中国妇幼健康研究
中國婦幼健康研究
중국부유건강연구
CHINESE JOURNAL OF MATERNAL AND CHILD HEALTH RESEARCH
2014年
2期
184-186
,共3页
张健%郑洪%刘光辉%孙路璐
張健%鄭洪%劉光輝%孫路璐
장건%정홍%류광휘%손로로
新生儿%胆红素脑病%早期诊断%神经损伤
新生兒%膽紅素腦病%早期診斷%神經損傷
신생인%담홍소뇌병%조기진단%신경손상
neonate%bilirubin encephalopathy%early diagnosis%nerve injury
目的：分析高胆红素血症患儿脑脊液未结合胆红素（ UCB）在诊断胆红素脑病时的敏感性和特异性。方法通过对36例高胆红素血症患儿进行脑脊液UCB、血清胆红素UCB、头颅核磁共振（MRI）、脑干听觉诱发电位（BAEP）及新生儿心理行为测定（ NBNA），综合评价胆红素脑病患儿早期的神经损伤情况及诊断的敏感指标。结果胆红素脑病患儿脑脊液UCB为（13．85±5．10）μmol/L，显著高于非胆红素脑病组的（6．12±4．55）μmol/L，差异有统计学意义（t＝6．888，P＜0．01）；ROC曲线分析显示脑脊液UCB诊断胆红素脑病的曲线下面积（0．910）大于血清UCB面积（0．690），临界值为9．50μmol/L时，其灵敏度为89．0％，特异度为91．2％，均高于血清UCB；胆红素脑病患儿头颅磁共振苍白球T1WI高信号发生率（77．8％），显著高于非胆红素脑病组（7．9％），差异有统计学意义（χ2＝37．088，P＜0．01）；BAEP异常率（80．6％）显著高于非胆红素脑病组（18．4％），差异有统计学意义（χ2＝28．569，P＜0．01）；其NBNA评分（34．0±2．4）低于非胆红素脑病组（36．6±2．3），差异有统计学意义（t＝-4．759，P＜0．01）。结论脑脊液UCB可作为新生儿胆红素脑病早期诊断的敏感指标，胆红素脑病患儿早期神经损伤发生率高，需早期干预及定期随访。
目的：分析高膽紅素血癥患兒腦脊液未結閤膽紅素（ UCB）在診斷膽紅素腦病時的敏感性和特異性。方法通過對36例高膽紅素血癥患兒進行腦脊液UCB、血清膽紅素UCB、頭顱覈磁共振（MRI）、腦榦聽覺誘髮電位（BAEP）及新生兒心理行為測定（ NBNA），綜閤評價膽紅素腦病患兒早期的神經損傷情況及診斷的敏感指標。結果膽紅素腦病患兒腦脊液UCB為（13．85±5．10）μmol/L，顯著高于非膽紅素腦病組的（6．12±4．55）μmol/L，差異有統計學意義（t＝6．888，P＜0．01）；ROC麯線分析顯示腦脊液UCB診斷膽紅素腦病的麯線下麵積（0．910）大于血清UCB麵積（0．690），臨界值為9．50μmol/L時，其靈敏度為89．0％，特異度為91．2％，均高于血清UCB；膽紅素腦病患兒頭顱磁共振蒼白毬T1WI高信號髮生率（77．8％），顯著高于非膽紅素腦病組（7．9％），差異有統計學意義（χ2＝37．088，P＜0．01）；BAEP異常率（80．6％）顯著高于非膽紅素腦病組（18．4％），差異有統計學意義（χ2＝28．569，P＜0．01）；其NBNA評分（34．0±2．4）低于非膽紅素腦病組（36．6±2．3），差異有統計學意義（t＝-4．759，P＜0．01）。結論腦脊液UCB可作為新生兒膽紅素腦病早期診斷的敏感指標，膽紅素腦病患兒早期神經損傷髮生率高，需早期榦預及定期隨訪。
목적：분석고담홍소혈증환인뇌척액미결합담홍소（ UCB）재진단담홍소뇌병시적민감성화특이성。방법통과대36례고담홍소혈증환인진행뇌척액UCB、혈청담홍소UCB、두로핵자공진（MRI）、뇌간은각유발전위（BAEP）급신생인심리행위측정（ NBNA），종합평개담홍소뇌병환인조기적신경손상정황급진단적민감지표。결과담홍소뇌병환인뇌척액UCB위（13．85±5．10）μmol/L，현저고우비담홍소뇌병조적（6．12±4．55）μmol/L，차이유통계학의의（t＝6．888，P＜0．01）；ROC곡선분석현시뇌척액UCB진단담홍소뇌병적곡선하면적（0．910）대우혈청UCB면적（0．690），림계치위9．50μmol/L시，기령민도위89．0％，특이도위91．2％，균고우혈청UCB；담홍소뇌병환인두로자공진창백구T1WI고신호발생솔（77．8％），현저고우비담홍소뇌병조（7．9％），차이유통계학의의（χ2＝37．088，P＜0．01）；BAEP이상솔（80．6％）현저고우비담홍소뇌병조（18．4％），차이유통계학의의（χ2＝28．569，P＜0．01）；기NBNA평분（34．0±2．4）저우비담홍소뇌병조（36．6±2．3），차이유통계학의의（t＝-4．759，P＜0．01）。결론뇌척액UCB가작위신생인담홍소뇌병조기진단적민감지표，담홍소뇌병환인조기신경손상발생솔고，수조기간예급정기수방。
Objective To analyze the sensitivity and specificity of unconjugated bilirubin ( UCB) in neonates with hyperbilirubinemia in the diagnosis of bilirubin encephalopathy .Methods UCB in cerebrospinal fluid (CSF), UCB in serum bilirubin, MRI, BAEP and NBNA of 36 neonates with hyperbilirubinemia were detected to evaluate the nerve injury and sensitive index of diagnosis in neonates with bilirubin encephalopathy.Results The level of CSF UCB in neonates with bilirubin encephalopathy was higher than that of controls (13.85 ±5.10μmol/L vs 6.12 ±4.55μmol/L), and the difference was statistically significant (t=6.888,P<0.01).The area under curve of CSF UCB (0.910) was larger than that of serum UCB (0.690) by ROC curve.When the cutoff value was 9.50μmol/L, the sensitivity was 89.0%and the specificity was 91.2%, which were higher than those of serum UCB .The incidence of MRI high signal of globus pallidus in T 1WI (77.8%) was significantly higher than that of the controls (7.9%) (χ2 =37.088, P<0.01).The abnormal rate of BAEP was 80.6%, which was significantly higher than that of the controls (18.4%) (χ2 =28.569, P<0.01).But the NBNA score was lower in than in controls (34.0 ±2.4 vs 36.6 ±2.3), and the difference was significant (t =-4.759, P <0.01).Conclusion CSF UCB can be considered as a sensitive index in the diagnosis of neonatal bilirubin encephalopathy .Neonates with bilirubin encephalopathy have high incidence of nerve injury at early stage , which needs early intervention and regular follow-up.
