脐血胆红素与新生儿黄疸的关系

临床上对新生儿高胆红素血症治疗是有效的,但对新生儿黄疸及胆红素脑损伤仍无可靠的预测方案。为能早期预防黄疸的危险程度,进行早期干预,减少胆红素脑损伤的发生,我们测定脐血胆红素浓度研究其对早期预测新生儿黄疸的意义。     

妈咪爱和鲁米那对早产儿儿胆红素代谢的影响

目的:治疗妈咪爱和鲁米那对早产儿胆红素代谢的影响.方法:将115例早产儿分为治疗组和对照组,治疗组出生1 d内口服妈咪爱和鲁米那,对照组不加任何干预,治疗组黄疸降至正常日龄,达到高胆红素血症标准(经皮测胆红素256.5 umol/L)的人数,5 d后血清总胆红素值.结果:治疗组降至正常日龄(8±1.8)d,对照组黄疸降至正常日龄(18±1.5)d;治疗组高胆红素血症3例;对照组高胆红素血症28例;治疗组和对照组在治疗5 d后血清总胆红素值分别为(44.8±18.2)μmol/L,(95.5±33.2)μmol/L.结论:早期服用妈咪爱和鲁米那能有效降低早产儿胆红素水平,促进黄疸消退,对预防早产儿高胆红素血症及胆红素脑病发生有一定作用.     

妈咪爱和鲁米那对早产儿儿胆红素代谢的影响

目的：治疗妈咪爱和鲁米那对早产儿胆红素代谢的影响。方法：将115例早产儿分为治疗组和对照组，治疗组出生1d内12＂服妈咪爱和鲁米那，对照组不加任何干预，治疗组黄疸降至正常日龄．达到高胆红素血症标准（经皮测胆红素256．5umol／L）的人数，5d后血清总胆红素值。结果：治疗组降至正常日龄（8±1．8）d，对照组黄疸降至正常日龄（18±1．5）d；治疗组高胆红素血症3例；对照组高胆红素血症28例；治疗组和对照组在治疗5d后血清总胆红素值分别为（44．8±18．2）mol／L，（95．5±33．2）mol／L。结论：早期服用妈咪爱和鲁米那能有效降低早产儿胆红素水平，促进黄疸消退，对预防早产儿高胆红素血症及胆红素脑病发生有一定作用。     

黄疸仪对35例新生儿高胆红素血症动态监测的临床观察

新生儿黄疸(neonatal jaundice)是指新生儿时期出现高胆红素血症的症状,是新生儿时期的常见疾病.2013-12月至2014年12月,共出生婴儿1113人,采用JH20-1B经皮黄疸仪行动态黄疸监测,实验证实黄疸仪监测经皮胆红素值(TCB)与微量血胆红素值相关性良好,因此采用日龄或小时龄胆红素值进行评估,动态监测黄疸值变化,是防止新生儿脑病发生及筛选病理性黄疸的关键.     

黄疸新生儿早期听力检测的临床意义

我科自1998年10月以来对黄疸新生儿在治疗前进行听力测试,通过检测听力改变以认识新生儿高胆红素血症早期引起的暂时性亚临床型胆红素神经中毒症,并早期给予及时有效的治疗以防止核黄疸的发生,取得一定成绩,现报告如下。1　资料和方法11　资料　黄疸患儿120例,年龄0～3ｄ96例,4～7ｄ24例,男72例,女48例。其中早产儿38例,新生儿窒息40例,新生儿胎粪吸入综合征16例,新生儿肺炎20例,ＡＢＯ溶血4例,Ｇ6ＰＤ缺乏2例。12　方法　所有病例治疗前先进行听力检测及血清胆红素检测。听力检测应用上海仪表厂生产的婴幼儿听力检测仪进行检查。对检测发现…     

