Renal tubular dysfunction in children living in the Aral Sea Region

Background: The Aral Sea region is a natural area seriously polluted by human activities. Recent surveillance revealed the increased prevalence of diverse chronic diseases in children. Aims: To investigate the function of renal tubules, which are most at risk of damage as a result of heavy metal intoxication, in children of the Aral Sea region. Methods: A group of 205 children living in Kazalinsk, close to the Aral Sea, and a group of 187 children living in Zhanakorgan, far from the Aral Sea, were examined by means of random urine samples. Both urinary N-acetyl-ß-D-glucosaminidase (NAG; U/mmol Cr) and ß₂ microglobulin (BMG; µg/mmol Cr) were calculated for each subject. Results: Mean urinary NAG and BMG were both significantly higher in Kazalinsk than in Zhanakorgan (NAG: 0.77 (0.58) and 0.62 (0.37) U/mmol Cr; BMG: 41.8 (54.8) and 22.5 (20.4) µg/mmol Cr, respectively; mean (SD), p < 0.01). The number of children with abnormal values of NAG (>1.5 U/mmol Cr) was significantly more prevalent in Kazalinsk than in Zhanakorgan (7.9% and 2.6%, respectively, p < 0.05). Conclusion: Renal tubular function of children around the Aral Sea region is profoundly impaired. This should be taken into account when considering the health problems of this area.     

Extremely high prevalence of hypercalciuria in children living in the Aral Sea region

The Aral Sea region is a natural area seriously polluted by human activities. In addition to the increased prevalence of diverse chronic diseases in children, the risk of developing urolithiasis is reported to be high in this region. This study was undertaken to clarify the prevalence of hypercalciuria in children of the Aral Sea region. A group of 205 children living in Kazalinsk, close to the Aral Sea, and a group of 187 children living in Zhanakorgan, far from the Aral Sea, were screened for hypercalciuria. Urinary sodium excretion (sodium per creatinine, uNa/Cr) in addition to calcium excretion (calcium per creatinine, uCa/Cr) was also calculated for each subject. Mean uCa/Cr (mmol/mmol) and uNa/Cr (mmol/mmol) excretions were significantly higher in Kazalinsk than in Zhanakorgan (uCa/Cr: 0.75 +/- 0.74 and 0.33 +/- 0.30; uNa/Cr: 3.54 +/- 2.27 and 2.89 +/- 1.69, respectively, mean +/- SD, p < 0.01). Hypercalciuria regarded as an uCa/Cr of more than 0.703 was observed in 79 out of 205 Kazalinsk children (38.6%) while this was seen in only 24 out of 187 Zhanakorgan children (12.8%). Linear regression analysis revealed a direct positive correlation between urinary calcium and sodium excretion (p < 0.01) in Kazalinsk children. Conclusion: The prevalence of hypercalciuria in children around the Aral Sea region is extremely high. This may be associated with excessive intake of calcium and sodium, or due to impaired renal tubular function caused by toxic chemicals. Therefore, hypercalciuria that may lead to urolithiasis should be taken into account when considering the health problems of this area.     

尿RBP NAG检测在早期诊断过敏性紫癜肾小管损伤的临床意义

目的　观察过敏性紫癜、紫癜性肾炎患儿尿视黄醇结合蛋白 (RBP)、尿-N -乙酰-β-D -氨基 -葡萄糖苷酶 (NAG)与肾小管受损之间的关系。方法　采用ELISA法测定 2 3例过敏性紫癜 (第 1组 ) ,31例紫癜性肾炎 (第 2组 )和 38例正常对照组儿童的尿RBP和尿NAG的含量。结果　第 1组尿RBP排量 (2 0 .9± 17.2 ) μg/mmolCr,第 2组尿RBP排量 (2 5 .7± 2 2 .8) μg/mmolCr,与对照组 (10 .4± 4.8) μg/mmolCr比较 ,差异有显著性意义 ,P <0 .0 5 ,P <0 .0 1。第 1组与第 2组之间比较差异无显著意义 ,P >0 .0 5。第 2组尿NAG排量 (3.6± 4.4)U/mmolCr ,明显高于第 1组 (1.5± 0 .8)U/mmolCr和对照组 (1.5± 0 .9)U/mmol,差异有显著性意义 (P <0 .0 5 ,P <0 .0 1)。结论　过敏性紫癜患儿尽管尿检正常 ,其近端肾小管已有不同程度损害 ,而紫癜性肾小管损害更明显。     

