肾血流动力学改变在窒息新生儿肾损伤中的诊断价值

The Value of Renal Hemodynamic Changes in Diagnosis of Renal Damage in Neonatal Asphyxia

目的探讨肾血流动力学改变在窒息新生儿肾损伤中的早期诊断价值。资料与方法根据Apgar评分标准将60例新生儿分成轻、重度窒息组及健康对照组,每组20例。运用彩色多普勒超声检测肾主动脉收缩期峰值速度(Vs)、舒张期末血流速度(Vd)及阻力指数(RI),并测定血清尿素氮(BUN)、肌酐(Cr)及尿内皮素-1(ET-1)水平。依据健康对照组设立正常参考值上、下限,高于上限或低于下限视为异常。同时分析各组间指标的变化及相关性。结果各窒息组Vs、Vd、RI及ET-1异常发生率更高,与健康对照组比较,差异有统计学意义(P<0.01)。各窒息组BUN、Cr异常发生率低,仅重度窒息组与健康对照组比较,差异有统计学意义(P<0.01)。窒息患儿Vs、Vd与BUN、Cr、ET-1之间呈负相关(P<0.01),RI与BUN、Cr、ET-1之间呈正相关(P<0.01)。结论窒息新生儿早期肾损伤伴有肾血流动力学改变,且与窒息程度相关,提示肾动脉血流动力学参数可作为判定窒息新生儿早期肾损伤的敏感指标。

Purpose To explore the value of renal hemodynamic changes in the early diagnosis of renal damage of neonatal asphyxia.Materials and Methods According to Apgar score standard,60 newborns were divided into mild asphyxia,severe asphyxia and healthy control groups,with 20 cases in each group.The level of endothelin-1（ET-1）,serum creatinine（Cr） and urea nitrogen（BUN） were recorded;the peak systolic（Vs）,diastolic flow velocities（Vd） and the resistance index（RI） the main renal artery were obtained by color Doppler ultrasonography,and were compared with the renal function parameters.The normal reference values were set up according to the values of the healthy control group.The aforementioned parameters were recorded and correlated among the groups.Results The abnormal rate of Vs,Vd,RI and ET-1 was significantly higher in both asphyxia groups compared with the healthy control group（P 0.01）,while the abnormal rate of Cr and BUN was lower and the significant difference was only found between the severe asphyxia group and the healthy control group（P 0.01）.The Vs and Vd were negatively correlated with BUN,Cr and ET-1（P 0.01）,while the RI was positively correlated with BUN,Cr and ET-1（P 0.01）.Conclusion Abnormal renal hemodynamic changes can occur in the early stage of renal damage in neonatal asphyxia,and are closely correlated to the severity of the asphyxia,indicating that the renal artery blood flow parameters can serve as sensitive indicators for detection of the early renal damage in neonatal asphyxia.