本文選題：高膽紅素血癥 + 膽紅素��； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：分析總膽紅素與白蛋白比值（B/A）和膽紅素腦損傷的關(guān)系。比較B/A與TSB值預(yù)測(cè)神經(jīng)毒性的能力。 方法：選取我院2011年12月至2013年12月考慮可能發(fā)生新生兒膽紅素腦損傷的患兒111例，分析其血清總膽紅素（total serumbilirubin，TSB）值、B/A、BAEP、NBNA評(píng)分、MRI等資料。根據(jù)BAEP結(jié)果是否異常將其分為BAEP正常組和BAEP異常組，分別比較兩組TSB值、 B/A；根據(jù)TSB值（TSB342μmol/L，342μmol/L TSB428μmol/L，TSB428μmol/L）分為三組，根據(jù)B/A（B/A7.2（mg/g），7.2（mg/g）B/A8.5（mg/g），B/A8.5（mg/g））分為三組，分別比較兩者在不同水平的BAEP異常情況。 結(jié)果： 1、將111例患兒根據(jù)BAEP結(jié)果是否正常分成兩組。BAEP正常組有76例，異常組有35例。正常組中時(shí)齡177.84±141.86h，胎齡275.72±8.08d，產(chǎn)重3339.41±409.85g，男42例，女34例，剖宮產(chǎn)30例，自然分娩46例。異常組中時(shí)齡178.60±114.78h，胎齡273.69±7.30d，產(chǎn)重3320.86±390.74g，男17例，女18例，剖宮產(chǎn)10例，自然分娩25例，兩組的基本資料（即時(shí)齡、胎齡、產(chǎn)重、性別、分娩方式）比較，，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 2、111例患兒中，考慮感染因素58例；溶血因素45例，其中ABO溶血病40例，Rh溶血病5例；原因不明者有8例。 3、BAEP正常組TSB值為418.7896.89μmol/L，B/A為6.32±1.43（mg/g），BAEP異常組的TSB值為451.72135.07μmol/L，B/A為7.23±2.39（mg/g），兩組的TSB值比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（t=-1.297，P0.05），兩組的B/A進(jìn)行比較，差異有統(tǒng)計(jì)學(xué)意義（t=-2.079，P0.05）。 4、將111例患兒根據(jù)TSB值水平分成三組，BAEP異常率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（χ2=0.157，P0.05），各組兩兩比較差異也無(wú)統(tǒng)計(jì)學(xué)意義（P0.050.05/3）；將111例患兒根據(jù)B/A水平分成的三組，BAEP異常率比較差異有統(tǒng)計(jì)學(xué)意義（χ2=12.060，P0.05）。 5、111例患兒中，NBNA評(píng)分異常者共25例，異常率22.5%。BAEP正常組中NBNA評(píng)分異常者15例，正常者61例，異常率19.7%；BAEP異常組中NBNA評(píng)分異常者10例，正常者25例，異常率28.6%。兩組異常率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（χ2=1.072，P0.05）。 結(jié)論： 1、不能依賴單一TSB值預(yù)測(cè)膽紅素神經(jīng)毒性，可將B/A作為預(yù)測(cè)指標(biāo)之一。 2、膽紅素的神經(jīng)毒性是多因素綜合作用的結(jié)果，不能僅僅依靠TSB值或B/A評(píng)估病情及預(yù)后，尚需同時(shí)考慮患兒血腦屏障狀態(tài)、是否合并高危因素等。 3、對(duì)高膽紅素血癥患兒應(yīng)爭(zhēng)取做到早期準(zhǔn)確的評(píng)估和及時(shí)恰當(dāng)?shù)闹委�，這將影響患兒病情的轉(zhuǎn)歸和預(yù)后。
[Abstract]:Aim: to analyze the relationship between total bilirubin and albumin ratio B / A) and bilirubin brain injury. The ability of B / A and TSB to predict neurotoxicity was compared. Methods: 111 cases of neonatal bilirubin brain injury were selected from December 2011 to December 2013 in our hospital. The data of total bilirubin total (TSBB) and NBNA scores were analyzed. They were divided into normal BAEP group and abnormal BAEP group according to the results of BAEP. The two groups were divided into three groups: TSB value, B / A value; TSB value: t SB 342 渭 mol / L = 342 渭 mol/L TSB428 渭 mol / L; TSB 428 渭 mol / L). According to B / A, B / A 7.2 mg / g / g = 7.2 mg / g / g, B / A / A 8.5 mg / g / L, respectively, they were divided into three groups, and they were divided into three groups to compare the BAEP anomalies at different levels. Results: 1. According to the results of BAEP, 111 cases were divided into two groups: 76 cases in normal group and 35 cases in abnormal group. In the normal group, the age was 177.84 鹵141.86 hours, the gestational age was 275.72 鹵8.08 days, the birth weight was 3339.41 鹵409.85 g, male 42 cases, female 34 cases, cesarean section 30 cases, natural delivery 46 cases. In the abnormal group, the age was 178.60 鹵114.78 h, the gestational age was 273.69 鹵7.30 d, the birth weight was 3320.86 鹵390.74 g, male 17, female 18, cesarean section 10 and natural delivery 25. There was no significant difference in basic data (instant age, gestational age, birth weight, sex, delivery mode) between the two groups. Among the 2111 cases, 58 cases were considered infection factors, 45 cases were hemolytic factors, 5 cases were ABO hemolytic disease, 8 cases were unknown reason. 3The TSB value of the normal group was 418.7896.89 渭 mol / L (6.32 鹵1.43 mg / g / A). The TSB value of the abnormal BAEP group was 451.72135.07 渭 mol / L (7.23 鹵2.39) mg / g / g respectively. There was no significant difference in TSB between the two groups. The difference between the two groups was statistically significant (P < 0.05). 4. There was no significant difference in abnormal rate of TSB between the three groups according to the level of TSB (蠂 2: 0. 157, P 0. 05), and there was no significant difference between the two groups (P 0. 05, P 0. 05, P < 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P < 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05). There were 25 cases of abnormal 22.5%.BAEP score in 5111 cases. The abnormal rate of NBNA score was abnormal in 15 cases and normal in 61 cases in normal group. The abnormal rate of NBNA score was abnormal in 10 cases and normal in 25 cases in the abnormal rate of 19.7B BAEP. The abnormal rate was 28.6%. There was no significant difference in abnormal rate between the two groups (蠂 2 + 1.072% P 0.05). Conclusion: 1. The bilirubin neurotoxicity could not be predicted by a single TSB value, and B / A could be used as one of the predictors. 2. The neurotoxicity of bilirubin is the result of multifactorial action. We should not only evaluate the condition and prognosis by TSB or B / A, but also consider the blood-brain barrier status and risk factors. 3. Children with hyperbilirubinemia should make early and accurate evaluation and timely and appropriate treatment, which will affect the prognosis and prognosis of children with hyperbilirubinemia.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R722.1

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