新生儿肾功能损害早期指标分析

Detection of the early markers for neonatal renal dysfunction

目的探讨血清胱蛋白酶抑制剂C(Cystain C)、尿微量蛋白系列在窒息后新生儿中的变化及意义,评价新生儿肾功能的检测指标。方法检测2004年9月—2005年9月68例足月窒息新生儿(Apgar评分<7分)和40例足月非窒息新生儿的血清Cr、BUN、血β2-微球蛋白(β2-MG)、Ccr、血Cystatin C、尿微量蛋白系列,按不同日龄分3次检测。结果①非窒息新生儿血清Cystatin C的平均值为(1.89±0.41)mg/L,血清Cys-tatin C在生后3周内不同日龄间差异无统计学意义,与身高、体重、胆红素之间无相关关系。②窒息组肾小球功能指标中血BUN、Cr、Ccr、Cystatin C、β2-MG明显高于非窒息组;窒息组肾小管功能指标中尿N-乙酰β-D-葡萄糖苷酶(NAG)、α1微球蛋白(α1-MG)明显高于非窒息组。③重度窒息组血BUN、Cr、Ccr、Cystatin C明显高于轻度窒息组;而肾小管功能指标差异无统计学意义。④肾小球功能指标中,尿Alb、IgG与血Cystatin C、血β2-MG呈正相关,尿转铁蛋白(TRF)、NAG与Ccr呈正相关J肾小管功能指标中尿NAG、α1-MG与血β2-MG呈正相关。⑤随访发现,血BUN、Cr恢复正常快,尿微量蛋白系列和血β2-MG、血Cystatin C恢复较慢。结论窒息可引起新生儿肾小球、肾小管功能改变,重度窒息对肾小球功能影响大于轻度窒息,血Cystatin C可作为评价肾小球滤过功能的敏感指标。临床可通过随访尿微量蛋白系列指标来评估肾小管、肾小球损害情况。

Objectives To evaluate the various markers of kidney function in asphyxiated neonates, especially the variation and values of serum Cystatin C and urine microprotein. Methods The asphyxia group contained 68 cases and non-asphyxia group contained 40 cases. Serum creatinine blood urea nitrogen （BUN）, serum β2-microglobulin （MG）, creatinine clearance rate （Ccr）, serum Cystatin C and urine microprotein were determined in three different periods： 1-7 days, 8-14 days and 14-28 days. Results （1）The average value of serum Cystatin C is （1.89 ± 0.41 ） mg/L in non-asphyxia group. There was no significant difference in serum Cystatin C in the third week after birth and the serum level of Cystatin C had no correlation with height, weight and bilirubin. （2） In the asphyxia group the glomerulus function markers （serum ereatinine, BUN, Ccr, serum Cystatin C, serum β2-MG）were higher than those of non-asphyxia group. In the asphyxia group the renal tubule markers （urine NAG, α1-MG）were also higher than those of non-asphyxia group. （3） Serum level of BUN, Cr, Ccr and Cystatin C in the neonates with severe asphyxia were higher than those in mild ones; however, there was no difference in renal tubule markers between them. （4） The glomerulus markers （urine Alb and IgG） were positively related to serum Cystatin C and the renal tubule markers （urine NAG and α1-MG） were positively with serum β2-MG. （5） During follow-up serum BUN and Cr were found to return to normal range faster than urine microprotein, serum β2-MG and serum Cystatin C did. Conclusions The function of glomerulus and renal tubule is impaired in asphysia neonates and the more serious the asphysia is the more severe the impairment is. Serum Cystatin C is a sensitive marker of glomerulus filtration function. Urine microprotein is suggested to be used to evaluate the function of glomerulus and renal tubule, which will be more convenient for the patients and reduce the invasive procedure.