Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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admin
1683-1764
1735-7322
10.18869/acadpub.tumj
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jalali
1390
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2011
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69
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fulltext
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مقایسه سطح سرمی منیزیم توتال در نوزادان مبتلا به زردی قبل و بعد از فتوتراپی
Total serum magnesium level in icteric neonates before and after phototherapy
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<p class="MsoNormal" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" dir="rtl"><strong><span style="font-size: 10pt">زمینه و
هدف:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">بیلیروبین
تمایل به فسفولیپیدهای غشای سلولی دارد، از مهمترین آنها رسپتور </span><span style="font-size: 7pt">N</span><span style="font-size: 8pt">-</span><span style="font-size: 7pt">M</span><span style="font-size: 8pt">ethyl-</span><span style="font-size: 7pt">D</span><span style="font-size: 8pt">-Aspartate</span><span style="font-size: 10pt"> <span lang="AR-SA">میباشد
منیزیم از مهمترین مهارکنندگان این رسپتور میباشد. هدف از این مطالعه مقایسه
میزان منیزیم قبل و بعد از فتوتراپی و ارزیابی روشهای نوین درمان (تجویز منیزیم) میباشد.</span></span><span style="font-size: 9pt"> </span><strong><span style="font-size: 10pt"><br></span></strong></p><p class="MsoNormal" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" dir="rtl"><strong><span style="font-size: 10pt">روش بررسی:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">مطالعه نیمهتجربی </span><span style="font-size: 8pt">(Semi-experimental)</span><span style="font-size: 10pt"> <span lang="AR-SA">و آیندهنگر
میباشد و جمعیت مورد مطالعه، نوزادان مبتلا به زردی بستری در بیمارستان علیاصغر
از فروردین الی اسفند 1389 بودند. معیارهای ورود به مطالعه شامل سن کمتر از 28
روز، عدم مالفور-ماسیون، اختلال متابولیسم و سپسیس، عدم دریافت منیزیم سولفات در
مادر بود</span></span><span style="font-size: 10pt">.<strong> </strong></span><strong><span style="font-size: 10pt"><br></span></strong></p><p class="MsoNormal" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" dir="rtl"><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">در مطالعه 106 نوزاد
زرد، 9/50 درصد پسر و 1/49 درصد دختر بودند. فراوانی علت زردی در بیماران شامل 37
نوزاد با ناسازگاری (34/9%) </span><span style="font-size: 7pt">ABO</span><span style="font-size: 10pt">، پنج نوزاد با ناسازگاری (4/7%)</span><span style="font-size: 7pt">R</span><span style="font-size: 8pt">h</span><span style="font-size: 10pt">،</span><span style="font-size: 10pt"> </span><span style="font-size: 10pt">17 نوزاد با مصرف کم شیر مادر (16%</span><span style="font-size: 10pt">)</span><span style="font-size: 10pt"> </span><span style="font-size: 8pt">Breast feeding</span><span style="font-size: 10pt"> <span lang="AR-SA">و 47
نوزاد ناشی از شیر مادر (3/44%) بود. میانگین منیزیم قبل (24/2) و بعد (12/2) از
فتوتراپی در بیماران مبتلا به زردی با اختلاف معنیدار کاهش مییابد (001/0</span></span><span style="font-size: 8pt">P<</span><span style="font-size: 10pt">) و بین دو جنس
و بین گروههای سن بارداری از نظر میانگین سطح سرمی منیزیم در زمان بستری (کمتر
از 34 هفته= 35/2، بین 35 تا 37 هفته= 27/2، بیش از 38 هفته= 17/2) و بین گروههای
وزنی از نظر میانگین منیزیم در زمان بستری (1500 تا2500 گرم= 4/2، بیش از 2500
گرم= 23/2) و بین گروههای شدت هیپربیلیروبینمی از نظر منیزیم سرمی در زمان بستری
(خفیف= 2/23، متوسط= 21/2، شدید= 29/2) اختلاف معنیدار وجود ندارد.</span><strong><em><span style="font-size: 10pt"> <br></span></em></strong></p><p class="MsoNormal" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" dir="rtl"><strong><em><span style="font-size: 10pt"></span></em><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">فتوتراپی میتواند منجر به کاهش
منیزیم توتال سرمی شود.</span></p>
<p style="text-align: justify"><strong>Background:</strong> Deposition of bilirubin in neurons causes permanent neuronal injury. Bilirubin exhibits an affinity for the phospholipids of plasma membrane like N-methyl-D-aspartate (NMDA) receptors. Magnesium is an NMDA antagonist and it acts against the neurotoxic effects of bilirubin. We compared pre- and post-phototherapy serum magnesium level of neonates with hyperbilirubinemia to find the best time of discharge and evaluate new management techniques such as magnesium supplementation.<br><strong></strong></p>
<p style="text-align: justify"><strong>Methods:</strong> In this semi-experimental study, we evaluated neonates admitted in Ali Asghar Children's Hospital in Tehran, Iran with signs of icter from 2009 to 2010. The inclusion criteria included age less than four weeks, no history of magnesium sulfate administration in the mother and absence of sepsis.<br><strong></strong></p>
<p style="text-align: justify"><strong>Results:</strong> From 106 patients with icter, 50.9% were male and 49.1% were female neonates. Their mean gestational age was 37.341.286 (33-41) weeks and the mean birth weight was 3172.12436.936 (2022-4300) grams. The frequency of underlying causes of hyperbillirubinemia included: ABO mismatch 9.34%, Rh incompatibility 4.7%, breastfeeding 16% and breast milk 44.3%. There was a significant difference (P≤0.001) between serum magnesium levels before (2.24mg/dl) and after phototherapy (2.12mg/dl). There were no significant differences between serum magnesium values in the two sexes (male=2.28, female=2.19), among different gestational age groups (<34 wks=2.35, 35-37 wks=2.27, >38 wks=2.17), between different birth weight groups (1500-2500 g=2.4 and >2500 g=2.23) or severity of hyperbilirubinemia (mild=2.23, moderate=2.21 and severe=2.29).<br><strong></strong></p>
<p style="text-align: justify"><strong>Conclusion:</strong> Phototherapy decreases the total magnesium concentration and magnesium administration will prevent bilirubin neurotoxicity in icteric neonates.</p>
هیپربیلیروبینمی،فتوتراپی،منیزیم
Hyperbillirubinemia,magnesium,phototherapy
432
437
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-214&slc_lang=fa&sid=1
Khosravi
N
نسترن
خسروی