摘要
目的研究全身运动(GMs)评估联合总胆红素值对重度黄疸患儿运动发育结局的预测价值。方法选取2014年6月至2019年6月在郴州市第一人民医院新生儿科治疗的重度黄疸患儿为研究对象。所有患儿在入院时均完成血清总胆红素值测定,并在生命体征平稳且校正胎龄37~48周完成GMs扭动阶段评估;根据患儿12月龄时运动发育结局分析GMs评估联合总胆红素值对患儿运动发育结局的预测价值。结果共纳入符合入选标准的患儿204例,血清总胆红素值(485.4±109.6)μmol/L。根据运动发育结局分为两组,运动发育结局异常组患儿总胆红素值、GMs异常比例、危险性总胆红素水平比例均较正常组高,差异有统计学意义(均P<0.05)。GMs扭动阶段评估正常13例(6.4%);异常191例(93.6%),其中单调性164例(85.9%),痉挛同步性27例(14.1%)。GMs异常和总胆红素值是运动发育异常的危险因素(OR=4.651,1.017,P<0.05)。异常GMs预测异常运动发育结局的灵敏度为100%、特异度为8.4%、阴性预测值为100%;扭动阶段痉挛同步预测脑性瘫痪的灵敏度为63.2%、特异度为91.9%、阴性预测值为96%。ROC曲线示GMs及总胆红素值预测运动发育异常的曲线下面积分别为0.765和0.757,二者联合预测运动发育异常的曲线下面积为0.854。结论全身运动评估联合总胆红素值对重度黄疸患儿运动发育结局具有一定的临床预测价值。
Objective To study the predictive values of the general movements(GMs)assessment combined total bilirubin for motor development outcomes in infants with severe neonatal jaundice.Methods From June of 2014 to June of 2019,infants with severe neonatal jaundice in Chenzhou First People′s Hospital were enrolled in the study.Inclusion criteria included,the serum total bilirubin was measured at the time of admission,corrected gestational age of 37 to 48 weeks.General assessment were carried out when the infant was stable.The patients were regularly followed-up until the age of 12months to evaluate the predictive values.Results A total of 204 patients with severe neonatal jaundice were enrolled in the study,with mean serum total bilirubin value(485.4±109.6)μmol/L.They were divided into two groups according to the outcome of motor development.The total bilirubin value,the proportion of abnormal GMs and dangerous total bilirubin level in the abnormal group were significantly higher than those in the normal group(all P<0.05).13 cases(6.4%)were normal in the torsion stage of GMs;191 cases(93.6%)were abnormal,including 164 cases(85.9%)of poor repertoire(PR)and 27 cases(14.1%)of cramped-synchronized(CS).Abnormal GMs and total bilirubin were the risk factors of abnormal motor development(OR=4.651,1.017,P<0.05).The predictive values of abnormal GMs for abnormal motor development outcomes were as following:sensitivity 100%,specificity 8.4%,negative predictive value(NPV)100%.The predictive values of CS for cerebral palsy were as following:sensitivity 63.2%,specificity 97.8%,NPV 96.0%.Receiver operating characteristic(ROC)curve showed that the area under the curve predicted by GMs and total bilirubin was 0.765 and 0.757,respectively.The area under the curve of motor dysplasia predicted by combining the two was 0.854.Conclusions The evaluation of general movement assessment combined total bilirubin has certain clinical predictive value for the outcomes of motor development in infants with severe neonatal jaundice.
作者
史廷娇
谭宁
吴州丽
谢月娥
谭若锟
周良芬
Shi Tingjiao;Tan Ning;Wu Zhouli;Xie Yue′e;Tan Ruokun;Zhou Liangfen(Department of Neonatology,Chenzhou First People′s Hospital,Chenzhou 423000,China)
出处
《中国医师杂志》
CAS
2021年第12期1818-1821,1827,共5页
Journal of Chinese Physician
基金
湖南省卫生计生委科研计划课题项目(B20180259)。
关键词
黄疸
新生儿
胆红素
全身运动评估
运动发育
Jaundice,neonatal
Bilirubin
General movement assessment
Motor development
