Abstract
目的 探讨新生儿溶血病中碳氧血红蛋白(COHb)检测的临床意义.方法以德国产800系列生化血气分析仪附加的270-血氧仪检测动脉化毛细血管血COHb,以COHb占总血红蛋白的百分比(%)表示.同步取静脉血检测血清总胆红素(STB).病例选自新生儿病房收治的母子血型不合溶血病(溶血组)75例(其中ABO溶血病71例,Rh溶血病4例).对照组40例为日龄匹配无病理性黄疸者. 结果 (1)溶血组与对照组比较,COHb:[3.7±0.8与2.4±0.4)%(t=9.3,P＜0.001)];STB:[(333.8±130.6与130.6±76.2) μmol/L(t=10.0,P＜0.001)],差异均有非常显著性.(2)ABO溶血病:生后1～2 d COHb达(3.5±0.5)%,已明显增高;STB并不高,为(184±45.8) μmol/L,两者无相关性(r=-0.1,P=0.7);但随黄疸加重STB≥257 μmol/L时两者呈正相关(r=0.5,P＜0.001);胆红素脑病者COHb均＞3.7%.(3)61例直接Coombs试验(+)及10例(-)两组的COHb均增高,差异无显著性[(3.7±0.9与3.6±0.6)%(t=0.5,P=0.6)].(4)31例静脉注射大剂量免疫球蛋白(IVIG)1 g/(kg*d),仅用1 d; 25例予小剂量IVIG 400 mg/(kg*d),连用3 d,前者COHb单位时间内下降速度明显(%/d)快于后者[(0.9±0.8与0.3±0.1)%/d(t=3.5,P=0.001)]. 结论 COHb的明显增高证实新生儿溶血病胆红素产量增多;子直接Coombs试验阴性时COHb可辅助诊断ABO溶血病;早期COHb升高较STB更为敏感地反映溶血的程度;当COHb＞3.7%时应警惕胆红素脑病;大剂量IVIG可更有效降低COHb及STB,减轻溶血。
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