新生儿高胆红素血症早期肾损伤及预后的影响因素分析

Analysis of influencing factors for early renal injury and prognosis in neonatal hyperbilirubinemia

摘要:

目的 分析新生儿高胆红素血症早期肾损伤发生及预后的影响因素。方法 选取2021年4月—2023年12月西安大兴医院新生儿科收治的高胆红素血症患儿。治疗前采用生化分析仪测定总胆红素（TBIL）水平，酶联免疫吸附试验检测血清神经元特异性烯醇化酶（NSE）水平，电化学发光法检测血清肌酐（Cr），免疫比浊法检测血β₂-微球蛋白（β₂-MG）水平。给予新生儿白蛋白、免疫球蛋白、肝酶诱导剂、益生菌等药物治疗，根据患儿是否发生肾损伤分为发生组和未发生组。比较发生组和未发生组患儿的临床资料，采用多因素逐步Logistic回归分析影响高胆红素血症患儿发生早期肾损伤的因素。对患儿随访3个月，采用婴幼儿智能发育量表（CDCC）评估其预后状况，比较预后不良组和预后良好组患儿的临床资料，采用多因素逐步Logistic回归分析影响高胆红素血症患儿预后不良的因素。结果 94例高胆红素血症患儿有20例（21.28%）发生早期肾损伤。发生组TBIL和β₂-MG水平均高于未发生组（P <0.05），Cr水平低于未发生组（P <0.05）。多因素逐步Logistic回归分析结果显示：TBIL水平高［O^R =3.494（95% CI：1.194，10.222）］、Cr水平低［O^R =0.660（95% CI：0.226，1.932）］和β₂-MG水平高［O^R =3.161（95% CI：1.081，9.249）］均是高胆素血症患儿发生早期肾损伤的影响因素（P <0.05）。94例高胆红素血症患儿有22例（23.40%）患儿预后不良。预后不良组Apgar评分、TBIL水平和NSE水平高于预后良好组（P <0.05）。多因素逐步Logistic回归分析结果显示：TBIL水平高［O^R =4.614（95% CI：1.577，13.498）］、NSE水平高［O^R =3.811（95% CI：1.303，11.151）］和Apgar评分高［O^R =3.611（95% CI：1.234，10.565）］均是高胆素血症患儿预后不良的影响因素（P <0.05）。结论 TBIL、Cr、β₂-MG是高胆红素血症患儿发生早期肾损伤的影响因素，及时有效地监测这些指标可提供更多的诊断信息；Apgar评分、TBIL、NSE是高胆红素血症患儿预后不良的影响因素，早期识别和纠正可逆因素有助于改善患儿预后。

Abstract:

Objective To analyze the incidence of early renal injury in neonatal hyperbilirubinemia and its relationship to prognosis.Methods Neonates diagnosed with hyperbilirubinemia admitted to the Department of Neonatology, Xian Daxing Hospital, from April 2021 to December 2023 were included in this study. Before treatment, biochemical analyzers were used to measure total bilirubin (TBIL) levels, enzyme-linked immunosorbent assay (ELISA) was performed to detect serum neuron-specific enolase (NSE) levels, electrochemiluminescence was used to assess serum creatinine (Cr), and immune turbidimetric assay was employed to evaluate neonatal serum β₂-microglobulin (β₂-MG) levels. Treatment involved administering albumin, immunoglobulin, hepatic enzyme inducers, and probiotics. Patients were categorized into an occurrence group and a non-occurrence group based on whether renal injury developed. Clinical data were compared between the groups, and factors influencing early renal injury in neonates with hyperbilirubinemia were analyzed. The neonates were followed up for 3 months, and the Infant Developmental Intelligence Score (CDCC) was used to assess prognosis. Clinical data were compared between the good prognosis and poor prognosis groups. Multivariate stepwise logistic regression analysis was performed to identify factors influencing poor prognosis in neonates with hyperbilirubinemia.Results Early renal injury was observed in 20 out of 94 neonates with hyperbilirubinemia, with an incidence rate of 21.28%. The TBIL and β₂-MG levels were higher in the occurrence group compared to the non-occurrence group (P <0.05), while Cr levels were lower in the occurrence group (P <0.05). Multivariate stepwise logistic regression analysis showed that higher TBIL levels [O^R =3.494 (95% CI: 1.194, 10.222)], lower Cr levels [O^R =0.660 (95% CI: 0.226, 1.932)], and higher β₂-MG levels [O^R =3.161 (95% CI: 1.081, 9.249)] were factors influencing the occurrence of early renal injury in neonates with hyperbilirubinemia (P <0.05). Among the 94 neonates with hyperbilirubinemia, 22 had poor prognosis, with an incidence rate of 23.40%. The Apgar score, TBIL levels, and NSE levels were higher in the poor-prognosis group compared to the good-prognosis group (P <0.05). Multivariate stepwise logistic regression analysis indicated that higher TBIL levels [O^R =4.614 (95% CI:1.577, 13.498)], higher NSE levels [O^R =3.811 (95% CI: 1.303, 11.151)], and higher Apgar scores [O^R =3.611 (95% CI: 1.234, 10.565)] were factors influencing poor prognosis in neonates with hyperbilirubinemia (P <0.05).Conclusion TBIL, Cr, and β₂-MG are key factors influencing the occurrence of early renal injury in neonates with hyperbilirubinemia. Timely and effective monitoring and application of these indicators provide more diagnostic information for clinical practice. In addition, Apgar score, TBIL, and NSE are factors associated with poor prognosis in neonates with hyperbilirubinemia. Early identification and correction of modifiable factors help improve prognosis in these patients.