| 陈晓艳,张修侠,史 坤,邹曼玉,尹 双,吴莉莉,陈兰兰,潘家华,聂 萍.皮胆红素百分位曲线图结合相关风险因素预测新生儿高胆红素血症的临床价值[J].,2022,(9):1785-1789 |
| 皮胆红素百分位曲线图结合相关风险因素预测新生儿高胆红素血症的临床价值 |
| Clinical Value of Percutaneous Bilirubin Percentile Curve Combined with Associated Risk Factors in Predicting Neonatal Hyperbilirubinemia |
| 投稿时间：2021-09-22 修订日期：2021-10-18 |
| DOI：10.13241/j.cnki.pmb.2022.09.037 |
| 中文关键词: 新生儿高胆红素血症 TcB百分位曲线图 风险因素 预测价值 |
| 英文关键词: Neonatal hyperbilirubinemia TcB percentile curve Risk factors Predictive value |
| 基金项目:安徽省高校自然科学研究重点项目（KJ2016A212） |
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| 摘要 目的：评价新生儿出生后72 h经皮胆红素（TcB）百分位曲线图结合临床相关风险因素，预测新生儿高胆红素血症的发生情况。方法：选择2018年1月-2019年12月在安徽理工大学第一附属医院出生的晚期早产儿和足月儿，使用经皮黄疸仪监测其黄疸值，绘制TcB百分位列线图，以新生儿出生后72 h内末次TcB值对应的风险区结合致病风险因素预测新生儿高胆红素血症发生的价值。结果：3818例新生儿出生后72 h后高危区人数为278例（7.28%）。TcB数值在4 h到48 h内上升最快，峰值出现在出生后84 h-120 h，P40、P75及P95峰值分别为193.75 μmol/L，224.75 μmol/L和282.25 μmol/L，其中P95峰值出现最晚。新生儿出生后0-48 h内共计有244例TcB值处于高危险区，其中92例在72 h后仍处高危区，预测灵敏度为29.97%，特异度为95.67%；49-72 h内共计有269例新生儿TcB值处于高危区，其中116例新生儿在72 h后TcB值仍处高危区，灵敏度为36.48%，特异度为95.62%。多因素Logistic回归分析显示，相关致病危险因素有：胎龄、住院时间、分娩方式、胎膜早破及喂养方式（P<0.05）。72 h内TcB危险区的受试者工作特征（ROC）曲线下面积为0.75（95%CI:0.56-0.93），结合相关风险因素的ROC曲线下面积为0.93（95%CI:0.81-1.00），预测价值明显提高。结论：TcB百分位曲线图结合"高危因素"预测新生儿高胆红素血症准确性较高，操作简便，具有较好的临床价值。 |
| 英文摘要: |
| ABSTRACT Objective: To evaluate the percutaneous bilirubin (TcB) percentile curve combined with associated risk factors of neonatal at 72 hours after birth, and to predict the occurrence of neonatal hyperbilirubinemia. Methods: Late preterm infants and term infants born in the First Affiliated Hospital of Anhui University of Technology from January 2018 to December 2019 were selected, the jaundice value was monitored by percutaneous jaundice instrument, the TcB percentile nomogram was drawed. The value of predicting neonatal hyperbilirubinemia was predicted by the risk area corresponding to the last TcB value within 72 h after birth combined with the risk factors. Results: Among 3818 neonates at 72h after birth, 278 (7.28%) were in the high risk area. The value of TcB increased fastest from 4 h to 48 h, and the peak value appeared from 84h to 120h postnatal. The peak values of P40, P75 and P95 were 193.75 μmol/L, 224.75 μmol/L and 282.25 μmol/L, respectively, and the peak value of P95 appeared last. There were 244 cases of TcB values in the high risk area within 0-48 h after birth, and 92 cases were still in the high risk area after 72 h. The predictive sensitivity was 29.97%, and the specificity was 95.67%. The TcB value of 269 neonates was in the high risk area within 49-72 h, and the TcB value of 116 neonates was still in the high risk area after 72 h, the sensitivity was 36.48%, and the specificity was 95.62%. Multivariate Logistic regression analysis showed that the related risk factors were gestational age, length of hospital stay, delivery mode, premature rupture of membranes and feeding mode(P<0.05). The area under receiver operating characteristic(ROC) curve of TcB risk area within 72 h was 0.75(95%CI:0.56-0.93), and the area under ROC curve of TcB risk area combined with related risk factors was 0.93(95%CI:0.81-1.00), indicating significantly improved predictive value. Conclusion: TcB percentile curve combined with "high risk factors" has high accuracy in predicting neonatal hyperbilirubinemia, which is easy to operate, and which has good clinical value. |
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