窒息新生儿尿系列微量蛋白与肾血流动力学改变的研究

Changes and related research of urine microprotein and renal blood flow in newborns with asphyxia

目的探讨不同窒息程度新生儿尿系列微量蛋白与肾脏血流动力学指标变化的关系。方法对轻度窒息组新生儿30例、重度窒息组新生儿22例和26例正常新生儿(对照组)在出生后和24h内24～48h,进行尿白蛋白(Alb)、转铁蛋白(TRF)、β2-微球蛋白(β2-MG)、α1-微球蛋白(α1-MG)和血肌酐(Cr)的检测;所有新生儿在出生24h内用彩色超声测定肾动脉血流参数变化,包括收缩期峰值流速(PSFV)、舒张末血流速度(EDFV)、阻力指数(RI)、搏动指数(PI)。结果窒息组与对照组比较,尿系列微量蛋白水平显著升高(P<0.01),以重度窒息组升高为显著;血Cr水平3组间差异无统计学意义(P>0.05);窒息组与对照组比较,肾动脉血流速度降低(P<0.05),血管阻力增大(P<0.05);生后24h内肾血流动力参数与生后24～48h尿中系列微量蛋白呈明显的相关性,肾动脉血流速度与尿系列微量蛋白水平呈负相关(P<0.05),血管阻力与系列微量蛋白呈正相关(P<0.05)。结论通过尿微量蛋白的高低评估患儿肾血流,通过肾血流检测可估计尿微量蛋白的高低。尿系列微量蛋白和肾血流动力参数的测定对窒息新生儿肾功能损伤的早期诊断具有重要作用。

Objective To observe correlation of microproteinuria and renal blood flow in newborns with diferent asphyxia.Methods Four urinary minimal proteins-albumin(Alb),transferrin(TRF),β2-microglobulin(β2-MG),α1-microglobulin (α1-MG) as well as serum creatinine(Cr) were measured in 30 mild asphyxia infants,22 severe asphyxia infants and 26 normal infants.an color Doppler ultrasound technology was adopted to monitor the changes of renal hemodynamicindex on the first day.Results The urinary levels of 4 measured proteins were much higher in the asphyxia groups(P<0.05),while there was no significant difference in scram Cr levels(P>0.05).On the first day after birth,the rate of renal aorta blood flow in neonatal group of asphyxia was lower than that in normal neonatal group(P <0.05);and renal aorta resistance was higher in asphyxia group(P <0.05).The change in mild asphyxia was obvious,but the change in severe asphyxia was even more obvious.The rate of renal aorta blood flow and measurements of urine four minimal proteins were negatively correlated.Aorta resistance and measurements of urine four minimal proteins were positively correlated.The renal blood flow parameters PSFV,EDFV and urine protein were negatively correlated(P<0.05),RI,PI and urine protein were positivly correlated(P<0.01).Conclusion The test of renal blood flow can estimat the level of protein in urine.Similarly,according to the levels of urine protein,we can estimate the situation of renal blood flow.The test of urine four minimal proteins and renal hemodynamic index play an important role for the early diagnosis of impaired renal function in newborns with asphyxia.