摘要目的 探讨严重高胆红素血症新生儿发生急性胆红素脑病(acute bilirubin encephalopathy,ABE)的危险因素.方法 回顾性分析2013年12月至2017年10月本院新生儿科确诊的严重高胆红素血症(血清总胆红素≥427.5 μmol/L)患儿,根据是否发生ABE分为ABE组和对照组.比较两组围产期资料及实验室结果,对单因素分析有统计学差异的资料进行多因素Logistic回归分析.结果 共纳入严重高胆红素血症患儿104例,ABE组32例,对照组72例.单因素分析显示,ABE组血清总胆红素(total serum bilirubin,TSB)峰值、血清总胆红素与白蛋白比值、间接胆红素峰值及葡萄糖-6-磷酸脱氢酶缺乏症、代谢性酸中毒、败血症、中药接触、外院治疗失败、流动人口比例均高于对照组,差异有统计学意义(P＜0.05).Logistic回归分析显示,TSB水平高(OR=1.013,95％ CIl.007 ～1.020)、合并败血症(OR =6.343,95％CI l.801～22.338)是严重高胆红素血症患儿发生ABE的独立危险因素.结论 合并感染性疾病的新生儿容易发生ABE,新生儿胆红素水平过高是引起ABE的高危因素.

abstractsObjective To study the risk factors of acute bilirubin encephalopathy (ABE) in neonates with severe hyperbilirubinemia (total serum bilirubin ≥ 427.5 μmol/L).Method Clinical information of neonates with severe hyperbilirubinemia admitted to the Neonatal Department of Baoan Maternal and Child Health Hospital in Shenzhen from December 2013 to October 2017 were collected.The enrolled cases were grouped as ABE and the control group (without ABE).The risk factors for ABE were compared between the two groups and the Logistic regression analysis was used to evaluate the independent risk factor.Result A total of 104 neonates were recruited.There were 32 cases in the ABE group and 72 cases in the control group.The level of total serum bilirubin and indirect bilirubin,the ratio of total bilirubin/albumin,the incidence of glucose-6-phosphate dehydrogenase deficiency and metabolic acidosis and sepsis,the rate of using traditional Chinese medicine and the failure of treatment in other hospitals and non-resident population were all significantly higher in the ABE group than the control (P ＜ 0.05).Logistic regression analysis showed that total serum bilirubin (OR =1.013,95％ CI 1.007 ～ 1.020) and sepsis (OR =6.343,95％ CI 1.801 ～22.338) were the independent risk factors for ABE.Conclusion The severe hyperbilirubinemia infants,particularly with sepsis,are at higher risk of developing acute bilirubin encephalopathy.