Clinical significance of serum myocardial injury markers in diagnosis and treatment of neonatal hyperbilirubinemia
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摘要: 目的探讨新生儿胆红素血症中高浓度胆红素水平对新生儿心肌损伤的影响。方法选取2020年12月至2021年9月南京医科大学附属儿童医院收治的191例新生儿高胆红素血症患儿，根据血清总胆红素(TBIL)水平将其分为轻度、中度、重度3组，其中TBIL>290.7 μmol/L的65例为重度组，TBIL 256.5~290.7 μmol/L的52例为中度组，TBIL 205.2~256.6 μmol/L的74例为轻度组，另选取同期健康新生儿49例为对照组。检测其血清TBIL、间接胆红素(IBIL)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸酶同工酶(CK-MB)、α-羟基丁酸脱氢酶(HBDH)水平，并采用Pearson相关分析TBIL、IBIL与心肌损伤标志物LDH、CK、CK-MB及HBDH水平之间的相关性。结果重度组LDH、CK、CK-MB、HBDH分别为(492.538±117.720)μmol/L、(172.384±74.847)μmol/L、(41.769±8.556)μmol/L、(310.123±96.591)μmol/L；中度组LDH、CK、CK-MB、HBDH分别为(476.692±137.934)μmol/L、(152.769±56.084)μmol/L、(37.692±5.703)μmol/L、(292.076±83.016)μmol/L；轻度组分别为(434.716±115.765)μmol/L、(129.094±47.226)μmol/L、(27.3514±5.336)μmol/L、(277.635±5.336)μmol/L；对照组分别为(362.018±86.065)μmol/L、(95.469±33.221)μmol/L、(26.428±4.55)μmol/L、(218.551±47.156)μmol/L]，4组之间差异有统计学意义(P＜0.05)，LDH、CK、CK-MB及HBDH与TBIL、IBIL之间呈显著正相关(P＜0.05)。结论新生儿高胆红素血症可能会对患儿的心肌造成损伤，因此在临床上需密切观察患儿的心肌标志物，随时关注患儿病情，及时进行诊断和治疗。Abstract: ObjectiveTo investigate the effect of high bilirubin level in neonatal bilirubinemia on neonatal myocardial injury.MethodsA total of 191 neonates with neonatal hyperbilirubinemia admitted to Children's Hospital affiliated to Nanjing Medical College from December 2020 to September 2021 were divided into mild group, moderate group and severe group according to serum total bilirubinemia(TBIL) level. A total of 65 cases with TBIL>290.7 μmol/L were classified as severe group, 52 patients with TBIL level of 256.5-290.7 μmol/L were selected as moderate group, 74 patients with TBIL level of 205.2-256.6 μmol/L were selected as mild group, and 49 healthy neonates were selected as control group. Serum levels of TBIL, indirect bilirubin(IBIL), lactate dehydrogenase(LDH), creatine kinase(CK), creatine isoenzyme(CK-MB) and α-hydroxybutyrate dehydrogenase(HBDH) were detected. The correlation between TBIL, IBIL and levels of myocardial injury markers LDH, CK, CK-MB and HBDH was analyzed by Pearson correlation analysis.ResultsLDH, CK, CK-MB, HBDH in severe group were (492.538±117.720)μmol/L, (172.384±74.847)μmol/L, (41.769±8.556)μmol/L, (310.123±96.591)μmol/L; (476.692±137.934)μmol/L, (152.769±56.084)μmol/L, (37.692±5.703)μmol/L, (292.076±83.016)μmol/L in moderate group; (434.716±115.765)μmol/L, (129.094±47.226)μmol/L, (27.3514±5.336)μmol/L, (277.635±5.336)μmol/L in mild group; (362.018±86.065) μmol/L, (95.469±33.221)μmol/L, (26.428±4.55)μmol/L, (218.551±47.156)μmol/L in control group.There were statistically significant differences among the control group, mild group, moderate group and severe group(P < 0.05), and there were significant positive correlations between LDH, CK, CK-MB and HBDH and TBIL and IBIL(P < 0.05).ConclusionNeonatal hyperbilirubinemia may cause myocardial damage in children, so it is necessary to closely observe the myocardial markers in children, pay attention to the condition of children at any time, and timely diagnosis and treatment.
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Key words:
- hyperbilirubinemia /
- total bilirubin /
- indirect bilirubin /
- lactate dehydrogenase /
- creatine kinase
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表 1 血清心肌标志物LDH、CK、CK-MB及HBDH水平比较
μmol/L，X±S 组别 例数 LDH CK CK-MB HBDH 对照组 49 362.018±86.065 95.469±33.221 26.428±4.55 218.551±47.156 轻度组 74 434.716±115.765 129.094±47.226 27.351±5.336 277.635±5.336 中度组 52 476.692±137.934 152.769±56.084 37.692±5.703 292.076±83.016 重度组 65 492.538±117.720 172.384±74.847 41.769±8.557 310.123±96.591 F 13.41 19.53 88.51 11.49 P ＜0.000 1 ＜0.000 1 ＜0.000 1 ＜0.000 1 
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表 2 血清LDH、CK、CK-MB及HBDH与TBIL、IBIL水平的相关性
指标 例数 TBIL IBIL r P r P LDH 191 0.250 8 0.000 5 0.249 1 0.000 5 CK 191 0.339 2 ＜0.000 1 0.344 0 ＜0.000 1 CK-MB 191 0.426 1 ＜0.000 1 0.427 0 ＜0.000 1 HBDH 191 0.220 3 0.002 2 0.214 2 0.002 9
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