DWI及常规MR在新生儿高胆红素血症及胆红素脑病诊断中的应用

目的 探讨DWI及常规MR在新生儿高胆红素血症及胆红素脑病诊断中的应用.方法 分析19例新生儿高胆红素血症及13例新生儿胆红素脑病患儿和8例健康新生儿(对照组)DWI及常规MR检查资料.结果 新生儿胆红素脑病常规MR表现:T1加权像可见苍白球对称性高信号,T2加权像可见苍白球呈等信号,13例病人中12例有此项MR表现,另外有6例新生儿胆红素脑病患儿底丘脑在T1加权像呈高信号,T2加权像呈等信号.13例新生儿胆红素脑病患儿苍白球及底丘脑DWI及ADC图信号均未见异常.19例高胆红素血症患儿苍白球及底丘脑T1加权像、T2加权像及DWI信号均未见异常.新生儿胆红素脑病组基底节区和丘脑ADC值较对照组和高胆红素血症组相比均稍微升高,但是3组差别无统计学意义(P＞0.05).结论 常规磁共振检查对从新生儿高胆红素血症患儿中早期发现新生儿胆红素脑病患儿并对新生儿胆红素脑病早期诊断可提供有益的帮助.DWI对于新生儿胆红素脑病患儿的早期诊断没有意义.     

新生儿高胆红素血症52例临床观察

新生儿高胆红素血症是临床常见的病理现象,把握病理性黄疸的治疗时机,是降低新生儿胆红素脑病致死率和致残率,提高本病治愈的关键。通过对52例新生儿高胆红素血症患者的临床资料进行回顾性分析,总结高胆红素血症的病因、临床特点、治疗体会。1资料与方法1.1一般资料2003年1月-2006年1月收治的52例新生儿高胆红素血症患者,其中男37例,女15例。黄疸出现≤24h,6例,-48h,19例,-72h,17例,-4d16例,-15d4例。合并胆红素脑病6例,早产儿6例(胎龄≤28W1例,32W4例,37W1例)。足月小样儿4例。1.2病因及诱发因素感染14例(巨细胞感染8例,败血症2例,弓型虫…     

关于早期新生儿高胆红素血症的诊疗探讨

目的：为了降低早期新生儿高胆红素血症的发病率及致残率,对其诊断及治疗进行探讨。方法：作者在日本研修期间,对340例早期新生儿高胆进行了研究。采用的高胆标准是以血清胆红素值结合出生体重,日龄及高危因素等综合评定,有利于早期诊断及早期干预。全部采用光疗,其中4例缺血。结果：全部治愈。早期高胆的诊断标准应以血清胆红素值并且结合日龄,出生体重及高危因素等制定出每日的标准。光疗是治疗高胆的主要方法,药物疗法应当放弃。结论：我国目前采用的早期新生儿高胆标准中,早产儿高胆值为15mg/dl,高于足月儿高胆值12mg/dl,没有考虑到早产儿这一高危因素,有必要修正。     

新生儿黄疸早期护理干预探讨

目的 分析探讨新生儿黄疸早期护理干预的方法 及作用.方法 选取收治的新生儿黄疸110例作为临床研究对象,随机分为观察组和对照组,每组各55例.对照组患儿给予常规护理,观察组患儿给予早期护理干预.比较两组患儿的体重、首次胎便转黄时间、血清胆红素浓度.结果 根据统计结果 ,观察组患儿的体重明显重于对照组,首次胎便转黄时间明显早于对照组,血清胆红素浓度明显低于对照组,比较结果 具有显著差异性(P<0.05).结论 新生儿黄疸早期护理干预能够有效增加患儿的体重,减轻高胆红素血症,值得在临床中推广使用.     

高压氧综合治疗对新生儿高胆红素血症的影响

黄疸是由于新生儿血中胆红素较高而出现的皮肤、黏膜、巩膜黄染现象,初生儿50％～90％在1周内发生,足月儿一般1～2周消失,早产儿3～4周消失,不伴其他不适者,无需治疗.当胆红素比较高时,特别是未结合胆红素高时,胆红素就易沉积在脑基底核、海马沟、视丘等处,即核黄疸,导致神经细胞的中毒性病变,重者可引起死亡,幸存者常留下"核黄疸四联症"和智力低下等神经系统后遗症.因此,正确认识新生儿高胆红素血症的危害性,并积极干预,对预防核黄疸及其后遗症的发生有着重要意义.我科2005年1月至2009年1月收住104例高胆红素血症新生儿,其中56例高胆红素血症新生儿在常规治疗基础上辅以高压氧(hyperbaric oxygen,HBO)治疗,与48例单纯常规治疗的高胆红素血症新生儿比较,取得了更好的疗效,黄疸消失时间明显缩短,核黄疸发生率显著下降,现报告如下.     

