窒息新生儿尿中尿酸/肌酐比值的变化及意义

Change of the Urinary Uric Acid/Creatinine Ratio in Neonates with Asphyxia

目的 探讨尿中尿酸 /肌酐比值的变化在新生儿窒息及窒息后肾损伤中的意义。方法 对 38例足月窒息新生儿 (轻度窒息 13例 ,重度窒息 2 5例 )和 15例正常新生儿的尿中尿酸 /肌酐比值及反映肾损伤指标N 乙酰 β D 氨基葡萄糖苷酶 (NAG)活性和β2 微球蛋白 (β2 MG)水平进行了检测。结果 与正常组 [(0 .5 6± 0 .2 0 ) ,(2 .73± 2 .5 0 )U/L ,(0 .10± 0 .0 1)mg/L]相比 ,轻度窒息组尿中尿酸 /肌酐比值、NAG ,β2 MG水平 [(1.19± 0 .5 3) ,(10 .34± 8.72 )U/L ,(2 .80± 1.95 )mg/L]显著升高 (P <0 .0 1) ,重度窒息组尿中上述指标 [(2 .6 0± 1.2 3) ,(2 6 .5 3± 10 .5 4 )U/L ,(5 .0 5± 2 .19)mg/L]也显著升高 (P <0 .0 1) ,且重度窒息组高于轻度窒息组 (P <0 .0 1)。在窒息组内 ,尿酸 /肌酐比值与Apgar评分呈显著负相关关系 (r为 - 0 .6 3,P <0 .0 1) ,与NAG活性及 β2 MG水平之间均呈显著正相关关系 (r分别为 0 .6 2 ,0 .89,P <0 .0 1)。结论 窒息新生儿尿中有较高的尿酸 /肌酐比值 。

Objective To study the change and significance of the urinary uric acid (UA)/creatinine ratio (Cr) in neonatal asphyxia and postasphyxial renal injuries. Methods The uric acid /creatinine ratio, the activity of Nacety β D amino glucosidase (NAG) and the level of β 2 microglobulin (β 2 MG) in urine were detected in 38 term neonates with asphyxia (13 cases of mild asphyxia and 25 cases of severe asphyxia) and 15 healthy newborns (controls). Results Compared with the controls [( 0.56 ± 0.20 ), ( 2.73 ± 2.50 ) U/L, ( 0.10 ± 0.01 ) mg/L], the UA/Cr ratio, and NAG and β 2 MG levels obviously increased in the mild asphyxia group [( 1.19 ± 0.53 ), ( 10.34 ± 8.72 ) U/L, ( 2.80 ± 1.95 ) mg/L](P< 0.01 ). In the severe asphyxia group, the above parameters [( 2.60 ± 1.23 ), ( 26.53 ± 10.54 ) U/L, ( 5.05 ± 2.19 ) mg/L] significantly increased compared with the mild asphyxia group and controls (P< 0.01 ). A significantly negative correlation was found in the asphyxia group between the UA/Cr ratio and the Apgar score (r= -0.63 , P< 0.01 ); while the obviously positive correlation was found between the UA/Cr ratio and NAG activity or β 2 MG level (r= 0.62 or 0.89 , both P< 0.01 ). Conclusions Infants with asphyxia have a higher urinary UA/Cr ratio. It might be used as an indicator for early assessment of the severity of asphyxia and postasphyxial renal injuries in neonates.