探討新生兒葡萄糖—6—磷酸脫氫酶缺乏癥患兒生后早期血清總膽紅素水平變化

郭洪創(chuàng)　肖奇志　黃輝文

【摘要】 目的：分析研討新生兒葡萄糖-6-磷酸脫氫酶（G-6-PD）缺乏癥患兒生后早期血清總膽紅素（TSB）指數(shù)狀況。方法：用隨機(jī)抽簽方式，從2015年2月-2016年7月將本院產(chǎn)科出生的足月兒90例納入到討論中，90例研討對象均接受臍帶血G-6-PD酶活性定量檢查，按照檢查結(jié)果分正常組（40例）和缺乏組（50例），統(tǒng)計(jì)記錄新生兒生后各階段TSB含量、高膽紅素血癥發(fā)生率，分析高膽紅素血癥發(fā)生率、TSB上升速率，并進(jìn)行比較。結(jié)果：新生兒出生3 h內(nèi)以及出生后第1、2、3天，缺乏組的TSB指數(shù)均高于正常組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。缺乏組高膽紅素血癥發(fā)生率為46.00%、TSB上升速率為（0.13±0.05）mg/（dL·h），均高于對照組的10.00%、（0.11±0.05）mg/（dL·h），差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。缺乏組男性比例高于正常組，女性比例低于正常組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。缺乏組的新生兒出生后3 h TSB指數(shù)與出生后第1、2、3天的TSB上升速率間均呈正比關(guān)系（P<0.05），正常組的新生兒出生后3 h TSB指數(shù)與出生后第1、2、3天的TSB上升速率間均呈正比關(guān)系（P<0.05）。結(jié)論：新生兒葡萄糖-6-磷酸脫氫酶缺乏癥溶血狀況在產(chǎn)婦宮內(nèi)發(fā)生，出生后3 h中TSB指數(shù)則對新生兒高膽紅素血癥有預(yù)測性作用。早期監(jiān)測TSB、篩查新生兒G-6-PD，可防治新生兒高膽紅素血癥發(fā)生，值得應(yīng)用。

【關(guān)鍵詞】 膽紅素； 血清； 新生兒葡萄糖-6-磷酸脫氫酶缺乏癥； 出生后

Investigation of Changes of Serum Total Bilirubin Levels in Neonates Glucose-6-phosphate Dehydrogenase Deficiency at Early Stage after Birth/GUO Hong-chuang，XIAO Qi-zhi，HUANG Hui-wen.//Medical Innovation of China，2017，14（30）：030-032

【Abstract】 Objective：To analyze and discuss the status of serum total bilirubin index in neonates with glucose-6-phosphate dehydrogenase deficiency at early stage after birth.Method：90 full-term infants and who born in our hospital department of obstetrics from February 2015 to July 2016 were included in the discussion by the random ballot method，and 90 discussion objects were received the quantitative examination of G-6-PD enzyme activity in cord blood，and were divided into the normal group （40 cases） and the lack group （50 cases）according to the results of the examination.The TSB content，hyperbilirubinemia rate and the rate of hyperbilirubinemia and the rising rate of TSB in neonates were recorded and compared.Result：The neonatal birth rate was 3 h and the first，second，third day after birth，the TSB indices in the absence group were higher than those in the normal group，the differences were statistically significant（P<0.05）.The rate of hyperbilirubinemia in the absence group was 46.00%，and the rate of TSB increase was （0.13±0.05）mg/（dL·h），which was higher than 10.00% and （0.11±0.05）mg/（dL·h）in the control group，the differences were statistically significant（P<0.05）.The proportion of men of the lack group was higher than that of the normal group，the proportion of women of lack group was lower than that in the normal group，the difference was statistically significant（P<0.05）.There were proportional relationship in the lack group between the TSB index after the birth for 3 h and the TSB rise rate after the birth for the first，second and third day（P<0.05），there were proportional relationship in the normal group between the TSB index after the birth for 3 h and the TSB rise rate after the birth for the first，second and third day（P<0.05）.Conclusion：Glucose-6-dehydrogenase deficiency of neonatal hemolysis occurs in the maternal intrauterine， after the birth of 3 h TSB index has a predictive effect on neonatal hyperbilirubinemia. Early detection of TSB， screening of neonatal G-6-PD， prevention and treatment of neonatal hyperbilirubinemia， worthy of application.endprint

【Key words】 Bilirubin； Serum； Neonatal glucose-6-phosphate dehydrogenase deficiency； After birth

First-authors address：The Maternal and Child Health Care Hospital of Zhuhai City，Zhuhai 519000，China

doi：10.3969/j.issn.1674-4985.2017.30.009

本院新生兒高膽紅素血癥多種因素中，較為常見的為新生兒葡萄糖-6-磷酸脫氫酶缺乏癥[1-2]，且在膽紅素腦病病因中占據(jù)首位。此研究采用分組研討90例新生兒的方式進(jìn)行分析，現(xiàn)報(bào)告如下。

1 資料與方法

1.1 一般資料 用隨機(jī)抽簽方式，從2015年

2月-2016年7月將本院產(chǎn)科出生的足月兒90例納入到討論中，入選標(biāo)準(zhǔn)：均為足月兒、出生體重正常[3-4]；排除標(biāo)準(zhǔn)：存在可能引發(fā)高膽紅素血癥的其他因素，如Rh和ABO血型不合造成的敗血癥、糖尿病母嬰、地中海貧血等，以及酸中毒、缺氧、窒息、早產(chǎn)、21-三體綜合征、新生兒頭顱血腫等[5-6]。90例研討對象均接受臍帶血G-6-PD酶活性定量檢查，按照檢查結(jié)果分正常組（40例）和缺乏組（50例）。正常組：出生體重（3152±388）g，胎齡（277.0±6.8）d，母親年齡（27.8±4.7）歲，19例自然分娩，3例使用催產(chǎn)素，開始排便時(shí)間（4.4±3.5）h，胎便排完時(shí)間（2.7±0.7）d；缺乏組：出生體重（3151±387）g，胎齡（278.0±6.7）d，母親年齡（27.9±4.6）歲，18例自然分娩，4例使用催產(chǎn)素，開始排便時(shí)間（4.5±3.4）h，胎便排完時(shí)間（2.8±0.6）d。……