Kaplan Michael, Gold Vadim, Hammerman Cathy, Hochman Ayala, Goldschmidt Doris, Vreman Hendrik J, Stevenson David K
Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.
Biol Neonate. 2005;87(1):44-50. doi: 10.1159/000081085. Epub 2004 Sep 30.
The potential for photo-oxidation during phototherapy in premature neonates was assessed by measuring parameters reflective of photo-oxidation.
Blood was sampled from premature neonates prior to, and after 4 and 24 h of phototherapy, respectively. Total plasma bilirubin (TPB), blood carboxyhemoglobin corrected for inspired carbon monoxide (COHbc) (a sensitive index of heme catabolism), blood thiobarbituric acid reacting substances (TBARS) (a measure of lipid peroxidation), and plasma protein carbonyls (representative of protein oxidation) were determined. Study measurements were compared with baseline values both for the entire study group, and also individually for subgroups < and > or = 1.5 kg birthweight, respectively. The percentage difference (%delta) between baseline and the 24-hour measurement was calculated for each parameter.
Forty-one premature neonates (mean [+/- SD] gestational age 30.5 +/- 2.7 weeks and birthweight 1,499 +/- 448 g) were studied. Mean TPB values decreased from a baseline of 9.1 +/- 2.3 to one of 7.2 +/- 2.8 mg/dl, p < 0.01, during the first 24 h of phototherapy. For the entire patient sample, neither COHbc, TBARS or protein carbonyl values increased significantly over baseline measurements: COHbc: 0.90 +/- 0.26% vs. 0.92 +/- 0.32%; TBARS: 19.0 +/- 5.6 vs. 18.0 +/- 4.5 nmol/ml, and protein carbonyls 7.73 +/- 3.78 vs. 7.63 +/- 3.56 U/ml (baseline and 24-hour samples only are shown in the abstract). Similarly, for the entire group, %delta (mean, interquartile range) were not significantly different between COHbc [-3.77 (-15.89-17.65)%], TBARS [-7.47 (-17.37-7.38)%], and protein carbonyls [-1.47 (-28.51-43.48)%], respectively. For subgroup analysis of neonates < or > or = 1.5 kg birthweight, respectively, no significant increases in COHbc, TBARS or protein carbonyls were documented. A significant increase in %delta for COHbc in the <1.5 kg birthweight subgroup compared with those > or =1.5 kg, possibly indicative of hemolysis, was not matched by similar changes in %delta for TBARS or protein carbonyls, and may therefore not be a result of photo-oxidation.
Except for changes in %delta in COHbc alone and in the smallest babies only, overall, short term phototherapy in premature infants was effective in reducing TPB concentrations without associated evidence reflective of photo-oxidation.
通过测量反映光氧化的参数，评估早产儿光疗期间光氧化的可能性。
分别在光疗前、光疗4小时后和24小时后从早产儿采集血液。测定总血浆胆红素（TPB）、校正吸入一氧化碳后的血液碳氧血红蛋白（COHbc）（血红素分解代谢的敏感指标）、血液硫代巴比妥酸反应物质（TBARS）（脂质过氧化的指标）和血浆蛋白羰基（蛋白质氧化的代表指标）。将研究测量值与整个研究组的基线值进行比较，也分别对出生体重<和>或=1.5kg的亚组进行单独比较。计算每个参数在基线和24小时测量值之间的百分比差异（%delta）。
研究了41例早产儿（平均[+/-标准差]胎龄30.5 +/- 2.7周，出生体重1499 +/- 448g）。在光疗的前24小时内，平均TPB值从基线的9.1 +/- 2.3降至7.2 +/- 2.8mg/dl，p < 0.01。对于整个患者样本，COHbc、TBARS或蛋白羰基值均未比基线测量值显著增加：COHbc：0.90 +/- 0.26%对0.92 +/- 0.32%；TBARS：19.0 +/- 5.6对18.0 +/- 4.5nmol/ml，蛋白羰基7.73 +/- 3.78对7.63 +/- 3.56U/ml（摘要中仅显示基线和24小时样本）。同样，对于整个组，COHbc [-3.77 (-15.89 - 17.65)%]、TBARS [-7.47 (-17.37 - 7.38)%]和蛋白羰基 [-1.47 (-28.51 - 43.48)%]的%delta分别无显著差异。对于出生体重<或>或=1.5kg的新生儿亚组分析，未记录到COHbc、TBARS或蛋白羰基有显著增加。出生体重<1.5kg亚组中COHbc的%delta显著高于出生体重>或=1.5kg的亚组，这可能表明存在溶血，但TBARS或蛋白羰基的%delta没有类似变化，因此可能不是光氧化的结果。
总体而言，除了仅COHbc的%delta变化以及仅在最小的婴儿中有变化外，早产儿的短期光疗在降低TPB浓度方面是有效的，且没有光氧化相关证据。
