文章摘要

静脉输注免疫丙种球蛋白治疗新生儿溶血病与并发坏死性小肠结肠炎的关系

作者: 1陈晚琴, 1石正英, 1刘金祥, 2吴琦
1 如皋市人民医院儿科,江苏 如皋 226500
2 南京市妇幼保健院新生儿科,南京 210000
通讯: 陈晚琴 Email: njgllsyc2020@163.com
DOI: 10.3978/j.issn.2095-6959.2021.05.010
基金: 国家卫生计生委医药卫生科技发展研究项目(W2016EWJS23)。

摘要

目的:分析静脉输注免疫丙种球蛋白(intravenous immunoglobin G,IVIG)治疗新生儿溶血病(hemolytic disease of the newborn,HDN)与并发坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的关系。方法:选择2016年9月至2019年10月南京市妇幼保健院新生儿科诊治的214例HDN患儿的临床资料。根据是否使用IVIG分为IVIG组(78例)与非IVIG组(136例),依据是否合并NEC分为NEC组和非NEC组。比较两组治疗HDN的效果及治疗后NEC的发生情况,并采用调查问卷及查阅临床资料相结合的方式,通过二分类logistic回归分析影响治疗后NEC发生的相关危险因素。结果:IVIG组患儿黄疸消退明显少于非IVIG组[(3.1±1.2) d vs (3.7±1.5) d,t=3.021,P=0.003],此外IVIG组患儿治疗后24 h、48 h血清总胆红素(total bilirubin,TBIL)水平明显低于非IVIG组(P<0.05),并于给药72 h后降至34.2 μmol/L以下;214例HDN患儿治疗后,共确诊28例NEC(IVIG组12例,非IVIG组16例),占13.1%;IVIG组与非IVIG组比较,NEC发生率差异无统计学意义(P<0.05);趋势性χ2检验初步筛选出了5个(早产、低出生体重儿、喂养不耐受、给药后早期贫血、小肠血栓)与HDN患儿治疗后NEC发生有关的危险因素;二分类logistic逐步回归分析结果显示喂养不耐受、给药后早期贫血、小肠血栓为HDN患儿治疗后NEC发生的危险因素。结论:静脉输注IVIG治疗新生儿HDN疗效显著且并未明显增加NEC发生风险,影响HDN患儿治疗后NEC发生的危险因素有喂养不耐受、给药后早期贫血、小肠血栓等。
关键词: 静脉输注;免疫丙种球蛋白;新生儿溶血病;坏死性小肠结肠炎;危险因素

Relationship between intravenous infusion of intravenous immunoglobin G in the treatment of neonatal hemolytic disease and necrotizing enterocolitis

Authors: 1CHEN Wanqin, 1SHI Zhengying, 1LIU Jinxiang, 2WU Qi
1 Department of Pediatric, Rugao People’s Hospital, Rugao Jiangsu 226500, China
2 Department of Neonatology, Nanjing Maternal and Child Health Hospital, Nanjing 210000, China

CorrespondingAuthor: CHEN Wanqin Email: njgllsyc2020@163.com

DOI: 10.3978/j.issn.2095-6959.2021.05.010

Foundation: This work was supported by the National Health and Family Planning Commission Medical Science and Technology Development Research Project, China (W2016EWJS23).

Abstract

Objective: To analyze the relationship between intravenous infusion of intravenous immunoglobin G (IVIG) in the treatment of hemolytic disease of newborn (HDN) and necrotizing enterocolitis (NEC). Methods: Clinical data of 214 cases of HDN children treated in the neonatal department of Nanjing Maternal and Child Health Hospital from September 2016 to October 2019 were selected. According to the use of IVIG, they were divided into IVIG group (78 cases) and non-IVIG group (136 cases). And they were divided into NEC group and non-NEC group according to whether NEC was combined or not. The effect of HDN treatment and the incidence of NEC after treatment were compared between the 2 groups. And questionnaires and clinical data were combined to analyze the risk factors of NEC after treatment by binary logistic regression. Results: The reduction of jaundice in IVIG group was significantly less than that in non-IVIG group [(3.1±1.2) d vs (3.7±1.5) d, t=3.021, P=0.003]. In addition, the serum total bilirubin (TBIL) level in IVIG group was significantly lower than that in non-IVIG group at 24 h and 48 h after treatment (P<0.05), and decreased to less than 34.2 μmol/L after 72 h of administration; After treatment, 28 cases of NEC (12 in IVIG group and 16 in non-IVIG group) were diagnosed, accounting for 13.1%. There was no significant difference in the incidence of NEC between IVIG group and non-IVIG group (P<0.05); 5 risk factors (preterm delivery, low birth weight infants, feeding intolerance, early anemia after administration, and small intestinal thrombosis) were preemptively screened by trend χ2 test for the occurrence of NEC after treatment in HDN children; The results of binary logistic stepwise regression analysis showed that feeding intolerance, early anemia after administration, and small intestinal thrombosis were the risk factors for NEC in children with HDN after treatment. Conclusion: Intravenous infusion of IVIG has a significant effect on neonatal HDN and does not significantly increase the occurrence of NEC. And risk factors affecting the occurrence of NEC in HDN children after treatment include feeding intolerance, early anemia after administration, small intestine thrombosis, etc.
Keywords: intravenous infusion; intravenous immunoglobin G; hemolytic disease of newborn; necrotizing enterocolitis; risk factors