尿视黄醇结合蛋白和N-乙酰-β葡萄糖苷酶对早产儿肾功能的评价意义

Evaluation of renal function with urinary retinol binding protein and N-acetyi-lS-glucosaminidase inpreterm neonate

目的分析尿视黄醇结合蛋白（RBP）、尿N-乙酰-β葡萄糖苷酶（NAG）对评价早产儿肾功能的临床意义。方法受选新生儿89例，分为早产儿窒息组（18例）、早产儿非窒息组（25例）和足月儿对照组（46例）。观察所选对象生后48h内晨尿的RBP和NAG水平，分别与尿肌酐（Cr）相比（以RBP／Cr和NAG／Cr表示）；观察血肌酐和血尿素氮，以及非窒息早产儿在生后0～48h，-96h，-168h的RBP／Cr、NAG／Cr变化情况。结果早产儿窒息组的尿RBP／Cr水平[（0．951±0．629）g／m01]高于非窒息组[（0．389±0．281）∥m01]和足月儿X寸照组[（0．119±0．081）g／m01]，3组间比较差异有统计学意义（P〈0．05）；非窒息组高于足月儿对照组（P〈0．05）。早产儿窒息组和非窒息组的尿NAG／Cr比值均高于足月儿对照组，差异有统计学意义（P〈0．05），但前两者比较差异无统计学意义（P〉0．05）。3组问的血肌酐和尿素氮比较差异无统计学意义（P〉0．05）。早产Jl,~b窒息组尿RBP／Cr与胎龄和日龄均无线性相关（P〉0．05），而NAG／Cr与胎龄呈线性负相关（r=一0．625，P〈0．05），与日龄呈正相关（P〈0．05）。结论尿RBP／Cr和NAG／Cr比值有助于评估早产儿肾功能，前者对窒息损害较后者敏感。后者受胎龄影响更大。

Objective To investigate the clinical value of urinary retinol binding protein（RBP） and N-acetyl-β-glucosaminidase（NAG） for evaluating renal function in preterm neonate. Methods 89 neonates in our NICU were selected, divided into three groups：the asphyxial preterm group （ 18 cases）, the no-asphxial preterm group （25 cases）, and the control group （46 term infants without asphyxia）. All objects were detected the urinary RBP,NAG and creatinine（Cr）. The levels of RBP/Cr and NAG/Cr and blood urea nitrogen （BUN） ,Cr were observed within 48 h after birth after birth. The fluctuations of urinary RBP/Cr and NAG/Cr in no-asphxial preterm group also were observed in 0-48 h, -96 h, -168 h after birth respectively. Results The urinary RBP/Cr levels in asphyxial preterm group E （0. 951±0. 629） g/moll were higher than those in no-asphxial preterm group E （0. 389 ± 0. 281 ） g/moll and the control group [（0. 119 ± 0. 081 ） g/moll （P 〈0. 05 ）. The urinary RBP/Cr levels in no-asphxial preterm group were also significantly higher than those in the control group （ P 〈 0. 05 ）. The levels of urinary NAG/Cr in the asphyxial and no-asphxial preterm groups were both higher than those in the control group（P 〈0. 05） ,but there was no difference betwteen the former two groups（ P 〉 0. 05 ）. The levels of serum Cr and BUN were no significant difference in the three groups（ P 〉0.05 ）. The urinary RBP/Cr level had non-linear correlation with either postnatal or gestational age in no-asphyxial preterm group. While the urinary NAG/Cr levels negative correlated with the gestational age（ r = -0. 625, P 〈 0.05 ）. And the correlation between the urinary NAG/Cr and postnatal age was postive（P 〈 0. 05 ）. Conclusion The determination of urinary NAG/Cr and RBP/Cr provides a sensitive and reliable method to evaluate the renal function of neonates, especially in preterm infants. The RBP/Cr is affected by asphyxia more than NAG/Cr, which is rather correlated with gestational age.