新生儿高胆红素血症不同光照治疗方法与免疫变化的研究

目的探讨新生儿高胆红素血症不同光照治疗方法中患儿体内胆红素、血清可溶性白介素-2受体(SIL-2R)以及粒细胞-巨噬细胞集落刺激因子(GM-CSF)水平的变化及其临床意义。方法选择2017年1月至12月内蒙古医科大学第三附属医院住院的60例高胆红素血症新生儿作为高胆组,再根据对高胆红素血症新生儿采取的光照治疗方法不同,分为高胆1组30例(每日蓝光治疗持续12 h)和高胆2组30例(每日蓝光间歇治疗6~8 h);选取同期与高胆组日龄相匹配的30例健康足月新生儿(无黄疸或血清胆红素水平≤205.2μmol/L)作为对照组。采用方差分析比较3组血清胆红素、SIL-2R、GM-CSF水平的差异,并进行组间的两两比较,采用Pearson相关性分析法分析高胆1、2组胆红素与SIL-2R及GM-CSF的相关性。结果治疗前,高胆1组及高胆2组新生儿SIL-2R值与对照组比较均偏高(42.99±7.02)pg/ml vs(45.02±7.93)pg/ml vs(25.92±6.98)pg/ml],差异均具有统计学意义(P均<0.001);而且高胆1组与高胆2组新生儿的GM-CSF值与对照组比较也升高(23.49±3.29)ng/L vs(25.34±2.58)ng/L vs(8.85±2.21)ng/L],差异均具有统计学意义(P均<0.001);治疗后,高胆1、2组患儿SIL-2R值与对照组比较(40.65±8.03)pg/ml vs(32.97±7.05)pg/ml vs(25.92±6.98)pg/ml],较对照组仍偏高;高胆1、2组患儿GM-CSF值与对照组比较亦偏高(22.45±3.64)ng/L vs(15.38±3.19)ng/L vs(8.85±2.21)ng/L],差异均具有统计学意义(P<0.001);高胆2组治疗后与治疗前SIL-2R值、GM-CSF值比较却明显降低,差异均具有统计学意义(t=63.264、10.917,P均<0.001)。治疗前总体的血清胆红素水平与高胆1、2组SIL-2R值呈正相关(r=0.523、0.578,P=0.003、0.001),与GM-CSF水平亦呈正相关(r=0.545、0.548,P均=0.002)。结论新生儿高胆红素血症时患儿体内存在免疫功能紊乱及细胞因子分泌紊乱情况,间歇光照治疗在降低高间接胆红素的同时对新生儿的免疫功能恢复有帮助。

Immune changes in neonates with hyperbilirubinemia on different phototherapies

ObjectiveTo investigate the changes of bilirubin, serum soluble interleukin-2 receptor (SIL-2R), and granulocyte-macrophage colony stimulating factor (GM-CSF) levels in neonates with hyperbilirubinemia on different phototherapies and their clinical significance. MethodsSixty newborns with hyperbilirubinemia who were hospitalized from January 2017 to December 2017 at the Third Affiliated Hospital of Inner Mongolia Medical College were randomly selected. According to the treatment methods used, the patients were equally divided into two groups: those receiving persistent blue light treatment for 12 h per day (group 1) and those receiving intermittent blue light treatment for 6-8 h per day (group 2). Thirty age-matched healthy newborns were included as a control group (no jaundice or serum bilirubin levels≤ 205.2 μmol/ L). SIL-2R and GM-CSF levels in peripheral venous blood samples from these neonates were measured, compared, and analyzed. Analysis of variance was used to compare the differences in serum bilirubin, SIL-2R, and GM-CSF levels in the three groups, and pairwise comparisons were performed between groups. Pearson correlation analysis was used to analyze the correlation of high bilirubin in groups 1 and 2 with SIL-2R and GM-CSF. ResultsBefore treatment, both SIL-2R (42.99±7.02) pg/ml vs (45.02±7.93) pg/ml vs (25.92±6.98) pg/ml, P<0.001] and GM-CSF (23.49±3.29) ng/L vs (25.34±2.58) ng/L vs (8.85±2.21) ng/L, P<0.001] levels in groups 1 and 2 were significantly higher than those in the control group. After treatment, SIL-2R (40.65±8.03) pg/ml vs (32.97±7.05) pg/ml vs (25.92±6.98) pg/ml] and GM-CSF (22.45±3.64) ng/L vs (15.38±3.19) ng/L vs (8.85±2.21) ng/L] levels in groups 1 and 2 were still both significantly higher than those in the control group (P<0.001); SIL-2R and GM-CSF levels were significantly lower in group 2 after treatment than pre-treatment (t=63.264 and 10.917, respectively, P<0.001). Serum total bilirubin levels were positively correlated with SIL-2R (r=0.523 and 0.578, respectively, P<0.01) and GM-CSF (r=0.545 and 0.548, respectively, P<0.01) levels in the hyperbilirubin group before treatment. ConclusionThere is a disturbance of cellular immunity and cytokine secretion in neonates with hyperbilirubinemia. Intermittent phototherapy is helpful to the recovery of immune function of neonates while reducing high indirect bilirubin.