脐血中性粒细胞明胶酶相关脂质运载蛋白在新生儿出生时缺氧器官受损中的变化及临床意义

The clinical significance of cord blood neutrophil gelatinase-associated lipocalin in neonates with perinatal hypoxic organ damage

目的:探讨新生儿出生时不同缺氧程度下脐血中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)的水平以及其与缺氧器官(肝脏、肾脏、心脏)受损的关系。方法:前瞻性选择2022年4~10月湖南妇女儿童医院产科分娩的所有新生儿为研究对象,根据宫内/产程中缺氧情况分为健康对照组、缺氧无窒息组、缺氧窒息组。所有新生儿断脐后均采集脐动脉血检测脐血血气及NGAL水平,生后24~48 h完善肝肾功能、心肌酶检测,分析脐血NGAL水平与各检测指标间的关系。结果:共纳入161例新生儿,健康对照组91例,缺氧无窒息组49例,缺氧窒息组21例。缺氧窒息组脐血NGAL水平高于缺氧无窒息组和健康对照组[(1.81±0.71)ng/ml比(1.22±0.53)ng/ml、(0.88±0.47)ng/ml],缺氧无窒息组高于健康对照组,差异均有统计学意义(P<0.05)。脐血NGAL水平与新生儿性别、胎龄、出生体重、母亲年龄、体重指数、肌酸激酶同工酶MB均无显著相关性(P>0.05),与Apgar评分、脐血血气pH、BE值存在较强负相关性(r<-0.3,P<0.05),与乳酸、谷丙转氨酶、肌酐存在较强正相关性(r>0.3,P<0.05)。受试者工作特征曲线分析显示,以谷丙转氨酶、肌酐、尿素氮、肌酸激酶同工酶MB联合作为新生儿肝脏、肾脏、心脏受损实验室标准,当NGAL水平截断值为1.07 ng/ml时,其敏感度和特异度分别为84.3%、60.3%。结论:脐血NGAL水平在新生儿出生时随着缺氧加重有升高趋势,可能与缺氧后器官(肝脏、肾脏、心脏)受损相关。

Objective To study the changes of cord blood neutrophil gelatinase-associated lipocalin(NGAL)under different levels of hypoxia at birth and its correlations with hypoxic organ damage(including liver,kidney and heart).Methods From April to October 2022,all neonates born in our hospital were prospectively enroll in the study.The neonates without perinatal risk factors were assigned into the control group.The neonates with intrauterine distress or hypoxia during labor were assigned into the hypoxia group(no asphyxia at birth)and the asphyxia group(with asphyxia at birth).Cord blood was collected from the umbilical artery and cord blood gas(CBG)and NGAL were measured.Liver enzymes,kidney function and cardiac enzymes as biomarkers for hypoxic organ damage were measured 24~48 h after birth.The correlations of NGAL and the biomarkers were analyzed.Results A total of 161 neonates were enrolled,including 91 in the control group,49 in the hypoxia group and 21 in the asphyxia group.NGAL in the asphyxia group was significantly higher than the hypoxia group and the control group[(1.81±0.71)ng/ml vs.(1.22±0.53)ng/ml,(0.88±0.47)ng/ml],NGAL in the hypoxia group significantly higher than the control group(P<0.05).NGAL was negatively correlated with Apgar score,pH and BE of CBG(r<-0.3,P<0.05)and positively correlated with lactate,ALT,creatinine(r>0.3,P<0.05).No significant correlations existed between NGAL and gender,gestational age,birth weight,mother's age,BMI and CK-MB(P<0.05).ROC curve showed that sensitivity and specificity of NGAL for predicting hypoxic organ damage were 84.3%and 60.3%,respectively,with a cut-off value of 1.07 ng/ml.Conclusions Cord blood NGAL may increase with the deterioration of hypoxia at birth and may be associated with hypoxic organ damage.