摘要
目的 探讨肠道微生态指标联合血清胆红素总量/白蛋白比值对新生儿高胆红素血症的诊断价值.方法 前瞻性选取2020年11月至2023年12月滁州市第一人民医院儿童医院收治的252例新生儿高胆红素血症患儿,设为研究组,根据黄疸分度将研究组分为轻度组(n=126)、中度组(n=95)及重度组(n=31),并纳入同期年龄、性别配对的70名体检健康新生儿作为对照组.采用Illumina Miseq测序平台测定肠道微生态指标,采用重氮盐法检测白蛋白、间接胆红素及总胆红素水平.比较各组的肠道微生态指标、白蛋白、间接胆红素、总胆红素及胆红素总量/白蛋白比值.多因素Logistic回归分析新生儿高胆红素血症患儿严重程度的影响因素.绘制受试者操作特征(ROC)曲线分析肠道微生态指标、白蛋白、间接胆红素等指标诊断新生儿高胆红素血症的预测价值.结果 重度组的克雷伯菌属、葡萄球菌属、埃希菌属均显著高于轻度组、中度组,中度组克雷伯菌属、葡萄球菌属、埃希菌属均显著高于轻度组,差异均有统计学意义(P＜0.05);4组的双歧杆菌属、乳酸菌属比较,差异均无统计学意义(P＞0.05).重度组的白蛋白显著低于轻度组、中度组,中度组白蛋白显著低于轻度组,差异均有统计学意义(P＜0.05);重度组的间接胆红素、总胆红素及血清胆红素总量/白蛋白比值显著高于轻度组、中度组,中度组间接胆红素、总胆红素及血清胆红素总量/白蛋白比值显著高于轻度组,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,克雷伯菌属、葡萄球菌属、埃希菌属、白蛋白、间接胆红素、总胆红素及血清胆红素总量/白蛋白比值均为新生儿高胆红素血症的影响因素(P＜0.05).肠道微生态指标联合血清胆红素总量/白蛋白比值诊断新生儿高胆红素血症的曲线下面积(AUC)、约登指数、特异度及敏感度均较高,具有较好预测价值(P＜0.05).结论 肠道微生态指标联合血清胆红素总量/白蛋白比值能够作为诊断新生儿高胆红素血症的可靠指标.
Abstract
Objective To investigate the diagnostic value of intestinal microecological index combined with serum total bilirubin/albumin ratio in hyperbilirubinemia of newborn.Methods A total of 252 neonates with hyperbilirubinemia admitted to Children's Hospital of Chuzhou First People's Hospital from November 2020 to December 2023 were prospectively selected as the study group.According to the degree of jaundice,the study group was divided into the mild group(n=126),the moderate group(n=95)and the severe group(n=31),and 70 healthy neonates with age and gender matching in the same period were included as the control group.The intestinal microecological indexes were determined by Il-lumina Miseq sequencing platform,the levels of albumin,indirect bilirubin and total bilirubin were detected by diazo salt method.And the intesti-nal microecological indexes,albumin,indirect bilirubin,total bilirubin,total bilirubin and total bilirubin/albumin ratio of each group were com-pared.The predictive value of intestinal microecological indicators,albumin,indirect bilirubin and other indicators in the diagnosis of neonatal hy-perbilirubinemia was analyzed by drawing the receiver operating characteristic(ROC)curve.Results The Klebsiella,Staphylococcus and Esche-richia in the severe group were significantly higher than those in the mild group and the moderate group,and the Klebsiella,Staphylococcus and Escherichia in the moderate group were significantly higher than those in the mild group,the differences were statistically significant(P＜0.05),and there were no statistically significant differences in Bifidobacterium and Lactobacillus among the four groups(P＞0.05).The albumin in the severe group was significantly lower than that in the mild group and the moderate group,and the albumin in the moderate group was significantly lower than that in the mild group,the differences were statistically significant(P＜0.05).The indirect bilirubin,total bilirubin and serum total bilirubin/albumin ratio in the severe group were significantly higher than those in the mild group and the moderate group,and the indirect biliru-bin,total bilirubin and serum total bilirubin/albumin ratio in the moderate group were significantly higher than those in the mild group,the differ-ences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that Klebsiella,Staphylococcus,Escherichia,al-bumin,indirect bilirubin,total bilirubin and serum total bilirubin/albumin ratio were the influencing factors of neonatal hyperbilirubinemia(P＜0.05).The area under the curve(AUC),Youden index,specificity and sensitivity of intestinal microecological index combined with serum to-tal bilirubin/albumin ratio in the diagnosis of neonatal hyperbilirubinemia were high,with good predictive value(P＜0.05).Conclusion In-testinal microecological index combined with serum total bilirubin/albumin ratio can be used as a reliable index for the diagnosis of hyperbilirubi-nemia of newborn.
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