足月新生儿缺氧缺血性脑病伴急性肾损伤的临床特征分析

Clinical characteristics of acute kidney injury in term neonates with hypoxic ischemic encephalopathy

目的总结住院足月新生儿缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)伴发急性肾损伤(acute kidney injury,AKI)的临床特征。方法选取2016年1月至2018年12月首都医科大学附属北京儿童医院新生儿中心诊断为HIE的足月新生儿,分析住院期间血电解质及肾功能指标,根据改善全球肾脏病预后组织(Kidney Disease Improving Global Outcomes,KDIGO)标准对HIE患儿进行新生儿AKI评估,分为HIE伴AKI组及HIE不伴AKI组。同时以正常足月新生儿作为对照组。结果本研究共纳入HIE新生儿87例,分为HIE伴AKI组13例,HIE不伴AKI组74例;对照组27例。HIE患儿AKI的发生率为14.9%(13/87),轻度及中重度HIE患儿AKI的发生率为12.8%和16.6%,差异无统计学意义(χ^2=0.04,P=0.84)。3组间血钠、血钙水平的差异有统计学意义(F=13.10,P=0.00;F=8.23,P=0.00),且血钠、血钙水平与AKI发生呈负相关(r=-0.39,P=0.00;r=-0.34,P=0.00),伴AKI组与不伴AKI组血钠、血钙水平比较,差异无统计学意义(P>0.05)。伴AKI组的BUN水平高于不伴AKI组及正常对照组,差异有统计学意义(F=11.11,P=0.00),其水平与AKI的发生呈正相关(r=0.41,P=0.00),伴AKI组与不伴AKI组的差异无统计学意义(P>0.05)。伴AKI组SCr水平高于另外两组,但差异无统计学意义(P>0.05)。GFR在伴AKI组中最低,但3组间比较,差异无统计学意义(P>0.05)。结论足月新生儿HIE的AKI发生率较高,伴AKI组患儿血钠、血钙水平降低,BUN水平显著升高。

Objective To investigate the incidence and manifestation of acute kidney injury(AKI)in hypoxic ischemic encephalopathy(HIE).Methods All the full-term newborns diagnosed with HIE from January 2016 to December 2018 were included,and were divided into AKI group and non-AKI group according to Kidney Disease Improving Global Outcomes(KDIGO)definition of neonatal AKI.Meanwhile,normal full-term newborns were randomly selected as the control group.Results A total of 87 newborns with HIE,there were 13 cases in AKI group,74 cases in non-AKI group and 27 cases in the control group respectively.The incidence of AKI in HIE was 14.9%(13/87),and that of mild and moderate severe HIE was 12.8%and 16.6%,respectively.There was no significant difference between the two groups(P=0.84).The levels of serum sodium and calcium in AKI group were significantly lower than those in non AKI group and the control group(F=13.10,P=0.00;F=8.23,P=0.00),and the levels of serum sodium and calcium were negatively correlated with the occurrence of AKI(r=-0.39,P=0.00;r=-0.34,P=0.00).The level of BUN in AKI group was higher than that in the other two groups(F=11.11,P=0.00),which was positively correlated with AKI(r=0.41,P=0.00).The level of SCr in AKI group was higher than that in the other two groups,but the difference was not statistically significant(P>0.05).Glomerular filtration rate(GFR)was the lowest in AKI group,but there was no significant difference among the three groups.Conclusions The incidence of AKI in full-term neonates with HIE is relatively high.The serum sodium and calcium levels of AKI group are lower,and BUN is remarkably higher.