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投稿时间：2024-12-02 网络发布日期：2025-09-19
投稿时间：2024-12-02 网络发布日期：2025-09-19
中文摘要: 目的 探讨碳氧血红蛋白（COHb）联合胆红素指标对ABO溶血病新生儿发生胆红素脑病严重程度的评估价值。方法 选取佛山市第二人民医院儿科2022年1月至2023年12月出生的100例母婴ABO血型不合、且诊断为高胆红素血症的患儿作为研究对象。根据患儿是否存在嗜睡、哭声高亢、肌张力异常和反射减退等神经系统表现，将患儿分为高危胆红素脑病组（n=42）和高危非胆红素脑病组（n=58）。对比两组患儿的临床资料及实验室相关指标，采用多因素logistic回归分析明确COHb、胆红素与ABO溶血病新生儿发生胆红素脑病之间的关联。绘制受试者工作特征（ROC）曲线分析COHb联合胆红素对新生儿ABO溶血病严重程度的评估价值。结果 高危胆红素脑病组与高危非胆红素脑病组胆红素［（347.68±68.35）μmol/L vs（245.86±75.26）μmol/L，t= 6.936，P＜0.01］、血红蛋白［（140.63±25.35）g/L vs（158.53±18.52）g/L，t= 4.082，P＜0.01］、COHb（2.53%±0.62% vs 1.73%±0.45%，t= 7.481，P＜0.01）差异有统计学意义。多因素logistic回归分析显示胆红素（OR= 3.804，95%CI:1.367~10.582，P＜0.01）和COHb（OR= 5.165，95%CI:1.376~19.395，P＜0.01）是ABO溶血病新生儿发生高危胆红素脑病的独立影响因素。ROC曲线显示，二者联合预测的敏感度（87.30%）、特异度（80.10%）及曲线下面积（0.852）均高于单一指标。结论 COHb、胆红素是ABO溶血病新生儿发生胆红素脑病的独立影响因素，二者联合对胆红素脑病具有较高的评估价值。动态监测COHb、胆红素可协助临床评估溶血病的进展情况。
Abstract:Objective To explore the evaluation value of carboxyhemoglobin (COHb) combined with bilirubin levels in assessing the severity of bilirubin encephalopathy in newborns with ABO hemolytic disease. Methods A total of 100 neonates born at the Foshan Second People’ s Hospital between January 2022 and December 2023, diagnosed with hyperbilirubinemia due to maternal-fetal ABO blood group incompatibility, were enrolled. Based on the presence of neurological manifestations (lethargy, high-pitched crying, abnormal muscle tone, and hyporeflexia), the newborns were divided into a high-risk bilirubin encephalopathy group (n=42) and a high-risk non-bilirubin encephalopathy group (n=58). Clinical data and laboratory indicators were compared between the two groups. Multivariate logistic regression analysis was used to determine the association of COHb and bilirubin with bilirubin encephalopathy in newborns with ABO hemolytic disease. Receiver operating characteristic (ROC) curve was plotted to analyze the evaluation value of combined COHb and bilirubin for assessing the severity of ABO hemolytic disease. Results There were significant differences in bilirubin [ (347.68 ± 68.35) μmol/L vs (245.86 ± 75.26) μmol/L, t= 6.936, P＜0.01], hemoglobin [ ( 140.63±25.35) g/L vs (158.53±18.52) g/L, t= 4.082, P＜0.01], and COHb (2.53%±0.62% vs 1.73%±0.45%, t= 7.481, P＜0.01) levels between the high-risk bilirubin encephalopathy group and the high-risk non-bilirubin encephalopathy group. Multivariate logistic regression analysis revealed that bilirubin (OR= 3.804, 95%CI: 1.367-10.582, P＜0.01) and COHb (OR= 5.165, 95%CI: 1.376-19.395, P＜0.01) were independent influencing factors for high-risk bilirubin encephalopathy in newborns with ABO hemolytic disease. ROC curve analysis demonstrated that the combined prediction of both indicators yielded higher sensitivity (87.30%), specificity (80.10%), and area under the curve (0.852) than either indicator alone. Conclusion COHb and bilirubin are independent influencing factors for bilirubin encephalopathy in neonates with ABO hemolytic disease. Their combination holds significant value in assessing bilirubin encephalopathy. Dynamic monitoring of COHb and bilirubin levels may assist in clinically evaluating the progression of hemolytic disease.
文章编号： 中图分类号：R562.7 文献标志码：A
基金项目:佛山市卫生健康局医学科研课题（2022038）
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引用文本：
梁燕婷,徐国明,陈守琴.碳氧血红蛋白联合胆红素指标对新生儿ABO溶血病严重程度的评估价值[J].中国临床研究,2025,38(9):1430-1433.
梁燕婷,徐国明,陈守琴.碳氧血红蛋白联合胆红素指标对新生儿ABO溶血病严重程度的评估价值[J].中国临床研究,2025,38(9):1430-1433.