新生儿高胆红素血症的光疗。

Photo-dermatology Pub Date : 1989-12-01
R Pratesi, G Agati, F Fusi
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引用次数: 0

摘要

光疗降低黄疸婴儿胆红素浓度的方法最近有了新的发现。高效液相色谱技术的引入导致了新的胆红素光异构体的发现,分别具有高和低量子产率的构型和结构异构体,并重新引起了对胆红素在体外和体内光化学性质的兴趣。圆二色性和吸收光谱显示,胆红素表现得像一个双色系,分子的两半在激发态强烈相互作用。这种耦合机制使得胆红素光化学的量子产率与波长有关,在胆红素吸收光谱的长波长边缘有明显的影响。黄疸大鼠和婴儿的胆红素光化学基本相似,并且与体外观察结果一致。然而,大鼠胆红素光产物的代谢有时与婴儿有很大的不同。特别是,只有低量子产率的结构异构体,发光素,被婴儿有效地排泄。虽然胆红素光过程在治疗高胆红素血症中的相对作用尚不确定,但通常认为结构光异构化是胆红素消除的主要途径。因此,确定优化新生儿荧光素形成过程的光谱波段可能是改进光疗临床方案的重要一步。因此,本文除了回顾了胆红素光化学和胆红素产物代谢的最新数据外,还对胆红素形成的最佳光进行了计算。胆红素的长波光化学和皮肤衰减的综合作用表明,最佳光谱范围应为480 ~ 510 nm。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Phototherapy for neonatal hyperbilirubinemia.

New light has recently been shed on the way phototherapy reduces bilirubin concentration in icteric infants. The introduction of a high-performance liquid chromatography technique led to the discovery of new photoisomers of bilirubin, the configurational and structural isomers with high and low quantum yields, respectively, and to a renewed interest in the photochemical properties of bilirubin in vitro and in vivo. Circular dichroism and absorption spectroscopies have then shown that bilirubin behaves like a bichromophoric system, with the 2 halves of the molecule strongly interacting in the excited state. This coupling mechanism makes the quantum yields of bilirubin photochemistry wavelength-dependent, with marked effects in the long wavelength edge of the bilirubin absorption spectrum. The photochemistry of bilirubin is substantially similar in icteric rats and babies, and is consistent with what is observed in vitro. However, the metabolism of bilirubin photoproducts in rats sometimes differs quite significantly from that in babies. In particular, only the low quantum yield structural isomer, lumirubin, is efficiently excreted by babies. Although the relative role of the bilirubin photoprocesses in the therapy of hyperbilirubinemia is not yet known with certainty, the structural photoisomerization is generally assumed to represent the main route of bilirubin elimination. As a consequence, the determination of the spectral band that optimizes the process of formation of lumirubin in neonate may represent an important step in the improvement of the clinical protocol of phototherapy. Therefore, in addition to reviewing the most recent data on bilirubin photochemistry and the metabolism of bilirubin products, this article presents a computation of the optimal light for lumirubin formation. The combined effects of long-wavelength photochemistry of bilirubin and skin attenuation show that the optimal spectral range should be between 480 and 510 nm.

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