血清总胆红素、白蛋白及神经肽Y水平与高胆红素血症患儿预后的关系

Associations between serum total bilirubin, albumin and neuropeptide Y levels and prognosis in children with hyperbilirubinemia

摘要:

目的 分析血清总胆红素（TBIL）、白蛋白（Alb）及神经肽Y（NPY）水平与高胆红素血症患儿预后的关系。方法 回顾性分析2022年1月—2024年8月安徽医科大学第二附属医院收治的110例重度高胆红素血症患儿的临床资料。患儿均行血清TBIL、Alb及NPY水平检测，经光疗后随访3个月，依据神经运动检查结果判定和统计预后情况。比较预后不良组和预后良好组的基线资料及血清TBIL、Alb及NPY水平，分析高胆红素血症患儿预后不良的影响因素，分析血清TBIL、Alb、NPY水平对高胆红素血症患儿预后不良的预测效能。结果 预后不良组胆红素所致神经功能障碍（BIND）评分及血清TBIL水平均高于预后良好组（P <0.05），血清Alb、NPY水平低于预后良好组（P <0.05）。预后不良组与预后良好组性别构成、病因、胎龄、日龄、出生体重、病因构成、黄疸起始日龄及持续时间比较，差异均无统计意义（P >0.05）。多因素一般Logistic回归分析结果显示：高BIND评分［O^R=3.658（95% CI：1.250，10.703）］、高TBIL水平［O^R=1.224（95% CI：1.050，1.426）］、低Alb水平［O^R=0.693（95% CI：0.592，0.812）］、低NPY水平［O^R=0.168（95% CI：0.058，0.493）］均为高胆红素血症患儿预后不良的危险因素（P <0.05）；3项联合的曲线下面积为0.976（95% CI：0.952，1.000），敏感性为96.4%（95% CI：0.927，1.000），特异性为87.8%（95% CI：0.765，0.968），均高于单一指标检测。结论 高BIND评分、TBIL水平和低Alb、NPY水平的重度高胆红素血症患儿更易出现预后不良，TBIL、Alb、NPY联合检测对患儿预后不良具有较高的预测效能。

Abstract:

Objective To analyze the associations between serum total bilirubin (TBIL), albumin (Alb) and neuropeptide Y(NPY) levels and prognosis in children with hyperbilirubinemia.Methods The clinical data of 110 children with severe hyperbilirubinemia admitted to the Second Affiliated Hospital of Anhui Medical University during January 2022 to August 2024 were retrospectively analyzed. Serum TBIL, Alb and NPY levels were detected in all children. After phototherapy, they were followed up for 3 months, and the prognosis was determined according to motor examination results. The prognosis of the children was recorded, and the baseline characteristics and serum TBIL, Alb and NPY levels were compared between the poor prognosis group and the good prognosis group. The factors contributing to poor prognosis of children with hyperbilirubinemia were analyzed, and the predictive value of serum TBIL, Alb and NPY levels for poor prognosis of children with hyperbilirubinemia was evaluated.Results BIND scores and serum TBIL levels in the poor prognosis group were higher than those in the good prognosis group (P < 0.05), and serum Alb and NPY levels in the poor prognosis group were lower than those in the good prognosis group (P < 0.05). There were no statistically significant differences between the poor prognosis group and the good prognosis group in terms of sex distribution, etiology, gestational age, postnatal age, birth weight, cause composition, onset age of jaundice, or duration of jaundice (P > 0.05). Multivariable Logistic regression analysis showed that high BIND scores [O^R = 3.658 (95% CI: 1.250, 10.703) ], high TBIL levels [O^R = 1.224 (95% CI: 1.050, 1.426) ], low Alb levels [O^R = 0.693 (95% CI: 0.592, 0.812) ] and low NPY levels [O^R = 0.168 (95% CI: 0.058, 0.493) ] were risk factors for poor prognosis in children with hyperbilirubinemia (P < 0.05). The combined detection of the three indicators yielded an area under the curve of 0.976 (95% CI: 0.952, 1.000), with a sensitivity of 96.4% (95% CI: 0.927, 1.000) and a specificity of 87.8% (95% CI: 0.765, 0.968), all of which were superior to those of the individual indicators.Conclusion Severe hyperbilirubinemia children with high BIND scores and elevated TBIL levels, as well as those with low Alb and NPY levels, are more likely to experience poor prognosis. The combined assessment of TBIL, Alb, and NPY demonstrates high predictive value for adverse outcomes in these patients.