Differences in B/A levels among neonates with different degrees of hyperbilirubinemia and the predictive value of B/A for bilirubin encephalopathy

Bi Xiaona; Wang Xue; Feng Xiangchun; Chen Huilan

doi:10.13406/j.cnki.cyxb.004136

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Differences in B/A levels among neonates with different degrees of hyperbilirubinemia and the predictive value of B/A for bilirubin encephalopathy

Clinical research | 更新时间：2026-10-26

- Differences in B/A levels among neonates with different degrees of hyperbilirubinemia and the predictive value of B/A for bilirubin encephalopathy
- Journal of Chongqing Medical University Vol. 51, Issue 10, Pages: 1504-1512(2026)
- 作者机构：
  
  青岛大学附属妇女儿童医院新生儿科，青岛 266000
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004136
  CLC： R722.1
- Received：28 November 2025，
  
  Revised：2026-03-30，
  
  Accepted：07 May 2026，
  
  Published：28 October 2026
- 稿件说明：
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毕晓娜，王雪，冯向春，等.不同程度高胆红素血症新生儿B/A水平差异及对胆红素脑病的预测价值[J].重庆医科大学学报，2026，51（10）：1504-1512.

Bi Xiaona,Wang Xue,Feng Xiangchun,et al.Differences in B/A levels among neonates with different degrees of hyperbilirubinemia and the predictive value of B/A for bilirubin encephalopathy[J].Journal of Chongqing Medical University,2026,51(10):1504-1512.
毕晓娜，王雪，冯向春，等.不同程度高胆红素血症新生儿B/A水平差异及对胆红素脑病的预测价值[J].重庆医科大学学报，2026，51（10）：1504-1512. DOI： 10.13406/j.cnki.cyxb.004136.

Bi Xiaona,Wang Xue,Feng Xiangchun,et al.Differences in B/A levels among neonates with different degrees of hyperbilirubinemia and the predictive value of B/A for bilirubin encephalopathy[J].Journal of Chongqing Medical University,2026,51(10):1504-1512. DOI： 10.13406/j.cnki.cyxb.004136.

摘要

目的

探究不同程度高胆红素血症（hyperbilirubinemia，HB）新生儿总胆红素/白蛋白比值（total bilirubin to albumin ratio，B/A）水平差异，并评估其对胆红素脑病的预测价值，以期为临床风险分层提供参考。

方法

选取2020年3月至2025年2月青岛大学附属妇女儿童医院收治的HB新生儿1 571例为研究对象，根据HB程度分为轻度组（

=608）、重度组（

=436）、极重度组（

=527）。比较3组患儿临床资料，采用多元线性回归分析B/A与肝功能指标的关系，采用受试者工作特征曲线（receiver operating characteristic curve，ROC）分析B/A对HB疾病进展的预测效能。另根据是否并发胆红素脑病分为病例组（合并胆红素脑病，

=296）和对照组（无胆红素脑病，

=1 275）。分析HB并发胆红素脑病的影响因素。采用Bootstrap法分析HB程度对B/A与胆红素脑病的中介效应，构建限制性立方样条模型（restricted cubic spline，RCS）分析不同HB程度下B/A与胆红素脑病的剂量反应关系。

结果

组患儿在新生儿行为神经测定量表（neonatal behavioral neurological assessment，NBNA）评分、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天冬氨酸氨基转移酶（aspartate aminotransferase，AST）、γ-谷氨酰转移酶（γ-glutamyltransferase，GGT）、乳酸脱氢酶（lactate dehydrogenase，LDH）、B/A、高敏C反应蛋白（hypersensitive C-reactiveprotein，hs-CRP）、神经元特异性烯醇化酶（neuron-specifi

c enolase，NSE）、神经肽Y（neuropeptide Y，NPY）、肌酸激酶同工酶（creatine kinase isoenzyme，CK-MB）、红细胞比容（hematocrit，HCT）、血清总胆红素（total serum bilirubin，TSB）方面差异有统计学意义（

0.05）。多元线性回归分析显示，患儿B/A水平与ALT、AST、GGT、LDH水平均呈正相关（

0.05）。ROC曲线分析显示，B/A水平对轻度HB新生儿发展成重度/极重度的曲线下面积（area under the curve，AUC）为0.714，灵敏度为0.698，特异度为0.705；在轻度/重度HB发展成极重度HB的预测中，B/A的AUC为0.882，灵敏度为0.861，特异度为0.879，各项效能指标均高于TSB，预测价值更优（均

