新生儿ABO溶血病中血清总胆红素、脐血胆红素水平及网织红细胞计数对神经系统损害的预测价值

doi:10.3760/cma.j.cn441417-20241125-09019

摘要/Abstract

摘要：

目的　探讨血清总胆红素（TBil）、脐血胆红素水平及网织红细胞（RET）计数在新生儿ABO溶血病中的表达异常情况，以及其对神经系统损害的预测价值。方法　选取2021年5月至2024年5月安康市中心医院收治的87例新生儿ABO溶血病患儿作为研究对象。出生后第7天，根据新生儿行为神经测定（NBNA）评分，将患儿分为神经损伤组（35例）和神经非损伤组（52例）。神经损伤组男20例，女15例；胎龄（38.53±0.36）周。神经非损伤组男28例，女24例；胎龄（38.49±0.39）周。收集患儿临床资料（胎龄、性别、体重等）。比较两组血清TBil、脐血胆红素水平及RET计数。采用独立样本t检验和χ2检验进行统计学分析；采用多因素logistic回归分析新生儿ABO溶血病患儿神经损伤的影响因素；采用受试者操作特征曲线（ROC）分析血清TBil、脐血胆红素水平及RET计数对新生儿ABO溶血病患儿神经损伤的预测效能，计算曲线下面积（AUC）。结果　两组临床资料比较，差异均无统计学意义（均P>0.05）。神经损伤组血清TBil、脐血胆红素水平及RET计数均高于神经非损伤组［（192.53±25.17）μmol/L比（169.46±21.42）μmol/L、（47.33±12.06）μmol/L比（31.16±8.95）μmol/L、（4.92±1.74）%比（3.36±0.98）%］（均P<0.05）。多因素logistic回归分析显示，血清TBil（OR=1.041，95%CI：1.008～1.074，P=0.013）、脐血胆红素水平（OR=1.141，95%CI：1.059～1.230，P=0.001）及RET计数（OR=2.675，95%CI：1.437～4.977，P=0.002）均是新生儿ABO溶血病患儿神经损伤的独立危险因素（均P<0.05）。ROC结果显示，血清TBil、脐血胆红素水平及RET计数联合预测新生儿ABO溶血病患儿神经损伤的AUC为0.922（95%CI：0.853～0.991），灵敏度为91.43%，特异度为96.15%，约登指数为0.779。结论　血清TBil、脐血胆红素水平和RET计数异常表达与新生儿ABO溶血病患儿神经损伤相关，联合预测的临床应用价值较高。

关键词: 总胆红素； , , 脐血胆红素； , , 网织红细胞计数； , , ABO溶血病； , , 新生儿； , , 神经系统损害预测

Abstract:

Objective　To investigate the abnormal expression of serum total bilirubin (TBil) level, umbilical cord bilirubin level, and reticulocyte (RET) count in neonatal ABO hemolytic disease and their predictive value for neurological damage. Methods　A total of 87 neonates with ABO hemolytic disease admitted to Ankang Central Hospital from May 2021 to May 2024 were selected as the study subjects. At the seventh day after birth, the neonates were divided into neurological damage group (35 cases) and neurological non-damage group (52 cases) according to the neonatal behavioral neurological assessment (NBNA) score. There were 20 boys and 15 girls in the neurological damage group, gestational aged (38.53±0.36) weeks. There were 28 boys and 24 girls in the neurological non-damage group, gestational aged (38.49±0.39) weeks. Clinical data of the patients was collected (gestational age, gender, weight, etc.). The serum TBil levels, umbilical cord bilirubin levels, and RET counts were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of neurological damage in neonates. The receiver operating characteristic curve (ROC) was used to verify the predictive value of serum TBil level, umbilical cord bilirubin level, and RET count for neurological damage in neonates with ABO hemolytic disease, and the area under the curve (AUC) was calculated. Results　There were no statistically significant differences in the clinical data between the two groups (all P>0.05). The serum TBil levels, umbilical cord bilirubin levels, and RET counts of the neurological damage group were higher than those of the non-damage group [(192.53±25.17) μmol/L vs. (169.46±21.42) μmol/L, (47.33±12.06) μmol/L vs. (31.16±8.95) μmol/L, (4.92±1.74)% vs. (3.36±0.98)%](all P<0.05). Multivariate logistic regression analysis showed that serum TBil level (OR=1.041, 95%CI: 1.008-1.074, P=0.013), umbilical cord bilirubin level (OR=1.141, 95%CI: 1.059-1.230, P=0.001) and RET count (OR=2.675, 95%CI: 1.437-4.977, P=0.002) were independent risk factors for neurological damage in neonates with ABO hemolytic disease (all P<0.05). ROC results showed that the AUC of the combined prediction of serum TBil level, umbilical cord bilirubin level and RET count for neurological damage in neonates with ABO hemolytic disease was 0.922 (95%CI: 0.853-0.991), the sensitivity was 91.43%, the specificity was 96.15%, and the Youden index was 0.779. Conclusion　Abnormal expression of serum TBil level, umbilical cord bilirubin level, and RET count are closely associated with neurological damage in neonates with ABO hemolytic disease. Combined detection of these indicators holds significant clinical value for predicting neurological damage.

Key words:

总胆红素, 脐血胆红素, 网织红细胞计数, ABO溶血病, 新生儿, 神经系统损害预测

中图分类号:

张森山蔡美孙锋. 新生儿ABO溶血病中血清总胆红素、脐血胆红素水平及网织红细胞计数对神经系统损害的预测价值 [J]. 国际医药卫生导报, 2025, 31(9): 1506-1510.

Zhang Senshan, Cai Mei, Sun Feng. Predictive value of total bilirubin, umbilical cord bilirubin level, and reticulocyte count in neonatal ABO hemolytic disease to neurological damage [J]. International Medicine and Health Guidance News, 2025, 31(9): 1506-1510.

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