新生儿黄疸-新医师培训20150813研究报告.ppt

* can scavenge the chain-carrying peroxyl radical by donating a hydrogen atom attached to the C-10 bridge of the tetrapyrrole molecule to form a carbon-centered radical Bil? LOO? + Bil ? LOOH + Bil? Bil? + LOO? ? Bil-OOL Bil? + O2 ?? Bil-OO? LOO? + BV ? LOO-BV? 新生儿出生后的胆红素水平是一个动态变化的过程，因此在诊断高胆红素血症时需考虑其胎龄、日龄和是否存在高危因素。 * * ?Initially, photooxidation was believed to be responsible for the beneficial effect of phototherapy. However, although bilirubin is bleached through the action of light, the process is slow and is now believed to contribute only minimally to the therapeutic effect of phototherapy.??Configurational isomerization is a very rapid process that changes some of the predominant 4Z, 15Z bilirubin isomer to water-soluble isomers in which one or both of the intramolecular bonds are opened (E,Z; Z,E; or E,E). In human infants, the 4Z,15E isomer predominates, and at equilibrium conditions, the isomer constitutes about 20% of circulating bilirubin after a few hours of phototherapy. This proportion is not influenced significantly by the intensity of light.??Structural isomerization consists of intramolecular cyclization, resulting in the formation of lumirubin. This process is enhanced by increasing the intensity of light. During phototherapy, lumirubin may constitute 2-6% of the total serum bilirubin concentration.The photoisomers of bilirubin are excreted in bile and, to some extent, in urine. The half-life of lumirubin in serum is much shorter than that in E isomers, and lumirubin is the primary pigment found in bile during phototherapy. Thus, although the E isomers predominate in serum, lumirubin is mostly responsible for the therapeutic effect of phototherapy of lowering the serum bilirubin level * Bile acid profiles from plasma and urine of six patients suffering from intrahepatic cholestasis were studied before and during treatment with phenobarbital. All patients responded to this treatment by decreasing their plasma bile acid levels. Using g