Cashore W J
J Pediatr. 1980 Mar;96(3 Pt 2):521-7. doi: 10.1016/s0022-3476(80)80860-2.
Free bilirubin concentration, bilirubin-binding capacity, and bilirubin-binding affinity were determined by peroxidase oxidation in 66 newborn infants. Twelve healthy term infants whose unconjugated bilirubin concentration was 15.8 +/- 3.7 mg/dl (mean +/- SD) had a binding capacity of 31.9 +/- 3.7 mg/dl (bilirubin: albumin molar ratio = 0.89 +/- 0.07) and Ka = 28 +/- 11 x 10(7)/M. Twelve term infants with clinical complications of asphyxia, acidosis, respiratory distress, or sepsis, and 17 preterm infants with no complications had lower serum albumin concentrations and slightly reduced binding capacity and affinity compared to the healthy term infants. Free bilirubin concentrations were similar in these three groups, averaging 8 to 9 nmol/l in each group. Twenty-five preterm infants with complications had significantly higher free bilirubin (19 +/- 11 nmol/l), lower binding capacity, and lower binding affinity than any of the other three groups (P less than 0.01 for all comparisons). Five of the 25 sick preterm infants had kernicterus at autopsy. These five infants were similar to the other 20 in birth weight, gestational age, serum bilirubin, and serum albumin level, but had significantly higher free bilirubin and significantly lower binding capacity and affinity. The data suggest that serious neonatal illness is associated with a marked reduction in bilirubin-binding capacity and affinity and an increased risk of kernicterus in preterm infants. The mechanism by which neonatal morbidity decreases bilirubin binding is not known.
采用过氧化物酶氧化法测定了66例新生儿的游离胆红素浓度、胆红素结合能力和胆红素结合亲和力。12例健康足月儿，其未结合胆红素浓度为15.8±3.7mg/dl（均值±标准差），结合能力为31.9±3.7mg/dl（胆红素：白蛋白摩尔比=0.89±0.07），Ka=28±11×10⁷/M。12例有窒息、酸中毒、呼吸窘迫或败血症临床并发症的足月儿以及17例无并发症的早产儿，与健康足月儿相比，血清白蛋白浓度较低，结合能力和亲和力略有降低。这三组的游离胆红素浓度相似，每组平均为8至9nmol/l。25例有并发症的早产儿的游离胆红素显著更高（19±11nmol/l），结合能力更低，结合亲和力也低于其他三组中的任何一组（所有比较P均<0.01）。25例患病早产儿中有5例尸检时发现有核黄疸。这5例婴儿在出生体重、胎龄、血清胆红素和血清白蛋白水平方面与其他20例相似，但游离胆红素显著更高，结合能力和亲和力显著更低。数据表明，严重的新生儿疾病与胆红素结合能力和亲和力的显著降低以及早产儿发生核黄疸的风险增加有关。新生儿发病降低胆红素结合的机制尚不清楚。
