健康新生儿经皮小时胆红素百分位列线图预测高胆红素血症的价值

Value of hour-specific transcutaneous bilirubin nomogram for prediction of hyperbilirubinemia in healthy neonates

摘要:

目的 绘制健康新生儿小时经皮胆红素(TCB)百分位列线图,评价其在预测高胆红素血症发生风险中的价值。方法 选取5 250 名足月儿或晚期早产儿(胎龄≥ 35 周,出生体重≥ 2 000 g),连续记录生后168 h TCB 值。将生后24~48 h、49~72 h 和73~96 h 内对应最高危区TCB 值作为预测指标,采用小时TCB 列线图结合受试者工作特征曲线(ROC 曲线)评价小时TCB 列线图对高胆红素血症的预测价值。结果 小时TCB百分位列线图显示,生后16~72 h TCB 快速上升明显,72 h 后至144 h 上升逐渐减缓,144 h 后维持一个平稳高值,其中第95 百分位(P₉₅)小时胆红素在96 h 已趋于稳定。P₄₀、P₇₅、P₉₅ 小时TCB 高峰值分别为173、217、248 μmol/L。生后24~48 h、49~72 h 和73~96 h 内TCB 水平预测高胆红素血症ROC 曲线下面积(AUC)分别为0.77、0.85 和0.87。24~48 h、49~72 h 和73~96 h 内高危区预测新生儿高胆红素血症患病率分别为35.03%、43.35% 和79.95%,阳性似然比分别为3.35、4.75 和22.70。结论 小 时TCB 百分位列线图结合TCB 值危险区的划分可较好预测新生儿高胆红素血症的发生。73~96 h 内小时胆红素若处于高危区,73~96 h 后有较大可能发生高胆红素血症。

Abstract:

Objective To plot a hour-specific transcutaneous bilirubin (TCB) nomogram for healthy neonates, and to evaluate its value for prediction of the risk of neonatal hyperbilirubinemia. Methods A total of 5 250 healthy fullterm or near-term neonates (gestational age ≥35 weeks, birth weight ≥2 000 g) were enrolled as subjects. Their TCB values were continuously recorded for 168 hours after birth. The TCB values in the high-risk zones of three time periods, 24-48, 49-72, and 73-96 hours after birth, were used as predictors. The hour-specific TCB nomogram combined with the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of hour-specific TCB nomogram for hyperbilirubinemia. Results According to the hour-specific TCB nomogram, the TCB value dramatically increased during 16-72 hours after birth, and the increase slowed down gradually during 72-144 hours. Finally, the curve reached a plateau after 144 hours. Particularly, the P₉₅ of TCB had been stabilized at 96 hours. The P₄₀, P₇₅, and P₉₅ peak values of TCB were 173, 217, and 248 μmol/L, respectively. For the prediction of hyperbilirubinemia, the areas under the ROC curve of TCB at 24-48, 49-72, and 73-96 hours after birth were 0.77, 0.85, and 0.87, respectively. The high-risk zones at 24-48, 49-72, and 73-96 hours after birth predicted the incidence rates of neonatal hyperbilirubinemia as 35.03%, 43.35%, and 79.95%, respectively, with positive likelihood ratios of 3.35, 4.75, and 22.70, respectively. Conclusions The hour-specific TCB nomogram and the division of TCB risk zones can give a satisfactory prediction of the incidence of neonatal hyperbilirubinemia. The neonate with a bilirubin level in the high-risk zone within 73-96 hours after birth is likely to have hyperbilirubinemia after 73-96 hours.