Changes of bilirubin, coagulation function and lactic acid before and after blood exchange therapy in neonates with pathological jaundice and its clinical significance
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摘要: 目的 分析新生儿病理性黄疸换血治疗前后血清胆红素、凝血功能、血乳酸水平变化及临床意义。方法 选取2017年1月至2021年6月收治的70例新生儿病理性黄疸患儿为研究对象(病理组)，并选取同期生产的60例生理性黄疸新生儿和60例健康新生儿分别作为生理组和对照组。病理组均采用换血治疗，各组检测胆红素水平：总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)，凝血功能指标：凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白(FIB)，血乳酸水平。采用ROC曲线分析胆红素水平、凝血功能指标和血乳酸水平对新生儿病理性黄疸的预测效能，并采用Pearson分析病理组血清胆红素与血乳酸水平和凝血功能指标的相关性。结果 病理组和生理组血清TBIL、DBIL、IBIL、血乳酸、PT、APTT高于对照组，病理组血清TBIL、DBIL、IBIL、血乳酸、PT、APTT、TT高于生理组(P< 0.05);生理组和对照组TT比较差异无统计学意义(P>0.05)，3组FIB比较差异无统计学意义(P>0.05)。病理组治疗后血清TBIL、DBIL、IBIL、血乳酸、PT、APTT、TT低于治疗前，FIB高于治疗前(P< 0.05)。ROC曲线分析显示，血清TBIL、DBIL、IBIL、血乳酸、PT、APTT预测新生儿病理性黄疸的价值较高(P< 0.05)。Pearson相关性分析显示，血清TBIL、DBIL、IBIL与PT、APTT、TT及血乳酸呈正相关，与FIB呈负相关(P< 0.05)。结论 新生儿病理性黄疸血清胆红素、血乳酸、PT、PT、APTT、TT水平呈高表达，且血清胆红素、血乳酸与凝血功能指标存在相关性，可为病情评估和疗效预测提供依据。Abstract: Objective To analyze the changes and clinical significance of serum bilirubin, coagulation function and blood lactic acid before and after blood exchange therapy for pathological jaundice in neonates.Methods Totally 70 neonates with pathologic jaundice(pathologic group), 60 neonates with physiologic jaundice(physiologic group) and 60 healthy neonates(control group) were selected as the research subjects between January 2017 and June 2021. Neonates in the pathologic group were treated with exchange transfusion. The level of total bilirubin(TBIL), direct bilirubin(DBIL), indirect bilirubin(IBIL), coagulation function indicators: prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrin(FIB) and blood lactic acid level were detected. The ROC curve was used to analyze the predictive efficacy of bilirubin level, coagulation function index and blood lactic acid level for neonatal pathological jaundice. Pearson correlation analysis was performed to analyze the correlation of serum bilirubin level with blood lactic acid level and coagulation function in the pathologic group.Results Serum TBIL, DBIL and IBIL levels, blood lactic acid levels, PT and APTT in the pathologic group and physiologic group were higher/longer than those in the control group(P< 0.05). Serum TBIL, DBIL and IBIL levels, blood lactic acid level, PT, APTT and TT in the pathologic group were higher/longer than those in the physiologic group(P< 0.05). There was no significant difference in TT between the physiologic group and the control group(P>0.05), and there was no significant difference in FIB level among the three groups(P>0.05). After treatment, serum TBIL, DBIL and IBIL levels, blood lactic acid level, PT, APTT and TT level decreased, and FIB level increased in the pathologic group(P< 0.05). ROC curve analysis showed that serum TBIL, DBIL, IBIL, blood lactic acid, PT and APTT were of high value in predicting neonatal pathologic jaundice(P< 0.05). Pearson correlation analysis showed that serum TBIL, DBIL and IBIL were positively correlated with PT, APTT, TT and blood lactic acid level, and negatively correlated with FIB(P< 0.05).Conclusion Neonates with pathologic jaundice have high serum bilirubin levels, blood lactic acid levels, long PT, PT, APTT and TT. Serum bilirubin and blood lactic acid levels may be correlated with coagulation function indicators, which can provide a basis for condition evaluation and curative effect prediction.
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表 1 各组治疗前血清胆红素、血乳酸水平比较
X±S 组别 例数 TBIL/(μmol·L-1) DBIL/(μmol·L-1) IBIL/(μmol·L-1) 血乳酸/(mmol·L-1) 病理组 70 385.51±32.661)2) 29.30±8.181)2) 356.21±27.211)2) 4.31±1.151)2) 生理组 60 113.62±18.041) 23.11±6.201) 77.41±14.861) 3.70±0.651) 对照组 60 17.48±5.22 3.28±0.77 14.09±4.13 2.62±0.44 与对照组比较，1)P < 0.05;与生理组比较，2)P < 0.05。 
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表 2 各组治疗前凝血功能指标比较
X±S 组别 例数 PT/s APTT/s TT/s FIB/(mg·L-1) 病理组 70 38.97±4.261)2) 51.65±10.311)2) 18.03±5.201)2) 1.97±0.221)2) 生理组 60 13.82±3.251) 40.33±6.541) 13.17±3.261) 2.04±0.261) 对照组 60 9.55±2.19 30.88±4.26 12.65±3.11 2.08±0.34 与对照组比较，1)P < 0.05;与生理组比较，2)P < 0.05。
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表 3 病理组治疗前后血清胆红素和血乳酸水平比较X±S
时间 TBIL/(μmol·L-1) DBIL/(μmol·L-1) IBIL/(μmol·L-1) 血乳酸/(mmol·L-1) 治疗前 385.51±32.66 29.30±8.18 356.21±27.21 4.31±1.15 治疗后 32.05±8.191) 11.37±3.351) 26.31±7.281) 3.04±0.521) 与治疗前比较，1)P < 0.05。
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表 4 病理组治疗前后凝血功能指标比较
X±S 时间 PT/s APTT/s TT/s FIB/(mg·L-1) 治疗前 38.97±4.26 51.65±10.31 18.03±5.20 1.97±0.22 治疗后 11.55±3.081) 41.88±7.261) 13.32±2.401) 2.04±0.281) 与治疗前比较，1)P < 0.05。
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表 5 血清胆红素和血乳酸水平及凝血功能指标对新生儿病理性黄疸的预测效能
指标 敏感度/% 特异度/% AUC 95%CI 最佳截断值 TBIL 82.00 67.00 0.835 0.731~0.939 351.14 μmol/L DBIL 88.00 70.00 0.858 0.755~0.962 25.53 μmol/L IBIL 82.00 66.00 0.834 0.727~0.941 219.36 μmol/L 血乳酸 75.00 60.00 0.720 0.594~0.847 4.10 mmol/L PT 77.50 65.00 0.746 0.626~0.866 30.57 s APTT 79.00 62.50 0.780 0.654~0.907 46.72 s
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表 6 病理组血清胆红素水平与血乳酸、凝血功能指标的相关性
组别 PT APTT TT FIB 血乳酸 r P r P r P r P r P TBIL 0.358 < 0.05 0.355 < 0.05 0.382 < 0.05 -0.371 < 0.05 0.352 < 0.05 DBIL 0.344 < 0.05 0.360 < 0.05 0.373 < 0.05 -0.362 < 0.05 0.370 < 0.05 IBIL 0.351 < 0.05 0.349 < 0.05 0.348 < 0.05 -0.379 < 0.05 0.366 < 0.05
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