呼气末一氧化碳对重度新生儿高胆红素血症的诊断价值
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i3.20428
Abstract
目的：通过检测呼气末一氧化碳（end-tidal carbon monoxide corrected for ambient carbon monoxide,ETCOc）测定，确定其对重度新生儿高胆红素血症（onatalhyperbilirubinemia,NHB）的诊断截断值，探讨ETCOc对重度新生儿高胆红素血症的诊断价值。方法：采用前瞻性观察性研究设计，纳入2023年10月至2024年12月收住昆明市儿童医院新生儿科的NHB患儿。入院后1小时内测量ETCOc并采集血清总胆红素。根据血清总胆红素水平分为重度NHB组与非重度NHB组。采用独立样本t检验、卡方检验比较两组基线资料及ETCOc水平，绘制受试者工作特征（ROC）曲线评估ETCOc对重度NHB的诊断效能。结果：共纳入397 例新生儿，其中重度NHB组120 例，非重度NHB组277 例，两组患儿性别、分娩方式、胎龄、出生体重、日龄方面差异均无统计学意义（P值>0.05），ROC分析显示，ETCOc的曲线下面积（AUC）为0.89（95%CI：0.856~0.923），当ETCOc截断值设为2.52 ppm时，约登指数最大（0.655），灵敏度90%，特异度76%。结论：出生后7天内的ETCOc值可作为重度NHB的早期筛查指标，具有较好的诊断价值。
Keywords
呼气末一氧化碳；重度新生儿高胆红素血症；诊断价值
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[2] 中华医学会儿科学分会新生儿学组,中华儿科杂志编辑委员会.新生儿高胆红素血症诊治指南（2025）[J].中华儿科杂志,2025,63(4):338-350.
[3] Shirzadfar H, Khanahmadi M. Application of biomarkers and biosensors to detect and track pathogenic agents[J]. Inter J Analy Tech, 2018, 4(1): 1-5.
[4] Stevenson DK, Wong RJ, Ostrander CR, et al. Increased carbon monoxide washout rates in newborn infants[J]. Neonatology, 2020, 117(1): 118-122.
[5] Du L, Ma X, Shen X, et al. Neonatal hyperbilirubinemia management: clinical assessment of bilirubin production [J]. Semin Perinatol, 2021,45(1):151351.
[6] 范礼英,冯彬彬,李婷,等.呼气末一氧化碳测定对新生儿溶血病的诊断价值[J].医学信息,2023,36(10):68-70.
[7] 程晓琴,林冰纯,陈雪雨,等.生后48h内呼气末一氧化碳值对溶血所致新生儿高胆红素血症的预测价值[J].中华围产医学杂志,2024,27(4):294-300.
[8] Bhutani VK, Wong RJ, Vreman HJ, et al. Bilirubin production and hour-specific bilirubin levels[J]. J Perinatol, 2015, 35(9): 735-738.
[9] Wells, S, Balasubramanian, R, Nguyen, K, et al. End-tidal carbon monoxide for routine monitoring of significant hemolysis in the management of newborn hyperbilirubinemia[J]. J PERINATOL. 2023; J PERINATOL.
[10] 中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识[J].中华儿科杂志,2014,52(10):745-748.
[11] Bhutani VK,Johnson-Hamerman L.The clinical syndrome of bilirubin-induced neurologic dysfunction[J].Semin Fetal Neonatal Med,2015,20(1):6-13.
[12] 杜立中.新生儿高胆红素血症早期筛查及风险评估若干进展[J].现代实用医学,2019,31(3):281-283.
[13] 何敏,刘玲,黄林波,等.呼气末一氧化碳在新生儿高胆红素血症中的应用进展[J].中华新生儿科杂志（中英文）,2025,40(1):50-53.
[14] Zhan, YL, Peng, HB, Jin, ZC, et al. Higher ETCOc predicts longer phototherapy treatment in neonatal hyperbilirubinemia. Front Pediatr[J]. 2023; 11 Front Pediatr.
[15] Bahr, TM, Shakib, JH, Stipelman, CH, et al. Improvement Initiative: End-Tidal Carbon Monoxide Measurement in Newborns Receiving Phototherapy[J]. J PEDIATR-US. 2021; 238 J PEDIATR-US.
[16] 胡忠华,林振浪.新生儿黄疸早期筛查的研究进展[J].中华围产医学杂志,2024,27(6):511-515.
[17] Bhatia, A, Chua, MC, Dela Puerta, R, et al. Noninvasive Detection of Hemolysis with ETCOc Measurement in Neonates at Risk for Significant Hyperbilirubinemia[J]. NEONATOLOGY. 2020; 117 NEONATOLOGY.
[18] Bao, Y, Zhu, J, Ma, L, et al. An End-Tidal Carbon Monoxide Nomogram for Term and Late-Preterm Chinese Newborns[J]. J PEDIATR-US. 2022; 250 J PEDIATR-US.
[19] Christensen, RD, Bahr, TM, Ohls, RK, et al. Neonatal/perinatal diagnosis of hemolysis using ETCOc[J]. SEMIN FETAL NEONAT M. 2023; SEMIN FETAL NEONAT M.
[20] Lozar Krivec, J, Lozar Manfreda, K, Paro-Panjan, D. Clinical Factors Influencing Endogenous Carbon Monoxide Production and Carboxyhemoglobin Levels in Neonates[J]. J PEDIAT HEMATOL ONC. 2022; 44 J PEDIAT HEMATOL ONC.
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