Objective To discuss the clinical significance of carboxyhemoglobin ( COHb) in ABO incompatibility of neonates of different day age. Methods A retrospective analysis was conducted among 812 neonates diagnosed with hyperbilirubinemia from January 2015 to March 2016, and 378 cases of neonatal ABO incompatibility were in case group and contro1 group included 434 non hemolytic jaundice cases. According to admission time, each group was divided into 0-3 day group and 5-7 day group. The gestational age, body weight, hospitalization time, COHb, serum total bilirubin (STB), hemoglobin (Hb) and reticulocyte (Ret) were compared among different groups. Area under the receiver operating characteristic ( ROC) curve ( AUC) and optimum sensitivity and specificity for COHb and Ret were evaluated. Results Days of age was negatively correlated to the value of COHb in every group. In the control group, there was statistical significance in COHb between 0-3 day group and 5-7 day group (t=6. 456, P<0. 01). The average gestational age, body weight and age at admission of the case group were significantly higher than those of the control group ( t value was 4. 916, 4. 692 and 2. 113, respectively, all P<0. 05). COHb, STB and Ret were significantly elevated but Hb declined in 0-3 day group of the case group compared to the control group (t value was 7. 582, 2. 338, 9. 143 and 8. 352, respectively, all P<0. 05). In 5-7 day group of the case group, COHb, STB and Ret were also significantly elevated compared to the control group ( t value was 6. 266, 3. 995 and 6. 256, respectively, all P<0. 01), but Hb was not significantly different (P>0. 05). The cut-off value of COHb for optimum prediction of hemolytic disease of newborn was 1. 4%. AUC was 0. 698, sensitivity was 55. 82%, and specificity was 72. 81%. The specificity of combined detection with Ret could reach 93. 78%. Conclusion With age increasing, COHb 3 days after birth declines significantly compared to that within 3 days, and COHb is a sensitive adjunctive marker for detecting neonatal ABO incompatibility. If combined with Ret detection, COHb will play an important role in early diagnosis and intervention.%目的 探讨碳氧血红蛋白(COHb)在不同日龄新生儿的ABO溶血病诊断中的价值.方法 收集浙江省永康市妇幼保健院2015年1月至2016年3月期间收治的812例高胆红素血症患儿,其中378例ABO溶血病患儿为病例组,434例非溶血性病理性黄疸患儿为对照组.每组根据入院时间分为0~3天组及5~7天组,比较其胎龄、体重、入院时间及相应COHb、血清总胆红素(STB)、血红蛋白(Hb)、网织红细胞(Ret),并建立工作曲线(ROC),确定COHb、Ret的曲线下面积(AUC),同时分析两者不同截断值的敏感度和特异度.结果 随着日龄的增加,不论是否存在ABO溶血病,COHb值均逐渐下降.对照组中0~3天与5~7天的COHb比较差异有统计学意义(t=6.456,P<0.01).病例组中的胎龄及体重均明显大于对照组,两组之间的入院日龄差异也有统计学意义(t值分别为4.916、4.692、2.113,均P<0.05).日龄0~3天病例组中COHb、STB、Ret均明显升高,Hb明显降低,与对照组比较差异均有统计学意义(t值分别为7.582、2.338、9.143、8.352,均P<0.05);而日龄5~7天病例组中COHb、STB、Ret均明显升高,与对照组比较差异均有统计学意义(t值分别为6.266、3.995、6.256,均P<0.01),两组间Hb差异无统计学意义(P>0.05).COHb预计新生儿溶血病的最佳截断值为1.4%.曲线下面积为0.698,其灵敏度为55.82%,特异度为72.81%,与Ret联合检测可使特异度高达93.78%.结论 随着日龄不断增加,出生3天后患儿的COHb较3天内明显下降,同时COHb是敏感的新生儿溶血病诊断指标,COHb与Ret联合早期诊断和治疗干预ABO溶血病有重要的意义.
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