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摘要: 目的 通过相关肝功能指标分析，探讨不同程度新生儿高胆红素血症患儿肝脏的损伤程度。方法 回顾性分析2022年1月—2022年12月医院收治的191例新生儿高胆红素血症患儿，以及同期体检的48例健康新生儿的临床资料。按照血清总胆红素(total bilirubin，TBIL)水平分为轻度组(n=74)、中度组(n=53)、重度组(n=64)以及对照组(n=48)4组。检测轻、中、重度组以及对照组新生儿的TBIL、谷丙转氨酶(alanine aminotransferase，ALT)、谷草转氨酶(aspartate aminotransferase，AST)、γ-谷氨酰转移酶(γ-glutamyltransferase，GGT)、碱性磷酸酶(alkaline phosphatase，ALP)、乳酸脱氢酶(lactic dehydrogenase，LDH)、羟丁酸脱氢酶(hydroxybutyrate dehydrogenase，HBDH)水平。统计分析4组肝功能指标，同时将肝功能指标与TBIL水平进行Pearson相关性分析。结果 轻、中、重度组以及对照组4组之间肝功能指标(ALT、AST、ALP、GGT、LDH、HBDH)差异有统计学意义(P＜0.05)，中度组AST、GGT、ALP、LDH、HBDH水平显著高于对照组(P＜0.05)，重度组ALT、AST、GGT、LDH、HBDH水平显著高于轻度组(P＜0.05)，重度组AST、HBDH水平显著高于中度组(P＜0.05)，ALT、AST、GGT、LDH、HBDH与TBIL水平之间呈显著正相关(P＜0.05)，而ALP与TBIL水平无相关性(P>0.05)。结论 在新生儿高胆红素血症患儿中，TBIL水平越高，肝脏受损程度越深，因此需要密切关注患儿的肝功能指标，监测病情进展情况，及时准确地开展相应的诊疗措施。Abstract: Objective To analyze the degree of liver injury in neonates with different degrees of hyperbilirubinemia using related liver function indexes.Methods The clinical data of 191 neonates with neonatal hyperbilirubinemia admitted to our hospital from January 2022 to December 2022 and 48 healthy neonates who underwent physical examination during the same period were retrospectively analyzed. According to the serum total bilirubin(TBIL) level, the patients were divided into four groups: mild group(n=74), moderate group(n=53), severe group(n=64) and control group(n=48). The levels of TBIL, alanine aminotransferase(ALT), aspartate aminotransferase(AST), γ-glutamyltransferase(GGT), alkaline phosphatase(ALP), lactic dehydrogenase(LDH)and hydroxybutyrate dehydrogenase(HBDH)in the mild, moderate and severe groups and the control group were detected. The liver function indexes(ALT, AST, ALP, GGT, LDH, HBDH) of the four groups were statistically analyzed, and Pearson correlation analysis was performed between the liver function indexes and the level of TBIL.Results There were significant differences in liver function indexes among the mild, moderate, severe groups and the control group(P<0.05). The levels of AST, GGT, ALP, LDH, HBDH in the moderate group were significantly higher than those in the control group(P<0.05). The levels of ALT, AST, GGT, LDH and HBDH in the severe group were significantly higher than those in the mild group(P<0.05), and the levels of AST and HBDH in the severe group were significantly higher than those in the moderate group(P<0.05). ALT, AST, GGT, LDH and HBDH were positively correlated with TBIL level(P<0.05), while ALP was not correlated with TBIL level(P>0.05).Conclusion In newborn children with high blood bilirubin, different levels of bilirubin may cause a certain degree of damage to the liver function. The higher bilirubin level, the deeper the degree of liver damage. So it need to pay close attention to the patient's liver function indicators, monitoring the progress of the disease, carry out the corresponding treatment measures timely and accurately.
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表 1 4组血清肝功能指标ALT、AST、ALP、GGT、LDH、HBDH水平比较
U/L，X±S 指标 对照组 轻度组 中度组 重度组 F P ALT 9.471±9.562 9.572±6.861 12.304±7.477 13.342±8.0831)2) 3.704 0.012 AST 23.851±15.413 27.322±9.016 33.963±12.1021)2) 39.303±17.6311)2)3) 14.597 ＜0.001 ALP 189.891±78.614 237.692±70.0601) 242.131±72.3821) 238.675±74.9071) 5.665 0.001 GGT 115.831±131.373 126.153±61.412 163.092±112.8341)2) 173.634±92.0951)2) 4.679 0.003 LDH 383.431±130.793 411.669±96.563 476.402±135.8441)2) 504.754±105.1841)2) 13.513 ＜0.001 HBDH 222.771±63.422 266.895±77.7671) 291.139±82.5031)2) 325.254±98.8261)2)3) 14.868 ＜0.001 与对照组比较，1)P＜0.05；与轻度组比较，2)P＜0.05；与中度组比较，3)P＜0.05。 
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