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目的探讨引起新生儿重症高胆红素血症的临床危险因素。方法2007年8月至2008年4月期间于本院新生儿内科病房住院的重症高胆红素血症患儿,研究组入选标准:出生14d之内,血清胆红素峰值达342μmol/L以上,以非结合胆红素增高为主,非结合胆红素占总胆红素的80%以上的患儿。设立对照组,入选标准:足月和早产儿生后14 d之内血清胆红素峰值分别>220.6μmol/L和256.5μmol/L,<342μmol/L。排除标准:患儿乙肝表面抗原阳性或其他由于肝性疾病引起的黄疸。应用Logistic回归模型,对临床常见的病因如感染、窒息、头颅血肿、早产、ABO或Rh溶血,遗传代谢病及病因不明进行回顾性分析。结果研究组有79例,对照组有96例。感染是引起新生儿高胆红素血症的最常见原因,其次是原因不明,早产,溶血,窒息,头颅血肿,遗传代谢病。应用Logistic回归分析显示,研究组与对照组对比,只有早产及原因不明两组因素差异存在统计学意义。结论新生儿高胆红素血症的病因发生了明显的变迁,临床原因不明的新生儿重症高胆红素血症将是未来研究的重点。
Objective To explore the clinical risk factors of neonatal severe hyperbilirubinemia. Methods From August 2007 to April 2008, children with severe hyperbilirubinemia hospitalized in neonatal medical ward in our hospital were enrolled in the study group. The peak value of serum bilirubin was above 342μmol / L within 14 days after birth , Mainly unconjugated bilirubin, unconjugated bilirubin accounted for more than 80% of total bilirubin in children. The control group was enrolled in the study. Serum bilirubin peak values were> 220.6μmol / L and 256.5μmol / L and <342μmol / L within 14 d of term and premature infants respectively. Exclusion criteria: children with hepatitis B surface antigen positive or other due to liver disease caused by jaundice. Logistic regression model was applied to retrospectively analyze common clinical causes such as infection, asphyxia, head hematoma, premature delivery, ABO or Rh hemolysis, genetic metabolic diseases and unknown etiology. Results The study group had 79 cases and the control group had 96 cases. Infection is the most common cause of neonatal hyperbilirubinemia, followed by unexplained, premature delivery, hemolysis, asphyxia, head hematoma, and genetic metabolic disease. Logistic regression analysis showed that there was statistically significant difference between the study group and the control group only in preterm birth and unexplained causes. Conclusions The etiology of neonatal hyperbilirubinemia has undergone obvious changes. The severe neonatal hyperbilirubinemia with unknown clinical cause will be the focus of future research.