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目的:探讨脑脊液中未结合胆红素检测在高胆红素血症新生儿中的临床应用价值。方法:对285例高胆红素血症新生儿的脑脊液和血液未结合胆红素水平进行检测,计算未结合胆红素/白蛋白比值(B/A),并进行新生儿行为神经评分(NBNA)。结果:警告期和痉挛期的胆红素脑病新生儿血中未结合胆红素(UCB)、脑脊液(CSF)中UCB和血B/A比值均明显高于单纯高胆红素血症的新生儿,差异有统计学意义(P<0.05),并且出现痉挛期的新生儿CSF中UCB高于警告期新生儿,差异有统计学意义(P<0.05),进一步研究发现血中UCB、CSF中UCB和B/A比值NBNA异常组患者均明显高于NBNA正常组新生儿,其中CSF中UCB与NBNA得分呈显著的负相关。结论:CSF中UCB检测不但能早期诊断胆红素脑病,并且能准确地反应高胆红素血症新生儿的脑功能情况。
Objective: To investigate the clinical application of unconjugated bilirubin in cerebrospinal fluid in neonates with hyperbilirubinemia. Methods: The cerebrospinal fluid (CSF) and blood unconjugated bilirubin levels were measured in 285 neonates with hyperbilirubinemia. Unconjugated Bilirubin / albumin ratio (B / A) was calculated and neonatal behavioral neurological score NBNA). Results: The levels of UCB, UCB and B / A in cerebrospinal fluid (CSF) were significantly higher in neonates with bilirubin encephalopathy during warning phase and spastic phase than those with hyperbilirubinemia (P <0.05), and the UCB in neonates with spasm was significantly higher than that in warning neonates (P <0.05). Further study found that UCB and CSF in the blood UCB and B / A ratios in patients with NBNA abnormalities were significantly higher than those in normal NBNA neonates, with a significant negative correlation between UCB and NBNA scores in CSF. Conclusion: UCB detection in CSF not only can early diagnosis of bilirubin encephalopathy, but also can accurately reflect the brain function of neonates with hyperbilirubinemia.