经皮黄疸仪在诊断新生儿高胆红素血症中的应用价值

目的评价经皮黄疸仪在诊断新生儿高胆红素血症中的应用价值。方法应用经皮黄疸仪检测856例新生儿的黄疸指数,同时采集静脉血测定血清总胆红素水平。以经皮黄疸仪黄疸指数>6、>12.9、>15,血清总胆红素水平>102μmol/L、>220.6μmol/L、>255μmol/L分别作为各自诊断出生24 h内、出生24 h后足月儿、出生24 h后早产儿高胆红素血症的标准。以血清总胆红素水平作为金标准,采用Yerushalmy四格表评价模式,计算敏感度、特异度、准确度、阳性似然比、阴性似然比。结果经皮黄疸仪诊断出生24 h内新生儿高胆红素血症敏感度(55.56%)欠佳,但诊断出生24h后足月儿高胆红素血症敏感度(95.73%)及特异度(90.11%)均好,诊断出生24h后早产儿高胆红素血症敏感度(94.12%)好,特异度(85.23%)尚可。结论经皮黄疸仪用于出生24 h后新生儿高胆红素血症筛查时漏诊率低,可根据其检测结果及早采取退黄治疗,但对于出生24 h内具有高胆红素血症高危因素的新生儿,应检测血清胆红素水平,以尽早诊治。     

新生儿高胆红素血症484例临床分析

目的了解住院新生儿高胆红素血症的发病情况及探讨采用间歇性蓝光照射治疗新生儿高胆红素血症的疗效。方法总结分析我院2002年1月至2007年8月收治的484例高胆红素血症患儿临床资料。结果高胆红素血症发病率占同期新生儿的40．5％，引起本组高胆红素血症的病因中，围产期因素占37．4％，感染占21．6％，母乳性黄疸占18．5％，新生儿溶血占6．2％。其中发病日龄在7天以内占69％。435例治愈，49例好转。结论加强围产期保健，对所有新生儿特别是7天内新生儿应进行每天至少1次的临床评估。对所有24小时内出现黄疸的新生儿应进行经皮测胆红素及血清总胆红素的监测。对耶些在血总胆红素达到高峰水平前离院的新生儿应随访。对于出生24小时内出现黄疸，早产儿低于正常值但有高危因素，健康足月儿总胆红素〉256μmol／L，无高危因素，都应积极治疗以降低高胆红素的发病率、死亡率和伤残率。     

新生儿经皮测胆红素的局限性

目的探讨经皮测胆红素的局限性。方法同时采集374例黄疸足月儿经皮测胆红素和血清总胆红素值,并对上述两指标进行正态分布检验和直线相关分析。结果374例足月儿经皮测胆红素、血清总胆红素两指标均服从正态分布(P>0.05)。经皮测胆红素与血清总胆红素之间呈正相关,相关系数(r=0.76,P<0.01)。将数据进一步划分,当血清总胆红素水平<290.7μmol/L时,两者的线性相关较好,r=0.7;但当血清总胆红素水平≥290.7μmol/L时,两者的线性相关减弱,r=0.46。结论经皮测胆红素与血清总胆红素总体上呈正相关,特别是对轻、中度黄疸,但对较重的黄疸,两者相关性减弱,提示经皮测胆红素适合作为筛查高胆红素血症的指标,在决定治疗时,尤其对较重的黄疸,应以血清总胆红素为标准。     

Diffusion-weighted imaging of patients with neonatal bilirubin encephalopathy

Purpose

The aim of the study is to evaluate neonatal bilirubin encephalopathy in the acute period by the DWI.

Materials and methods

Thirty newborn babies with hyperbilirubinemia at the gestational age of 38–40 weeks, diagnosed with acute neonatal bilirubin encephalopathy as a result of clinical findings were included in the study, and a further 24 newborn babies, whose ages, weights and gestational ages were equalized, were regarded as a control group. DWI was performed on both patient and control groups.

Results

When DWI apparent diffusion coefficients (ADC) of both neonatal bilirubin encephalopathy patients and the control group were compared, ACD values of neonatal bilirubin encephalopathy patients were found to be statistically significantly highly compared to that of the control group (p < 0.001). There was a significant correlation between bilirubin values and DWI findings (r = 0.41, p < 0.05).

Conclusion

The ADC measurement could be a promising parameter in detecting neonatal bilirubin encephalopathy.     

