高胆红素血症新生儿63例肾功能状况的追踪观察

目的追踪观察高胆红素血症新生儿肾功能损害的变化规律，探讨高胆红素血症新生儿肾功能损害的预后和转归。方法对63例高胆红素血症（高胆组）和30例非高胆红素血症（非高胆组）的新生儿出生后第3天进行血尿素氮、肌酐和血β2-微球蛋白测定，并对高胆组新生儿出生后第7、10、14、21天进行血B：．微球蛋白测定。结果出生后第3天高胆组血β2-微球蛋白（4．43±0．8）mg·L^-1高于非高胆组（1．50±0．26）mg·L^-1，差异有统计学意义（P〈0．01）；且中度高胆组（4．54±0．22）mg·L^-1。高于轻度高胆组（3．49±0．29）mg·L^-1，差异有统计学意义（P〈0．05）；重度高胆组（5．34±0．16）mg·L^-1。高于中度高胆组，差异有统计学意义（P〈0．05）。轻、中、重度高胆组血β2-微球蛋白浓度分别在出生后第10、14、21天降至正常范围。高胆组血胆红素水平与血β2-微球蛋白浓度经线性相关分析呈高度直线正相关（r=0．96，P〈0．01）。结论新生儿高胆红素血症时血β2-微球蛋白明显增高，存在肾小球滤过率的下降，并随着血胆红素浓度的增加而加剧，高胆程度越重其恢复越慢，但高胆所至的肾功能损害是暂时性的，预后良好。

Tracking observation of renal function in 63 neonates with hyperbilirubinemia

Objective To observe the change rules of renal function in neonates with hyperbilirubinemia and explore the prognosis of damage of renal function in neonates with hyperbilirubinemia. Methods In 63 neonates with hyperbilirubinemia and 30 neonates without hyperbilirubinemia at the first 3 days after the birth blood urea nitrogen, serum creatinine and β2-microglobulin were determined. In 63 neonates with hyperbilirubinemia at the first 7,10,14, 21 days after the birth serum β2-microglobulin were determined. Results At the first three day after the birth serum β2-microglobulin （4. 43 ± 0. 8）mg· L^-1 in hyperbilirubinemia group was higher than that in the not hyperbilirubi- hernia group （1.5 ± 0. 26）mg·L^-1（ p 〈 0. 01 ）, and β2-microglobulin in moderate hyperbilirubinemia group （4. 54 ± 0. 22） mg·L^-1 was higher than that in mild hyperbilirubinemia group （ 3.49 ± 0. 29 ） mg·L^-1 （ p 〈 0. 05 ）, β2- microglobulin in severe hyperbilirubinemia group （5.34 ± 0. 16）mg·L^-1 was higher than that in moderate hyperbil- irubinemia group （P 〈 0. 05）. The levels of serum β2-mieroglobulin in mild, moderate, severe hyperbilirubinemia groups reduced to the normal range respectively at the first 10, 14, 21 days after the birth. The linear correlation analysis showed there was highly linear positive correlation between level of blood bilirubin and serum β 2-microglobulin （r = 0. 96, P 〈 0. 01 ）. Conclusion When neonatal hyperbilirubinemia occurs β2-microglobulin significantly increase, glomerular filtration rate drop, and with the increase of concentration of blood bilirubin its drop increase, heavier high bilirubin degree slower its restore, but high bilirubin induced renal impairment is temporary and its prog-nosis is good.