0.001）。NBNA评分、ALT、AST、B/A、HB程度、hs-CRP、NSE、NPY、CK-MB、HCT是HB患儿并发胆红素脑病的影响因素（

0.05）。中介效应分析显示，95%CI为0.549~1.328，提示HB程度在B/A与并发胆红素脑病之间存在完全中介效应。RCS分析显示，B/A与不同HB程度下的胆红素脑病之间存在非线性剂量反应关系（

0.05）。不同HB程度下，随着B/A水平上升，胆红素脑病发生风险呈增加趋势。

结论

不同程度HB患儿B/A水平存在差异，B/A对胆红素脑病具有预测价值且与HB程度存在完全中介效应，二者呈非线性剂量反应关系。

Abstract

Objective

To explore the differences in the total bilirubin to albumin ratio（B/A） levels of neonates with different degrees of hyperbilirubinemia（HB），evaluate the predictive value of B/A for bilirubin encephalopathy，and provide a reference for clinical risk stratification.

Methods

A total of 1571 newborns with HB admitted to Women and Children’s Hospital Affiliated to Qingdao University between March 2020 and February 2025 were selected as the subjects and divided into the mild group（

=608），the severe group（

=436），and the extremely severe group（

=527） according to the degree of HB. The clinical data of the three groups of children were compared. The relationships between B/A and liver function indicators were analyzed by multiple linear regression. The predictive efficacy of B/A for the progression of HB was analyzed by receiver operating characteristic curves. In addition，they were divided into the case group（with bilirubin encephalopathy，

=296） and the control group（without bilirubin encephalopathy，

=1275） according to the pres

ence or absence of bilirubin encephalopathy. The risk factors of HB complicated with bilirubin encephalopathy were analyzed. The Bootstrap method was used to analyze the mediating effect of HB degree on the association between B/A and bilirubin encephalopathy. The dose-response relationship between B/A and bilirubin encephalopathy under different HB degrees was analyzed by constructing a restricted cubic spline model.

Results

There were significant differences in Neonatal Behavioral Neurological Assessment score，alanine aminotransferase，aspartate aminotransferase，γ-glutamyltransferase，lactate dehydrogenase，B/A，high-sensitivity C-reactive protein，neuron-specific enolase，neuropeptide Y，creatine kinase isoenzyme， hematocrit，and total serum bilirubin among the three groups（

0.05）. The results of multiple linear regression analysis showed that B/A level was positively correlated with the levels of alanine aminotransferase，aspartate aminotransferase，γ-glutamyltransferase，and lactate dehydrogenase（

0.05）. The results of receiver operating characteristic curve analysis showed that the area under the curve of B/A level for predicting the development of mild HB into severe/extremely severe cases was 0.714，the sensitivity was 0.698，and the specificity was 0.705；in the prediction of mild/severe HB developing into extremely severe HB，the area under the curve of the B/A level was 0.882，the sensitivity was 0.861，and the specificity was 0.879. All the efficacy indicators were higher than those of total serum bilirubin，and the predictive value was better（all

0.001）. The Neonatal Behavioral Neurological Assessment score，alanine aminotransferase，aspartate aminotransferase，B/A，HB degree，high-sensitivity C-reactive protein，neuron-specific enolase，neuropeptide Y，creatine kinase isoenzyme，and hematocrit were the risk factors of bilirubin encephalopathy in children with HB（

0.05）. The results of the mediating effect analys

is showed that the 95%CI was 0.549 to 1.328，suggesting that HB degree played a complete mediating role between B/A and bilirubin encephalopathy. The restricted cubic spline analysis results showed that there was a nonlinear dose-response relationship between B/A and bilirubin encephalopathy at different levels of HB（

0.05）. Under different levels of HB，with the increase of B/A levels，the risk of bilirubin encephalopathy increased.

Conclusion

There are differences in B/A levels among children with different degrees of HB. B/A has predictive value for bilirubin encephalopathy，with HB degree showing a complete mediating effect between B/A and bilirubin encephalopathy. A nonlinear dose-response relationship was observed between B/A and bilirubin encephalopathy.

关键词

Keywords

references

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