换血疗法在新生儿高胆红素血症中的临床疗效

目的探讨换血疗法在新生儿高胆红素血症中的临床效果。方法选取66例高胆红素血症新生儿作为研究对象,收集所有患儿临床资料,比较患儿治疗前后各项指标的变化情况,观察临床治疗效果。结果经过换血治疗后,所有患儿血清胆红素水平显著下降,治疗前后比较,差异具有统计学意义（P〈0.01）,血红蛋白水平明显提高、红细胞计数、血清K＋浓度也得到在一定程度上提高。结论换血治疗新生儿高胆红素血症具有显著的疗效,发生不良反应的几率较小,是临床治疗高胆红素血症的良好方法,值得推广应用。     

新生儿高胆红素血症巨细胞病毒抗体检测的意义

目的 探讨新生儿高胆红素血症与巨细胞病毒(CMV)感染的关系及临床意义。方法 采用金标免疫斑点法对178份血清进行CMV抗体IgG,IgM检测,其中包括39例临床确诊的高胆红素血症新生儿及其母亲(78份血清),50例正常新生儿及其母亲(100份血清)作为对照组。结果 高胆红素血症新生儿CMV感染率为61.54％,对照组CMV感染率4％,均表现为IgG阳性;与对照组比,患儿CMV感染率明显增高,有显著差异,X~2=35.08,P<0.01;存在CMV感染的新生儿,其母也均对应有CMV感染,感染率与新生儿一致,表现以IgG,IgM均阳性为主或单一的IgG阳性。结论 新生儿高胆红素血症与母体感染CMV后造成的宫内感染和产通感染有明显的关系,围产期CMV感染可能是引起新生儿高胆红素血症的一个重要因素,CMV抗体检测可以作为临床上新生儿高胆红素血症病因诊断的依据。     

1H MR spectroscopic characteristics of kernicterus: a possible metabolic signature

BACKGROUND AND PURPOSE: MR examination of infants with kernicterus shows abnormal changes in signal intensity in various parts of the brain, including the globus pallidus and subthalamic regions. The purpose of this study was to retrospectively analyze proton (¹H) MR spectroscopic data to see if the MR spectroscopic profiles of infants with hyperbilirubinemia and symptoms of kernicterus provide new insights into the pathophysiology of bilirubin neurotoxicity.METHODS: Six patients aged 3 days to 3 weeks, with hyperbilirubinemia and symptoms of kernicterus underwent MR imaging and MR spectroscopy with a single-voxel point-resolved spectroscopic sequence. The voxel of interest was centered in the basal ganglia with CSF excluded. Quantitative analysis was done by using LCModel. Between-subject comparisons were based on metabolite ratios relative to creatine.RESULTS: Ratios of taurine, glutamate and glutamine, and myoinositol relative to creatine were significantly elevated (P < .001), whereas the ratio of choline to creatine was significantly decreased (P < .001) compared with normal values published for this age group. Lactate levels were not significantly elevated.CONCLUSION: Kernicterus has a characteristic signature that is detectable on ¹H-MR spectroscopy. Our results are generally in agreement with what is known about bilirubin pathology, and the finding of increased glutamate and glutamine and decreased choline ratios indicates a possible link between hepatic encephalopathy and kernicterus. This observation may help in elucidating the pathophysiology of bilirubin neurotoxicity.

