窒息后早产儿肾功能动态变化

The Dynamic Changes of Renal Function in Premature Infants after Asphyxia

目的 研究窒息后早产儿尿蛋白变化 ,探讨窒息对早产儿肾功能的影响。 方法 利用免疫比浊法、EL ISA法、速率法、酶法和苦味酸法测定窒息早产儿及正常不同胎龄早产儿生后第 1、4、7天尿微量白蛋白 (m Alb)、视黄醇结合蛋白 (RBP)、 N-乙酰 -β-氨基葡萄糖苷酶 (NAG)、血尿素氮(BUN )、肌苷 (Cr)值。 结果 同一胎龄随日龄增加 ,尿 m Alb有下降趋势 ,但差异无显著性 (P>0 .0 5 ) ;同一日龄随胎龄增加尿 m Alb明显降低 ,差异有显著性 (P<0 .0 5或 <0 .0 1) ;窒息组早产儿随日龄增加尿 m Alb无明显变化 ,但显著高于正常早产儿组 [于生后第 7天为 (4 0 .2± 4 .8) mg/ mmolCr,P<0 .0 1]。尿 RBP、NAG在 2 8～ 31周组和 35～ 36周组随日龄增加 ,于生后第 4天达峰值 [(2 8～31周组 RBP为 (190 9± 2 4 5 )μg/ m mol Cr,NAG为 (30 .3± 14 .7) U / mmol Cr],而后明显下降 ,差异有非常显著性 (P<0 .0 1) ;在同一日龄随胎龄增加 ,尿 RBP、NAG明显降低 ,尤为生后第 4天和第 7天 ,各组间差异有显著性 (P<0 .0 5或 <0 .0 1) ;窒息组早产儿随日龄增加尿 RBP于生后第 4天达高峰为 (340 4± 10 17)μg/ mmol Cr,而后明显下降 ,且各日龄段均显著高于正常早产儿组 (P<0 .0 5或<0 .0 1) ;尿

Objective To study changes of urinary protein in premature infants after asphyxia in order to explore influence of asphyxia on the renal function. Methods Microalbumin(mAlb),retinal-bindingprotein (RBP) ,N-acety-β-D-aminoglucosidase in urine and serum urea nitrogen(BUN),creatinine(Cr) were performed in 56 normal premature infants and 49 asphyxia ones with immunoturbidimetric method, ELISA method, rate method , enzymic method and picric acid method when they were 1,4,7 day age after born. Results (1)With ages increasing urinary mAlb took on decreasing trend in the same gestation age but there was no different while with the gestation age increasing in the same ages urinauy mAlb was decreased significantly (P<0.05 or <0.01). In asphyxia group urinary mAlb did not substantially differ with ages increasing but it was higher significantly than normal groups.(40.2±4.8 mg/mmol Cr in the 7 th day). (2)The level of urinary RBP and NAG were increased and reached a peak in 4 days in 28~31 weeks[the level of RBP was (1 909±245) μg/mmol Cr and NAG was (30.3±14.7) U/mmol Cr] and 35~36 weeks group then they were decreased significantly especeally in 28~31 weeks group (P<0.01);With gestation age increasing in 4 th day and 7 th day the level of urinary RBP and NAG were different (P<0.05 or <0.01).In asphyxia group urinary RBP reached peak in 4 th day [(3 404±1 017) μg/mmol Cr]then was decreased ,but still were higher than normal group(P<0.05 or <0.01).Although there were no different in asphyxia group urinary NAG was increased compared with normal group. (3)In normal group serum BUN and Cr were decreased while they reached peak in 4 th day in asphyxia group[BUN was(11.4± 4.5) mmol/mmol Cr, Cr was (112±27) μmol/L] and were higher than normal guoup in 4 th and 7 th days (P<0.01). Conclusion The stature of glomerulus and renal tubules were still developing and asphyxia had significant influnence on urinary proteins.