血、尿β_2-MG及尿NAG测定与新生儿窒息后肾功能评价

目的：新生儿窒息可引起全身多脏器功能损害,该文通过观察窒息新生儿血、尿β2微球蛋白(β2-MG)及尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)含量的变化以评价新生儿窒息后肾功能的改变。方法：采用放射免疫法和对硝基酚比色法对28例窒息新生儿(又分为重度窒息组13例和轻度窒息组15例)和16例正常新生儿血、尿β2-MG及尿NAG同时进行检测。结果：窒息组血、尿β2-MG及尿NAG值［(4.46±1.42) mg/L,(2.69±1.80) mg/L,(13.68±2.01) U/mmol.Cr］明显高于正常组［(2.97±1.24) mg/L,(0.96±0.82) mg/L,(6.12±1.16) U/mmol.Cr］(P<0.01)。重度窒息组血、尿β2-MG及尿NAG值［(4.99±1.28) mg/L,(3.86±1.14) mg/L,(13.94±3.82) U/mmol.Cr］高于轻度窒息组［(4.30±1.21) mg/L,(2.93±0.87) mg/L,(9.68±1.27) U/mmol.Cr］(P<0.05)。窒息新生儿尿β2-MG较血β2-MG升高更明显(P<0.01)。结论：血、尿β2-MG及尿NAG测定对早期评价新生儿窒息后肾功能损害,尤其是对肾小球或肾小管的损害定位、预测损伤程度具有重要意义。     

Increased urinary excretion of renal N-acetyl-beta-glucosaminidase in hypercalciuria

Urinary excretion of N-acetyl-beta-glucosaminidase (NAG), a lysosomal enzyme, was examined in 33 children with hypercalciuria. Urinary NAG excretion in 13 healthy children was 5.84 +/- 9.35 nmole/hr/mg of creatinine (NAG/Cr) (mean +/- SD) compared with 35.61 +/- 42.04 nmole/hr/mg of creatinine in 23 children with renal hypercalciuria, and 28.99 +/- 13.69 nmole/hr/mg of creatinine in ten children with absorptive hypercalciuria. In children with renal hypercalciuria, NAG/Cr excretion was not statistically different between children with either urolithiasis or hematuria without calculi. In six children with renal hypercalciuria, no significant change in NAG/Cr excretion occurred after a mean duration of 25 weeks of hydrochlorothiazide therapy although urinary calcium to creatinine ratios (UCa/Cr) decreased from 0.24 +/- 0.11 to 0.16 +/- 0.11. We conclude that increased urinary calcium excretion produces renal tubular injury and that the renal injury may not be reversed by short-term alterations in urinary calcium excretion.     

Change of renal function during vancomycin therapy in extremely low birthweight infants

Twenty extremely low birthweight infants were treated with vancomycin (VCM). Their gestational age was 26.3 ± 1.4 weeks (range 24.0–28.7 weeks) and their birthweight was 829 ± 133 g (range 562–990 g). At the time of initial administration of VCM, postnatal age was 29.5 ± 15.8 days (range 5–54 days). Vancomycin was administered in a dose between 9.3 and 11.0 mg/kg every 12 h for a period of 6.3 ± 2.4 days (range 4–13 days). Serum and urinary specimens were obtained before and after (within 24 h following the last dose) VCM therapy. Serum creatinine and sodium, and urinary N-acetyl-β-D-glucosaminidase (NAG) activity, creatinine, sodium, and β-2-microglobulin (BMG) concentrations were measured. Fractional excretion of sodium (FENa) and NAG index (NAG: creatinine ratio) were calculated. There were no significant differences between the before and after VCM treatment in serum creatinine, urinary BMG concentration, FENa and NAG index. No infant showed any symptoms of renal insufficiency. However, the NAG index and FENa increased after treatment in 1 of 20 infants. Vancomycin is effective and safe in the treatment of serious infections in extremely low birthweight infants.     

