Kappas A, Drummond G S, Manola T, Petmezaki S, Valaes T
Rockefeller University Hospital, New York, NY 10021.
Pediatrics. 1988 Apr;81(4):485-97.
In two separate studies, in which two different treatment regimens of Sn-protoporphyrin were used, a total of 69 control and 53 treated infants were studied to determine whether this potent inhibitor of the enzyme, heme oxygenase, could ameliorate the severity of the hyperbilirubinemia which develops in term babies with direct Coombs-positive ABO incompatibility. The results indicate that Sn-protoporphyrin can, in appropriate doses, moderate the postnatal rate of increase of plasma bilirubin levels and diminish the intensity of hyperbilirubinemia in treated babies. In addition, a decreased use of phototherapy in Sn-protoporphyrin-treated infants was observed. No rebound hyperbilirubinemia was detected during the six- to eight-day period after Sn-protoporphyrin administration. The plasma clearance (t1/2) of Sn-protoporphyrin was much faster in newborns than in adults (approximately 1.6 hours v 3.5 hours, respectively). The incidence of clinical side effects in the 53 Sn-protoporphyrin-treated infants was limited to the development of transient erythema during the use of concurrent phototherapy in two babies. In both infants this reaction subsided completely without sequelae. The use of Sn-protoporphyrin or related synthetic heme analogues to diminish the severity of hyperbilirubinemia in newborn infants merits further study because inhibition of the rate-limiting enzyme in the catabolism of heme to bilirubin may prove to be a useful therapeutic approach in the clinical management of neonatal hyperbilirubinemia, especially in settings in which, for social or economic reasons, other treatment modalities are not available.
在两项分别使用两种不同锡原卟啉治疗方案的研究中，共对69名对照婴儿和53名接受治疗的婴儿进行了研究，以确定这种血红素加氧酶的强效抑制剂是否能改善足月直接抗人球蛋白试验阳性ABO血型不合婴儿发生的高胆红素血症的严重程度。结果表明，锡原卟啉在适当剂量下可以减缓血浆胆红素水平的出生后上升速度，并降低接受治疗婴儿的高胆红素血症强度。此外，观察到锡原卟啉治疗的婴儿光疗使用减少。在给予锡原卟啉后的6至8天期间未检测到反跳性高胆红素血症。锡原卟啉在新生儿中的血浆清除率（t1/2）比成人快得多（分别约为1.6小时对3.5小时）。53名接受锡原卟啉治疗的婴儿中临床副作用的发生率仅限于两名婴儿在同时进行光疗期间出现短暂红斑。两名婴儿的这种反应均完全消退且无后遗症。使用锡原卟啉或相关合成血红素类似物来减轻新生儿高胆红素血症的严重程度值得进一步研究，因为抑制血红素分解代谢为胆红素过程中的限速酶可能被证明是新生儿高胆红素血症临床管理中的一种有用治疗方法，特别是在由于社会或经济原因无法采用其他治疗方式的情况下。
