新生儿呼吸衰竭患儿血清胱抑素C水平的临床变化特点及意义

Changes and significance of serum cystain C in neonatal respiratory failure

目的 探讨新生儿呼吸衰竭（NRF）患儿血清胱抑素C水平的临床变化特点及意义.方法 选择2010年1月至2011年12月山东省聊城市人民医院新生儿重症监护病房（NICU）收治的足月NRF患儿368例作为NRF组,选择同期在本院产科分娩的30名正常足月新生儿作为正常对照组.NRF组患儿治疗前检测血清胱抑素C、尿素氮、肌酐水平,与正常对照组相比较;其中329例患儿在入院第7天（治疗后）进行了复查,与自身入院第1天的指标进行对比.另外将329例患儿中入院治疗第1周内未曾应用血管活性药物的247例患儿采用随机数字表法分成常规治疗组（124例）与川芎嗪组（123例）,常规治疗组采用常规支持疗法和对症处理,川芎嗪组在常规治疗组治疗基础上加用川芎嗪注射液6 mg/kg,溶入30 ml5％葡萄糖注射液中静脉滴注,1次/d,连续7d.结果 NRF组患儿入院第1天血清胱抑素C水平高于正常对照组及本组入院第7天[（1.86±0.32） mg/L比（1.07±0.24） mg/L,t=13.09,P＜0.01;（1.84±0.31） mg/L比（1.33 ±0.27） mg/L,t=26.99,P＜0.01],血清尿素氮、肌酐水平与正常对照组比较差别无统计学意义[（6.1±2.0） mmol/L比（5.4±1.5） mmol/L,t=1.94,P＞0.05;（77±20）μmmol/L比（69±16） μmmol/L,t=1.93,P＞0.05],与本组入院第7天比较差异亦无统计学意义[（5.8±1.4） mmol/L比（6.0±1.9） mmol/L,t=1.96,P＞0.05;（74±15） μmmoL/L比（76±19） μmmol/L,t =1.95,P＞0.05].治疗组血清胱抑素C和肌酐水平均低于常规治疗组[（1.23±0.19） mg/L比（1.43±0.33） mg/L,t =5.70,P＜0.01;（72±15） μmmol/L比（74±14） μmmol/L,t =0.91,P＜0.05];血尿素氮与对照组差异无统计学意义（t=0.36,P＞0.05）.以1.87 mg/L为界值,血清胱抑素C判断肾损害的敏感度、特异度分别为0.924和0.818;血清胱抑素C与尿素氮、肌酐之间存在直线相关关系（r=0.441、0.503,P＜0.01）.结论 开展血清胱抑素C的检测可以早期发现肾损害;且随着肾损害的治疗修复而呈下降趋势.

Objective To analyze the changes and significance of serum cystain C （ Cys C） in neonatal respiratm failure （NRF）. Methods Totally 368 cases of NRF （ NRF group） and 30 normal neonates （ control group） from January 2010 to December 2011 were retrospectively analyzed. The levels of Cys C, urea nitrogen （BUN） and creatinine （Cr） in serum were detected and compared between NRF group and control group. In 368 cases of NRF, 329 cases were reexamined on the seventh day of treatment and compared with the first day （ before treatment）. Totally 247 cases, excluding those treated with vasoactive drugs, were randomly divided into the rou- tine therapy group （ 124 eases） receiving routine symptomatic treatment and ligustrazine group （123 cases） admin- istrated with ligustrazine injection （6 mg/kg, intravenous drip, 1 time per day for 7 days） in addition to the rou- tine treatment. Changes of above indices were detected after treatment. Results The levels of serum Cys C in NRF on the first day were higher than those of the normal therapy group and the seventh day[ （ 1.86 ± 0.32 ） mg/L vs （1.07 ±0.24）mg/L,t = 13.09,P 〈0.01; （1.84 ±0.31） mg/L vs （ 1.33 ±0.27） mg/L,t =26. 99,P 〈 0.01 ] , while serum BUN and Cr on the first day made no significant difference between the normal group[ （6.1 ± 2.0 ） mmol/L vs （ 5.4 ± 1.5 ） retool/L, t = 1.94, P 〉 0.05 ; （ 77 ± 20） μmmol/L vs （ 69 ± 16 ） μmmol/L, t = 1.93, P〉0.05] and after treatment[（5. 8 ± 1.4）mmol/L vs （6.0 ± 1.9）mmol/L,t = 1. 96,P 〉0.05; （74 ± 15 ） μmmol/L vs （76 ± 19） μmmoL/L,t = 1.95,P 〉 0.05 ]. After treatment with ligustrazine injection, the Cys C and creatinine nmde significant difference between the ligustrazine group and the normal therapy group [ （ 1.23 ± 0.19 ） mg/L vs （ 1.43 ± 0.33 ） mg/L, t = 5.70, P 〈 0.01 ; （ 72 ± 15 ） μmmol/L vs （ 74 ± 14 ）μmmol/L, t = 0.91, P〈0.051 and BUN made no difference（t =0. 36,P 〉0.05）. If 1.87 mg/L was used as the boundary value of Cys C, The sensitivity and specificity of kidney injury were 92.4% and 81.8% ; There was a fine positive linear correlation between serum Cys C and BUN, creatinine（ r = 0. 441 ,r = 0. 503,P 〈 0.01 ）. Conclusions Deteetion of serum cystatin C can find renal damage early. Cystatin C may decrease with the kidney recovery after treatment.