摘要
目的探讨胆红素/白蛋白比值预测高胆红素血症新生儿神经发育的价值,并构建诺莫图预测模型。方法随机纳入宣城市中心医院于2019年8月-2020年8月出生的高胆红素血症患儿145例作为试验组,纳入同期健康新生儿作为对照组。检测两组患儿不同时期胆红素/白蛋白比值,并于出生后7、14、21、28 d进行新生儿行为神经评定(NBNA),于婴儿6月使用听性脑干反应评定其神经发育情况,采用Logistic回归模型分析NBNA评分、胆红素/白蛋白比值与远期神经发育的关系,建立神经发育诺模图预测模型,并进一步验证。结果试验组患儿脐血、黄疸高峰期胆红素/白蛋白比值明显高于对照组(t=2.768、6.853,P均<0.05),并且试验组新生儿7、14、21、28d NBNA评分均明显低于对照组(P均<0.05)。试验组异常概率明显高于对照组,差异有统计学意义(χ^(2)=23.651,P=0.000)。Logistic回归分析显示,黄疸高峰期胆红素/白蛋白比值是神经发育不良的最危险因素(OR=32.22,95%CI:11.320~54.260,P=0.000)。通过建立诺莫图预测模型,当应用诺莫评分体系时,预测出生后6个月发生高胆红素血症患儿神经发育不良的几率和实际发生的几率完全吻合。结论高胆红素血症对神经发育可造成不良影响,胆红素/白蛋白升高对高胆红素血症的新生儿神经发育状况具有良好的预测价值。
Objective To explore the value of bilirubin/albumin ratio in predicting neurodevelopment of neonates with hyperbilirubinemia,and construct a nomogram prediction model.Methods A total of 145 children with hyperbilirubinemia born in Xuancheng Central Hospital from August 2019 to August 2020 were randomly included as the experimental group,and healthy newborns during the same period were included as the control group.and the bilirubin/albumin ratio was calculated.Neonatal behavioral neurological assessment(NBNA)was performed at 7,14,21,and 28 days after birth.The neurodevelopmental status of infants was assessed using auditory brainstem responses at 6 months.Logistic regression model was used to analyze the relationship between NBNA,bilirubin/albumin and long-term neurodevelopment,and a neurodevelopmental nomogram prediction model was established,which was further verified.Results The ratio of bilirubin/albumin in cord blood and jaundice peak period in the experimental group was significantly higher than those in the control group(t=2.768,6.853,all P<0.05),and the NBNA scores of the neonates in the experimental group on 7,14,21,and 28days were all significantly lower than the control group(P<0.05).The abnormal probability in the experimental group was significantly higher than that of the control group(χ^(2)=23.651,P=0.000).Logistic regression analysis showed that the peak period of jaundice bilirubin/albumin ratio was the most risk factor for neurodevelopmental dysplasia(OR=32.22,95%CI:11.32-54.26,P=0.000).By establishing a nomogram prediction model,when the Nomo scoring system was applied,the predicted probability of neurodevelopmental dysplasia in children with hyperbilirubinemia at 6 months after birth was in complete agreement with the actual probability.Conclusion Hyperbilirubinemia could have adverse effects on neurodevelopment,and elevated bilirubin/albumin had a good predictive value for the neurodevelopmental status of neonates with hyperbilirubinemia.
作者
宋菲菲
曾峰
殷苑琴
SONG Fei⁃fei;ZENG Feng;YIN Wan⁃qin(Department of Neonatal,Xuancheng City Center Hospital,Xuancheng,Anhui 242000,China)
出处
《热带医学杂志》
CAS
2022年第7期996-1000,共5页
Journal of Tropical Medicine
基金
国家卫生健康委医药卫生科技发展研究中心(WA2020HK60)