窒息新生儿尿中尿酸/肌酐比值的变化及意义

目的：探讨尿中尿酸/肌酐比值的变化在新生儿窒息及窒息后肾损伤中的意义。方法：对38例足月窒息新生儿(轻度窒息13例，重度窒息25例)和15例正常新生儿的尿中尿酸/肌酐比值及反映肾损伤指标N-乙酰-β-D-氨基葡萄糖苷酶(NAG)活性和β2-微球蛋白 (β2-MG)水平进行了检测。结果：与正常组［(0.56±0.20)，(2.73±2.50) U/L，(0.10±0.01) mg/L］相比，轻度窒息组尿中尿酸/肌酐比值、NAG，β2-MG水平［(1.19±0.53)，(10.34±8.72) U/L，(2.80±1.95) mg/L］显著升高(P<0.01)，重度窒息组尿中上述指标［(2.60±1.23)，(26.53±10.54) U/L，(5.05±2.19) mg/L］也显著升高(P<0.01)，且重度窒息组高于轻度窒息组(P<0.01)。在窒息组内，尿酸/肌酐比值与Apgar评分呈显著负相关关系(r为-0.63，P<0.01)，与NAG活性及β2-MG水平之间均呈显著正相关关系(r分别为 0.62，0.89，P<0.01)。结论：窒息新生儿尿中有较高的尿酸/肌酐比值，该比值有望成为反映新生儿窒息程度和窒息后肾损伤的早期指标。     

Comparative study of 24-hour calciuria and urinary calcium/creatinine ratio in children over 4 years of age]

The relationship between 24 hour urinary calcium excretion (U Ca/24 h) and urinary calcium/creatinine ratio (U Ca/creat) measured for morning and evening urine samples was studied in 56 children aged 4-15 years and hospitalized for benign conditions. Depending on the length of hospitalisation, 1 to 3 determinations of U Ca/24 h and U Ca/creat ratio were carried out for each child. Mean +/- SD U Ca/24 h was 0.05 +/- 0.058 mmol/kg. Mean U Ca/Cr, expressed in mmol/mmol, was 0.368 for total 24 h urine, 0.358 for the morning sample and 0.358 for the evening sample respectively. A good correlation was found between U Ca/24 h and 24 h U Ca/Cr ratio (r = 0.89), morning U Ca/creat (r = 0.83) and evening U Ca/creat ratio (r = 0.81) respectively. It is concluded that determination of the U Ca/Cr ratio for morning or evening urine samples is an efficient means of detecting hypercalciuria.     

尿视黄醇结合蛋白和N-乙酰-β葡萄糖苷酶对早产儿肾功能的评价意义

目的 分析尿视黄醇结合蛋白(RBP)、尿N-乙酰-β葡萄糖苷酶(NAG)对评价早产儿肾功能的临床意义.方法 受选新生儿89例,分为早产儿窒息组(18例)、早产儿非窒息组(25例)和足月儿对照组(46例).观察所选对象生后48h内晨尿的RBP和NAG水平,分别与尿肌酐(Cr)相比(以RBP/Cr和NAG/Cr表示);观察血肌酐和血尿素氮,以及非窒息早产儿在生后0~48h,~96h,~168h的RBP/Cr、NAG/Cr变化情况.结果 早产儿窒息组的尿RBP/Cr水平[(0.951±0.629)g/mol]高于非窒息组[(0.389±0.281)g/mol]和足月儿对照组[(0.119±0.081)g/mol],3组间比较差异有统计学意义(P<0.05);非窒息组高于足月儿对照组(P<0.05).早产儿窒息组和非窒息组的尿NAG/Cr比值均高于足月儿对照组,差异有统计学意义(P<0.05),但前两者比较差异无统计学意义(P>0.05).3组间的血肌酐和尿素氮比较差异无统计学意义(P>0.05).早产儿非窒息组尿RBP/Cr与胎龄和日龄均无线性相关(P>0.05),而NAG/Cr与胎龄呈线性负相关(r=-0.625,P<0.05),与日龄呈正相关(P<0.05).结论 尿RBP/Cr和NAG/Cr比值有助于评估早产儿肾功能,前者对窒息损害较后者敏感,后者受胎龄影响更大.

