尿大分子碱性磷酸酶变化与新生儿缺氧缺血性脑病肾功能衰竭的关系

Changes of urinary high molecular alkaline phosphatase in hypoxic-ischemic encephalopathy neonates with acute renal failure

【目的】研究新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)尿大分子碱性磷酸酶(highmolecular alkaline phosphatase,HMAP)水平的变化,探讨HMAP与新生儿HIE急性肾功能衰竭(acute renal failure,ARF)的关系。【方法】利用抗HMAP的单克隆抗体,免疫催化方法检测30例正常对照组新生儿、44例HIE肾衰组新生儿及48例HIE非肾衰组新生儿不同时期尿HMAP的水平,并同时留尿测定各组β2-微球蛋白(β2-MG)的水平。【结果】发病初期,肾衰组、非肾衰组尿HMAP、β2-MG水平高于恢复期和对照组(P均<0.001),且肾衰组尿HMAP高于非肾衰组(P<0.05);发病初期,肾衰组、非肾衰组HIE新生儿尿HMAP与β2-MG均呈显著正相关(P<0.001)。尿HMAP判断HIE新生儿ARF的敏感性、特异性分别为98.7%、80.0%。【结论】在HIE新生儿ARF病程中尿HMAP呈先上升后下降变化趋势,与肾脏的损害及修复过程密切相关,它能比尿β2-MG更灵敏地早期判断HIE肾损伤及严重程度。

[ Objective] To investigate the dynamic changes of urinary high molecular alkaline phosphatase （HMAP） in hypoxic-ischemic encephalopathy （HIE） neonates and their relationship with acute renal failure（ARF）. [ Methods] By using a monoclonal antibody immunocatalytic assay method, the concentrations of urinary HMAP were determined at the different stages in 44 HIE neonates with ARF （ARF group） and 48 HIE neonates without ARF （non-ARF group） and 30 healthy controls. The concentrations of urinary β2-MG in three groups were also determined. [ Results] The levels of urinary HMAP and β2-MG in ARF group and non-ARF group at the initial stage of the illness were higher than those in control group （P〈0. 001） ,and decreased significantly at the recovery stage （P〈0. 001）, which were no differ from control group（P〉0.05）. The levels of urinary HMAP in ARF group were higher than those in the non-ARF group （P〈0.05）. Urinairy HMAP was positively correlated with β2-MG in ARF group and non-ARF group at the initial stage（P〈0. 001）. The sensitivity and specificity of urinary HMAP to determine ARF were 98.7% and 80G respectively. [Conclusions] The levels of urinary HMAP in HIE neonates with ARF showed a changing trend from rising at first to dropping afterwards. The alteration pattern is correlative with the course of renal injury and recovery. Urinary HAMP is a more sensitive diagnostic parameter than urinary β2-MG and may be used for early detection of HIE renal dysfunction and its severity.