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目的 探讨新生儿重度高间接胆红素血症 (高胆 )脑脊液未结合胆红素浓度的影响因素和临床意义。方法 取高胆病人 2 3例在治疗前进行血清、脑脊液胆红素测定及血气、血浆蛋白检查 ,并计算B/A比值 ,追踪 12月龄时用CDCC智测评价DQ ;对照组 11例为同期住院的其他疾病不伴有黄疸者。结果 ①高胆病人脑脊液胆红素平均 12 39± 6 0 9μmol/L ,明显高于对照组 4 31± 1 37μmol/L(P <0 0 1) ,临床诊断胆红素脑病 13例脑脊液胆红素浓度 13 97± 3 2 5 μmol/L。②脑脊液胆红素与血清浓度无相关性 (γ =0 2 79,P >0 0 5 ) ,而与B/A比值 (未结合胆红素 /白蛋白 )有显著相关性 (γ =0 6 ,P <0 0 5 ) ,与血液酸碱度程度之间差异有显著意义 (t=2 0 6 ,P <0 0 5 )。③溶血性黄疸与非溶血性黄疸脑脊液胆红素差异无显著意义 (t=0 2 17,P>0 0 5 )。④临床有神经症状者脑脊液胆红素浓度 >8 4 μmol/L ,12月龄DQ异常率为 30 % ,而 <8 4 μmol/L者 12月龄DQ异常率为 0。结论 脑脊液胆红素与血液酸碱度和B/A比值直接相关 ,脑脊液胆红素可作为胆红素脑病诊断和判断预后的敏感指标。
Objective To investigate the influencing factors and clinical significance of cerebrospinal fluid unbound bilirubin concentration in neonates with severe hyperbilirubinemia (hypercholesterolemia). Methods Serum and cerebrospinal fluid bilirubin and blood gas and plasma protein were measured in 23 cases of patients with hypercholesterolemia before treatment. The B / A ratio was calculated and DQ was evaluated with CDCC. The control group was 11 Other hospitalized diseases over the same period are not associated with jaundice. Results ① The mean bilirubin concentration in cerebrospinal fluid of patients with hypercholesterolemia was 12 39 ± 6 0 9 μmol / L, which was significantly higher than that of the control group 4 31 ± 1 37 μmol / L (P 0 01). Thirteen cases of bilirubin encephalopathy The concentration was 13 97 ± 3 25 μmol / L. There was no significant correlation between serum bilirubin and cerebrospinal fluid (γ = 0 2 79, P 0 05) and B / A ratio (unbound bilirubin / albumin) (γ = 0 6 , P <0 05), and the difference of blood pH value was significant (t = 206, P <0 05). ③ hemolytic jaundice and non-hemolytic jaundice cerebrospinal fluid bilirubin no significant difference (t = 0 2 17, P> 0 0 5). ④ In patients with neurological symptoms, cerebrospinal fluid bilirubin concentration was> 8 4 μmol / L, and the abnormality rate of DQ at 12 months was 30%. However, the abnormality rate of DQ at 12 months of <8 4 μmol / L was 0. Conclusions Cerebrospinal fluid bilirubin is directly related to blood pH and B / A ratio. Cerebrospinal fluid bilirubin can be used as a sensitive index for the diagnosis and prognosis of bilirubin encephalopathy.