Ostrea E M, Bassel M, Fleury C A, Bartos A, Jesurun C A
J Pediatr. 1983 Mar;102(3):426-32. doi: 10.1016/s0022-3476(83)80670-2.
We studied the risk of a large group of jaundiced neonates for bilirubin encephalopathy by serial assessment of their reserve serum albumin binding capacity as measured by the saturation index test. In 1271 infants with serum bilirubin concentration greater than 10 mg/dl, 12% had a saturation index (SI) of 7% or greater and therefore were clinically at or near risk for bilirubin encephalopathy. Treatment with glucose infusion (1 gm/kg over one hour) was highly effective in lowering the SI (delta = -3.7%. P less than 0.001). In none of the infants did SI rebound to 7% or greater within 24 hours after the infusion. In a detailed study of 19 infants who received glucose, the highly significant (P less than 0.001) fall in SI (delta = -3.7%) was accompanied by an equally significant rise in serum values for insulin (delta = +21.6 mcu/ml) and fall in serum free fatty acids (delta = -0.51 mEq/L). Many factors in the study, such as prematurity, hemolysis, acidosis, and hypoxemia, could have predisposed the infants to the risk of bilirubin encephalopathy. However, the facility by which most (93%) of the infants with high SI, including those who were premature or had evidence of hemolysis or respiratory insufficiency, responded to infusion of glucose indicates that serum free fatty acids may be the principal factor contributing to the high saturation index and therefore an underestimated factor in bilirubin binding to albumin.
我们通过用饱和指数试验连续评估一组黄疸新生儿的储备血清白蛋白结合能力，研究了他们发生胆红素脑病的风险。在1271名血清胆红素浓度大于10mg/dl的婴儿中，12%的婴儿饱和指数（SI）为7%或更高，因此临床上处于或接近发生胆红素脑病的风险。静脉输注葡萄糖（1g/kg，1小时内输完）治疗在降低SI方面非常有效（Δ=-3.7%，P<0.001）。输注后24小时内，没有婴儿的SI反弹至7%或更高。在对19名接受葡萄糖治疗的婴儿进行的详细研究中，SI显著下降（Δ=-3.7%，P<0.001）的同时，胰岛素血清值显著升高（Δ=+21.6mcu/ml），血清游离脂肪酸下降（Δ=-0.51mEq/L）。该研究中的许多因素，如早产、溶血、酸中毒和低氧血症，可能使婴儿易患胆红素脑病。然而，大多数高SI婴儿（93%），包括早产或有溶血或呼吸功能不全证据的婴儿，对葡萄糖输注有反应，这表明血清游离脂肪酸可能是导致高饱和指数的主要因素，因此是胆红素与白蛋白结合中一个被低估的因素。
