【摘要】 目的分析高胆红素血症患儿换血术前后的血清免疫球蛋白水平变化。方法选取在本市第一人民医院及第三人民医院新生儿病房住院的高胆红素血症患者65例,根据ABE(急性胆红素脑病)评分分为无ABE组,轻度、中度和重度ABE组。比较患者换血前后胆红素的变化、免疫球蛋白IgA、IgM、IgG的变化、血液生化指标异常发生率和严重不良反应的发生率。结果换血后总胆红素(190.67±85.46)μmol/L、间接胆红素(204.64±90.57)μmol/L和白蛋白(31.65±3.23)μmol/L明显低于换血前(P<0.05);换血前轻度-重度ABE患者的IgG均高于无ABE组(P<0.05);换血后各组的IgA和IgM较换血前有所升高(P<0.05),换血后各组的IgG较换血前降低(P<0.05);中度和重度ABE组的IgM在换血后明显高于无ABE组(P<0.05)。换血后高钙血症和低镁血症的发生率在不同ABE分组间的差异有统计学意义(P<0.05),在换血后研究对象发生呼吸暂停8例(12.31%),呼吸衰竭6例(9.23%),发绀4例(6.15%),酸中毒6例(9.23%),血压波动5例(7.69%),换血后再输血7例(10.77%)。结论高胆红素血症患儿换血后胆红素降低,IgA和IgM升高,IgG降低;但换血术会造成一定的血液指标变化和严重不良反应的发生。更多还原

【Abstract】 Objective To explore the change of serum immunoglobulin levels before and after blood transfusion of patients with hyperbilirubinemia. Methods Sixty five neonatal patients in the hospitals were selected. They were divided into normal,mild,moderate and severe groups according to ABE scoring. The changes of bilirubin level,immunoglobul of IgA,IgM,IgG,abnormal frequencies of biochemical markers and severe by-side reactions were compared after transfusion. Results After blood exchange by transfusion,levels of total bilirubin(190.67±85.46) umol/L,indirect bilirubin(204.64 ±90.57)umol/L and albumin(31.65±3.23)umol/l were significantly lower than those before transfusion(P<0.05); the IgG in mild-severe ABE groups were high compared with that in normal patients(P<0.05). The IgA and IgM antibodies in all groups were increased(P<0.05),whereas IgG was decreased(P<0.05) after transfusion. A significant difference was seen of the incidence of hypercalcemia and hypomagnesemia after treatment among the groups(P<0.05). After blood exchange treatment,there occurred the apnea(8 cases,50.0%),respiratory failure(6 cases,9.23%),cyanosis(4 cases,6.15%),acid poisoning(6 cases,9.23%),and blood pressure fluctuations(5 cases,7.69%). Conclusion The patients with hyperbilirubinemia after blood exchange via transfusion presented decreased bilirubin and IgG,and increased IgA and IgM antibodies. Transfusion,however,may cause changes of blood markers and serious adverse reactions.更多还原