重度新生儿高胆红素血症发生急性胆红素脑病的危险因素 及头颅磁共振G/P 值联合血清TSB、NSE 的预测价值研究.

Objective: To analyze the risk factors for the acute bilirubin encephalopathy (ABE) occurrence in severe neonatal hyperbilirubinemia (NHB) and to investigate the predictive value of cranial magnetic resonance pale globule to shell nucleus T1-weighted imaging signal intensity ratio (G/P value) combined with total serum bilirubin (TSB) and neuron-specific enolase (NSE). Methods: 369 children with severe NHB who were admitted to the Tianmen First People's Hospital of Hubei Province from January 2018 to January 2020 were selected, and they were divided into ABE group and non-ABE group according to whether ABE occurred within 1 week after admission. Clinical data of all children were collected, the cranial magnetic resonance G/P value were calculated, and serum TSB and NSE levels were detected. Univariate and multivariate Logistic regression were used to analyze the influencing factors of ABE occurrence in severe NHB. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of cranial magnetic resonance G/P value combined with serum TSB and NSE for ABE occurrence in severe NHB. Results: The incidence of ABE in 369 children with NHB was 12.47% (46/369). Multivariate Logistic regression analysis showed that lower birth weight, shorter hospital admission days, longer hospital stay, non-breastfeeding, increased hemoglobin and G/P value, increased TSB and NSE were independent risk factors for ABE occurrence with severe NHB (P＜0.05). ROC curve analysis showed that the area under curve predicted ABE occurrence of severe NHB by G/P value combined with serum TSB and NSE was larger than that predicted by G/P value combined with serum TSB and NSE alone (P＜0.05). Conclusion: Lower birth weight, shorter hospital admission days, longer hospital stay, non-breastfeeding, increased hemoglobin, increased G/P value, increased TSB and increased NSE are risk factors for ABE occurrence in severe NHB. The value of cranial magnetic resonance G/P value combined with serum TSB and NSE is higher in predicting ABE. [ABSTRACT FROM AUTHOR]

目的：分析重度新生儿高胆红素血症（NHB）发生急性胆红素脑病（ABE）的危险因素并探讨头颅磁共振苍白球与壳核T1 加 权成像信号强度比值（G/P 值）联合血清总胆红素（TSB）、神经元特异性烯醇化酶（NSE）的预测价值。方法：选取2018 年1 月～ 2020 年1 月湖北省天门市第一人民医院收治的369 例重度NHB 患儿，根据入院1 周内是否发生ABE 分为ABE 组和非ABE 组。收集所有患儿临床资料，计算头颅磁共振G/P 值和检测血清TSB、NSE 水平。采用单因素和多因素Logistic 回归分析重度 NHB 发生ABE 的影响因素，受试者工作特征（ROC）曲线分析头颅磁共振G/P 值联合血清TSB、NSE 对重度NHB 发生ABE 的 预测价值。结果：369 例NHB 患儿ABE 发生率为12.47％（46/369）。多因素Logistic 回归分析显示，出生体重较低、入院日龄缩短、 住院时间延长、非母乳喂养、血红蛋白升高和G/P 值、TSB、NSE 升高为重度NHB 发生ABE 的独立危险因素（P＜0.05）。ROC 曲 线分析显示，头颅磁共振G/P 值联合血清TSB、NSE 预测重度NHB 发生ABE 的曲线下面积大于头颅磁共振G/P 值和血清TSB、 NSE 单独预测（P＜0.05）。结论：出生体重较低、入院日龄缩短、住院时间延长、非母乳喂养、血红蛋白升高、G/P 值升高、TSB 升高、 NSE 升高是重度NHB 发生ABE 的危险因素，头颅磁共振G/P 值联合血清TSB、NSE 预测ABE 的价值较高。 [ABSTRACT FROM AUTHOR]