新生儿急性肾功能衰竭抗利尿激素水平的变化

The change of antidiuretic hormone in the acute renal failure of newborn

目的 探讨新生儿急性肾功能衰竭 (NARF)血浆抗利尿激素 (ADH)的变化及其对肾功能的影响。方法 NARF 3 3例 ,其中少尿型 10例 ,非少尿型 2 3例 ,对照组为同期肾功能正常的轻型病例 2 8例。FM - 6型冰点渗透压仪测定血浆、尿液渗透压 ,放射免疫法检测血清ADH ,同时检测血钠、尿钠、血肌酐、尿肌酐 ,计算出钠排泄分数 (FENa)、肌酐清除率 (Ccr)、肾衰指数 (RFI)、自由水清除率 (CH2 O)。结果 少尿型、非少尿型ARF及对照组的ADH分别为 18.98± 7.65、14.2 3± 6.61、6.5 8± 3 .46ng/L ,差异有显著性意义 (P <0 .0 5 )。FENa、RFI、Ccr、CH2 O 3组比较 ,差异有显著性意义 (P <0 .0 5 )。 3组尿 /血渗透压无显著性差异 (P >0 .0 5 )。ADH与RFI、FENa均正相关 (r=0 .3 6 P =0 .0 0 5 ) ,与Ccr负相关 (r=- 0 .3 6 P =0 .0 0 5 )。结论 NARF有ADH的异常分泌 ,ADH增高与肾小球滤过率降低相关 。

Objective To investigate the change of antidiuretic hormone(ADH) and its influence in renal function in the acute renal failure(ARF) of newborn.Methods Thirty three newborns with ARF were divided into non oliguria group (23 cases) and oliguria group( 10 cases). Osmolarity of plasma and urine were measured with FM 6 type zero point osmometer. ADH in serum were detected by radioimmunoassay. Serum and urine sodium , creatine , creatine clearance (Ccr), fractional sodium excretion (FENa), renal failure index (RFI), free water clearance (CH 2O) were also detected.Twenty eight newborns with normal renal function as control group.Results The ADH of oliguria , non oliguria and control groups were 18.98±7.65, 14.23±6.61, 6.58±3.46 ng/L respectively and were significantly difference among three groups (P<0.05). FENa,RFI,Ccr,CH 2O were significantly difference among three groups (P<0.05) and plasma urine osmolarity ratio were not significantly among three groups (P>0.05). ADH was positive correlated with RFI, FENa (r=0.36 P=0.005) and was negative correlated with Ccr( r=-0.36 P=0.005).Conclusions The newborn with ARF are accompanied by ADH abnormal secretion , ADH increasing is correlated with glomerular filtrating rate decreasing . The renal tubules response to ADH is blunted in the newborn with ARF.