯市中心医院、内蒙古自治区人民医院、包头市第四医院、通辽市医院、呼和浩特市妇幼保健院、赤峰学院附属医院、满洲里市人民医院和赤峰市医院收治的重度高胆红素血症患儿的临床资料。根据是否发生ABE,将研究对象分为ABE组和非ABE组。采用多因素logistic回归分析ABE的高危因素。采用t检验、Wilcoxon符号秩和检验或χ^(2)检验进行统计学分析。对差异有统计学意义的指标纳入多因素logistic回归模型,采用逐步回归法分析ABE的影响因素。结果(1)共543例患儿进入本研究,占同期收治新生儿总数的3.7%(543/14831)。543例患儿中,ABE 81例(14.9%),非ABE 462例(85.1%);入院日龄(7.2±2.1)d,住院时间(5.2±2.2)d;开奶时间为生后2 d(1~4 d)。543例TSB峰值为(385.98±51.22)µmol/L,TSB达峰值日龄为(4.4±2.1)d。14例(2.5%)入院后逐渐达到峰值[(392.01±61.24)µmol/L],529例(97.5%)入院时TSB即达到峰值[(386.42±50.22)µmol/L]。543例中,356例病因明确(65.6%,其中278例为单一病因,78例病因≥2种),187例(34.4%)病因不明。(2)ABE组开奶时间晚于非ABE组[6 h(2~6 h)与2 h(1~3 h),Z=-6.87],住院时间长于非ABE组[(6.5±1.9)d与(5.0±2.1)d,t=0.55],母乳喂养、胎便排出延迟、同族免疫性溶血和母亲合并妊娠期糖尿病的比例,以及峰值TSB和峰值TSB时的B/A水平均高于非ABE组[64.2%(52/81)与36.8%(170/462),χ^(2)=21.96;16.0%(13/81)与2.4%(11/462),χ^(2)=27.32;27.2%(22/81)与10.6%(40/462),χ^(2)=16.61;24.7%(20/81)与13.6%(63/462),χ^(2)=6.50;(442±68)与(375±39)µmol/L,t=-8.55;(11.9±1.6)与(9.8±1.2),t=-11.61;P值均<0.05]。ABE组的入院体重,以及本院�ObjectiveTo investigate the risk factors for severe hyperbilirubinemia complicated by acute bilirubin encephalopathy(ABE),and the value of total serum bilirubin(TSB)and bilirubin(B)/albumin(A)ratio in predicting ABE.MethodsClinical data of children with severe hyperbilirubinemia admitted to the Affiliated Hospital of Inner Mongolia Medical University,Ordos Central Hospital,People's Hospital of Inner Mongolia Autonomous Region,the Fourth Hospital of Baotou,Tongliao Hospital,Maternal and Child Health Hospital of Hohhot,the Affiliated Hospital of Chifeng University,Manzhouli People's Hospital,and Chifeng Hospital from January 1,2020,to December 31,2021,were retrospectively collected.The subjects were divided into ABE and non-ABE groups based on the occurrence of ABE.Multivariate logistic regression analysis was used to identify high-risk factors for ABE.Statistical analysis was performed using t-test,Wilcoxon signed-rank test,or Chi-square tests.Indicators with statistically significant differences were included in the multivariate logistic regression model,and stepwise regression was used to analyze the influencing factors of ABE.Results(1)A total of 543 children were included in this study,accounting for 3.7%(543/14831)of the total admissions during the same period.Among the 543 children,81(14.9%)had ABE,and 462(85.1%)did not.The age at admission was(7.2±2.1)d,and the length of hospital stay was(5.2±2.2)d.The breastfeeding initiation time was 2 d(1-4 d)after birth.The peak TSB of the 543 cases was(385.98±51.22)µmol/L,and the age at peak TSB was(4.4±2.1)d.Fourteen cases(2.5%)gradually reached the peak TSB after admission[(392.01±61.24)µmol/L],while 529 cases(97.5%)had already reached the peak TSB at admission[(386.42±50.22)µmol/L].Among the 543 cases,356 had a clear etiology(65.6%,with 278 cases having a single cause and 78 cases having more than two causes),and 187 cases(34.4%)had an unknown etiology.(2)Compared with the non-ABE group,the breastfeeding initiation in the ABE group was later[6 h(2-6 h)vs.2

关 键 词：高胆红素血症 新生儿 急性胆红素脑病 危险因素 预测指标 

分 类 号：R722.1[医药卫生—儿科]