尿微量蛋白在新生儿窒息肾损害早期诊断中的意义

Significance of urinary microproteins in early diagnosis of kidney damage in asphyxiated neonates

目的探讨尿微量蛋白测定在新生儿窒息早期肾损害的临床意义。方法63例窒息足月新生儿（窒息组），平均日龄（1±1．8）d，其中轻度窒息36例，重度窒息27例，于出生后第2d及第5d检测尿中尿清蛋白（ALB）、α1微球蛋白（α1—MG）、转铁蛋白（TRF）、β2微球蛋白（β2-MG）的水平及尿常规，同时查血尿素氮（BUN）及肌酐（Cr）。30例正常足月新生儿用作对照组。结果窒息组新生儿出生后第2d的尿ALB、（α1—MG、TRF、β2-MG均显著高于对照组，均P〈0．01，第5d尿ALB、TRF、α1-MG、β2-MG仍显著高于对照组，P〈0．05，0．05，0．01，0．01。重度窒息组生后第2d的尿ALB、α1-MG、TRF、β2-MG均显著高于轻度窒息组，均P〈0．01，第5d的尿ALB、TRF、α1—MG、β2-MG仍显著高于轻度窒息组，P〈0．05，0．05，0．01，0．01。尿ALB、α1—MG、TRF、β2-MG的高低与窒息的程度呈正相关，均P〈0．05。结论联合检测尿ALB、α1-MG、TRF、β2-MG能更敏感地评估新生儿窒息早期。肾损伤的程度及肾脏功能，为临床诊疗提供依据。

Objective To investigate the clinical significance of urinary microproteins in the early diagnosis of kidney damage in asphyxiated neonates.Methods Specimens of urine were collected from 63 full-term neonates with asphyxia, aged （1 ±1.8） days, 36 with mild asphyxia and 27 with severe asphyxia, to examine the levels of albumin （ALB）, transferring （TRF）, α 1-microglobulin （α1-MG）, and β2-MG, and routine urianalysis was conducted 2 days and 5 days after birth. Meanwhile blood samples were collected to test the blood urea nitrogen （BLN） and serum creatinine （Cr）. Thirty age-matched healthy normal full-term newborns were used as control group.Results The ALB, α1-MG, TRF, and β2-MG levels 2 days after birth of the asphyxia group were all significantly higher than those of the control group, allP 〈0.01 and the urine ALB, TRF, α1-MG, and β2-MG levels 5 days after birth of the asphyxia group were still significantly higher than those of the control group, P 〈0.05, 0.05, 0.01, 0.01. The ALB, α1-MG, TRF, and β2-MG levels 2 days after birth of the severe asphyxia group were all significantly higher than those of the mild asphyxia group, all P 〈0.01 and the urine ALB, TRF, α1-MG, and β2-MG levels 5 days after birth of the severe asphyxia group were still significantly higher than those of the mild asphyxia group, P 〈0.05, 0.05, 0.01, 0.01. The levels of ALB, α1-MG, TRF, and β2-MG were positively correlated to the severity of asphyxia, all P 〈0.05; Conclusion Combined tests of ALB, α1-MG, TRF, and β2-MG sensitively assess early kidney damage and kidney function in neonates with asphyxia, thus providing a basis for clinical diagnosis and treatment.