中性粒细胞明胶酶相关脂质运载蛋白、和肽素及血肌酐在窒息足月新生儿缺氧性肾损伤中的临床价值

Clinical value of NGAL,copeptin and creatinine in hypoxic renal injury of full-term neonates with asphyxia

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、和肽素、血肌酐在窒息足月新生儿缺氧性肾损伤中的临床价值。方法选择2015年6月至2017年10月期间在河北省人民医院出生的1 000名婴儿中的48名足月新生儿为研究对象进行前瞻性研究,其中包括患有急性肾损伤(AKI)的9名窒息新生儿和39名窒息但无AKI迹象新生儿,另选取30名健康新生儿作为对照组。测量受试者的脐带血和出生后24h血液中NGAL、和肽素及肌酐的浓度。结果研究结果显示AKI组、非AKI组和对照组在脐带血中以及出生后24h血液中肌酐、和肽素水平以及血清渗透压无显著性差异。AKI组新生儿中,脐带血的NGAL和出生后24h的血液NGAL水平明显高于非AKI组和对照组。NGAL浓度与脐动脉pH (ρ=-0. 42,P=0. 04)、碱基过量(ρ=-0.31,P=0. 03)和Apgar评分在出生后第1分钟(ρ=-0. 41,P=0. 02)以及在第5分钟评分(ρ=-0. 20,P=0. 001)呈显著负相关。ROC曲线分析显示,出生后24h血液NGAL水平具有良好的预测价值(140. 7 ng/mL),可用于预测窒息新生儿的AKI发生。结论出生后24h血液NGAL是一个很有前景的物质,由于其具有高灵敏度、高特异性,可以作为早期预测窒息足月新生儿发生缺氧性肾损伤的标志物,但是和肽素与血肌酐并没有达到预期作为预测标志物的要求。

Objective To explore the clinical value of NGAL,peptide,and creatinine in the hypoxic renal injury of full-term neonates with asphyxia. Methods During June 2015 to October 2017,selected 48 full-term newborns from 1 000 babies born in our hospital,A prospective study was conducted on 48 full-term newborns. 9 asphyxiated neonates( 18. 6%) had AKI,while 38 had no AKI signs and 30 healthy infants. Umbilical cord blood and 24 h after birth serum NGAL,creatinine,and peptide hormone were measured in all asphyxiated and controls neonates. Results The results showed that there are no differences in creatinine and peptide hormones levels,as well as serum osmotic pressure in all three investigated groups( AKI,no-AKI,and controls) in umbilical cord blood and 24 h after birth.Compared with the non-AKI and control group,the serum NGAL level in umbilical cord blood was significantly higher than in the AKI group at 24 h after birth. NGAL concentration showed a strong negative correlation to umbilical artery pH( ρ =-0. 42,P = 0. 04),base excess( ρ =-0. 31,P = 0. 03)and Apgar score in the first minute( ρ =-0. 41,P = 0. 02) and 5 minutes of life( ρ =-0. 20,P = 0. 20). The ROC curve analysis showed that NGAL level had a good predictive value( 140. 7 ng/mL),which could be used to diagnose the AKI of neonatal asphyxia. Conclusions NGAL is a very promising material,due to its high sensitivity,high specificity,can be used as the early oxygen deficiency of kidney damage prediction diagnostic markers,and peptide hormones and creatinine,however,does not meet expectations as a biomarker for predicting requirements.