Kernicterus, or bilirubin encephalopathy, is a relatively rare disease, but it has become more prevalent in recent years as a result of early hospital discharge, increased practice of breastfeeding (1,2), and occurrence of glucose-6-phosphate dehydrogenase deficiency (3,4). Improved understanding of the chemical mechanisms of the brain damage caused by bilirubin could help in suggesting new treatments, which, in conjunction with the treatment of hyperbilirubinemia, may help prevent or reverse bilirubin neurotoxicity.Bilirubin is one of the end products of hemoglobin metabolism. Neonates, whose bilirubin metabolism and excretion mechanisms are immature, often develop jaundice as a result of excess serum bilirubin (5,6). When serum bilirubin exceeds the binding capacity of albumin, or when the blood-brain barrier is immature or injured, bilirubin can enter the brain (5,7), resulting in encephalopathy called kernicterus (8). Bilirubin neurotoxicity damages specific areas of the brain, including the brain stem, basal ganglia, cerebellar gray matter, and hippocampus. However, the pathogenesis is only partially understood (9).Neonatal jaundice is easily treatable with phototherapy, albumin infusion, or exchange transfusion (10,11). However, the damage inflicted on the brain by bilirubin is not always reversible. Long-term survivors of kernicterus can have athetoid cerebral palsy, deafness or hearing loss, impairment of upward gaze, and enamel dysplasia of the primary teeth (9).Abnormally increased signal intensity on T2-weighted MR images of the globus pallidus, subthalamic nuclei, and hippocampus in the subacute and chronic phases of kernicterus are well described (12, 13), and these findings are correlated with gliosis in those regions. MR imaging during the acute phase of kernicterus has also been described (14), with abnormally increased signal intensity on T1-weighted images in the globus pallidus and subthalamic nuclei in neonates with kernicterus. Loss of this T1 marker and conversion to the more permanent change in T2 signal intensity in these regions is reported to occur during the late neonatal period (14).Some of the neurotoxic effects of bilirubin are gliosis, demyelination (9), and inhibition of glutamate (Glu) uptake by astrocytes (15) in the basal ganglia. ¹H-MR spectroscopy should be able to depict these metabolic changes. The objective of this study was to determine whether ¹H-MR spectroscopic profiles in infants with hyperbilirubinemia and symptoms of kernicterus provide new insights into the pathophysiology of bilirubin neurotoxicity.     

Elevated bilirubin and visual perception in pilots

BACKGROUND: A fatal aircraft accident of a Bo-105 helicopter on May 20, 1996 led to the suspicion that the pilot's raised serum bilirubin level could have contributed to the accident. It was suspected that an increase of bilirubin beyond 20.52 micromol x L(-1) could disturb visual perception. METHODS: In 1998 and 1999, 101 pilots with functional hyperbilirubinemia, diagnosed as Gilbert's syndrome, were subjected to perceptual-psychological testing (signal detection test) during their periodic medical examinations at the German Air Force Institute of Aviation Medicine. The results of the psychophysiological testing were compared with a control group. RESULTS: Reaction time and perception range increased with age and were independent of serum bilirubin level. CONCLUSION: There is no evidence that raised serum bilirubin levels can diminish visual perceptional performance.     

新生儿高胆红素血症中胱抑素C临床意义

目的探讨测定胱抑素C(Cys C)在新生儿高胆红素血症的临床价值。方法以74例高胆红素血症患儿(高胆红素血症组)和45例非高胆红素血症新生儿(对照组)作为研究对象,对两组新生儿的血尿素氮(BUN)、肌酐(CR)和Cys C进行测定。结果高胆红素血症组新生儿的BUN、CR检测指标和对照组比较,差异均无统计学意义(P>0.05);而高胆红素血症组新生儿的Cys C检测指标高于非高胆红素血症组,两组比较,差异有显著统计学意义(P<0.01);轻、中、重度高胆红素血症组新生儿Cys C检测指标逐渐增高,组间比较差异有显著统计学意义(P<0.01)。结论高胆红素血症时,Cys C水平随病情严重程度及时间增长而升高。     

原位肝移植术后肝动脉并发症介入治疗患者的预后及其影响因素分析

目的 探讨介入治疗肝移植术后肝动脉并发症患者的预后及影响预后的相关因素.方法 回顾性分析21例肝移植术后发牛肝动脉并发症,并接受肝动脉溶栓、腔内血管成形术(PTA)和(或)肝动脉支架置入术等治疗患者的临床资料,根据移植肝脏预后分为预后不良组和预后较好组,比较2组胆道并发症、肝动脉再狭窄、早期并发症或是晚期并发症等15项变量,采用二值Logistic回归分析方法 筛选出影响介入治疗疗效的因素.结果 21例患者平均随访时间为436 d,中位随访时问464 d(3～1037 d).其中预后不良组11例(5例再次肝移植,6例死亡),平均存活时间191 d,中位存活时问为73 d(3～616 d);预后较好组10例,移植肝平均存活时间706 d,中位存活时间692 d(245～1037 d).单因素分析两组患者差异有统计学意义的因素有:胆道并发症、血总胆红素水平以及间接胆红素水平;经Logistic回归分析显示,主要危险因素是胆道并发症(P=0.027,OR=22.818). .结论 伴有胆道并发症,是影响肝移植术后肝动脉并发症患者介入治疗效果的主要因素.