换血对新生儿高胆红素血症肾功能的影响

Effect of renal function on newborns with hyperbilirubinemia by exchange transfusion

目的探讨换血对高胆红素血症新生儿肾功能的影响作用。方法将359例高胆红素血症新生儿分为2组,换血组(137例)采用外周动静脉同步换血。光疗组(222例)每天蓝光治疗12h,连续光疗2-3 d。所有患儿均在入院时以及换血或光疗结束后检测血尿素、尿酸、肌酐、胱抑素C和β2微球蛋白(β2MG)及总胆红素。结果光疗组血尿素、尿酸、肌酐和胱抑素C和β2微球蛋白光疗前分别为(2.90±1.35)mmol/L、(177.70±70.21)μmol/L、(32.54±11.59)μmol/L,(1.67±0.41)mg/L,(2.68±1.84)mg/L。光疗后分别为(4.81±1.83)mmol/L、(196.79±80.97)μmol/L、(38.94±12.34)μmol/L、(1.83±0.43)mg/L,(3.32±1.66)mg/L。光疗后均进一步升高(P<0.01)。换血组换血前分别为(3.69±1.85)mmol/L、(195.68±86.26)μmol/L、(38.16±14.20)μmol/L、(1.71±0.43)mg/L、(2.97±1.35)mg/L。换血后分别为(3.44±1.50)mmol/L、(176.75±59.18)μmol/L、(35.98±9.99)μmol/L、(1.03±0.27)mg/L、(1.67±0.68)mg/L。换血后均明显降低(P<0.01)。结论新生儿高胆红素血症存在肾功能损害,换血后与换血前尿素、尿酸、肌酐和胱抑素C和β2微球蛋白均有显著的下降,显示换血对新生儿高胆红素血症患儿的肾功能具有一定的改善作用。光疗后与光疗前相比,无论是胱抑素C和β2微球蛋白还是尿素、尿酸和肌酐均有显著的上升,提示光疗虽然能有效的降低胆红素水平,但短期内并不能改善肾功能的实验室指标,其肾功能的影响仍在继续,可见光疗不能阻断新生儿高胆红素血症肾功能改变的进一步发展,而换血能在短期内迅速有效的改善其肾功能指标,对高胆红素血症新生儿的肾功能具有一定的保护作用。

Objective To observe the protective effect of exchange transfusion on newborns with hyperbilirubinemia. Methods 359 newborns with hyperbilirnbinemia were divided into two groups ： an exchange transfusion group （ n = 137 ） baby which performed synchronous peripheral arteriovenous exchange transfusion and a phototherapy group （n = 222） who re- ceived phototherapy （blue light） for 12 hours every day and underwent continuous phototherapy for 2 -3 days. Blood urea, uric acid, creatinine, cystatin C, β2-microglobulin and total bilirubin were measured before and after exchange transfusion or phototherapy. Results The blood urea, uric acid, creatinine, cystatin C and β2-microglobulin before phototherapy were （2.90±1.35） mmol,/L, （177.70±70.21） la,mol/L, （32.54 ± 11.59） Ixmol/L, （1. 67 ±0.41） mg/L, （2.68 ± 1.84） mg/L, respectively and after phototherapy, they were （4. 81 ± 1.83 ） mmol/L, （ 196. 79 ± 80. 97） ixmol/L, （38. 94 ± 12. 34） μmol/L, （1.83 ±0. 43） mg/L, （3.32 ＋ 1.66） mg/L, respectively. These values showed an increase after photo- therapy treatment （ P 〈 0. 01 ）. However, before exchange transfusion,these values were （3.69 ± 1.85 ） mmol/L, （ 195.68 ±86. 26） μmol/L, （38.16 ± 14.20） μmol/L, （1. 71 ± 0.43） rag/L, （2. 97 ± 1.35 ） mg/L and after exchange transfusion, thee values were （3.44±1.50）mmol/L, （176.75 ±59.18） lamaol/L, （35.98 ±9.99） μmol/L, （1.03 ±0.27） mg/L, （1.67 ±0.68）mg/L. These values were significandy reduced （P〈0.01）. Conclusion Hyperbilirubinemia can induce harm to renal functions in newborn. Exchange transfusion treatment facilitates the reduction of blood urea, uric acid, ereatinine, cystatin C and β2-microglobulin, indicating that exchange transfusion can contribute to renal improvement in neo- natal hyperbilirubinemia. Phototherapy indicates an increase in blood urea, uric acid, creatinine, cystatin C and β2-micro- globulin, suggesting that although this treatment can reduce the level of bilirnbin, but short term renal functions cannot be improved. Therefore, exchange transfusion may have a protective effect on short-term neonatal renal function in newborns with hyperbilirubinemia.