Abstract：

Objective To investigate the clinical value of urinary retinol binding protein(RBP) and N-acetyl-β-glucosaminidase(NAG) for evaluating renal function in preterm neonate.Methods 89 neonates in our NICU were selected,divided into three groups:the asphyxial preterm group (18 cases),the no-asphxial preterm group (25 cases),and the control group (46 term infants without asphyxia).All objects were detected the urinary RBP,NAG and creatinine(Cr).The levels of RBP/Cr and NAG/Cr and blood urea nitrogen(BUN),Cr were observed within 48h after birth after birth.The fluctuations of urinary RBP/Cr and NAG/Cr in no-asphxial preterm group also were observed in 0~48h,~96h,~168h after birth respectively.Results The urinary RBP/Cr levels in asphyxial preterm group [(0.951±0.629)g/mol] were higher than those in no-asphxial preterm group[(0.389±0.281)g/mol] and the control group[(0.119±0.081)g/mol](P<0.05).The urinary RBP/Cr levels in no-asphxial preterm group were also significantly higher than those in the control group(P<0.05).The levels of urinary NAG/Cr in the asphyxial and no-asphxial preterm groups were both higher than those in the control group(P<0.05),but there was no difference betwteen the former two groups(P>0.05).The levels of serum Cr and BUN were no significant difference in the three groups(P>0.05).The urinary RBP/Cr level had non-linear correlation with either postnatal or gestational age in no-asphyxial preterm group.While the urinary NAG/Cr levels negative correlated with the gestational age(r=-0.625,P<0.05).And the correlation between the urinary NAG/Cr and postnatal age was postive(P<0.05).Conclusion The determination of urinary NAG/Cr and RBP/Cr provides a sensitive and reliable method to evaluate the renal function of neonates,especially in preterm infants.The RBP/Cr is affected by asphyxia more than NAG/Cr,which is rather correlated with gestational age.     

Urinary N-acetyl-beta-D-glucosaminidase activity in type I diabetes mellitus

We measured urinary albumin excretion rate (AER) and N-acetyl-beta-D-glucosaminidase (NAG) activity in relation to disease duration, acetylated hemoglobin (HbA1c), hypertension and puberty in 44 children and adolescents with type 1 diabetes mellitus. AER and Urinary NAG activity were significantly higher in the patients compared to controls (AER 19.4 +/-; 35.8 vs 4.7 +/- 4.4, NAG activity 5.6 +/- 0.6U vs. 1.6 +/- 0.2U). Microalbuminuria was present in seven patients (15.9%), all of whom were pubertal. There was no correlation between AER and urinary NAG activity. There was a significant direct correlation between AER and disease duration (P <0.05), HbA1c (P < 0.05), diastolic blood pressure (P <0.05) and puberty (P <0.05). None of the microalbuminuria related variables was significantly correlated with urinary NAG activity. Puberty was an independent factor for elevated urinary NAG activity. This study shows that urinary NAG is elevated in children and adolescents with type 1 diabetes mellitus, but is not associated with AER related factors except for puberty. Urinary NAG activity does not appear to be a useful marker for early detection of diabetic nephropathy in children and adolescents with type 1 diabetes mellitus.     

盐酸氨溴索对体外循环患儿术后肾功能的影响

目的：有研究表明盐酸氨溴索可减轻体外循环所致的肺损伤,但其对体外循环患者术后肾功能损害的作用尚不十分清楚。该研究拟探讨盐酸氨溴索对体外循环下室间隔缺损修补术患儿肾功能的影响,为临床应用提供参考。方法：选择在体外循环下择期行室间隔缺损修补术患儿40例,年龄3～8岁,心功能I或II级,随机分为对照组和盐酸氨溴索组,每组20例。盐酸氨溴索组切皮后缓慢静脉注射4.5 mg/kg盐酸氨溴索 (生理盐水稀释至10 mL),对照组静脉输注等容量生理盐水。分别于术前、术后2 h、12 h、24 h及48 h取静脉血及新鲜尿液,检测尿中视黄醇结合蛋白(RBP)、N-乙酰-β-D-氨基葡萄糖酐酶(NAG)、β2-微球蛋白(β2-MG)水平及血清β2-MG、肌酐(Cr)、尿素氮(BUN)浓度。结果：与术前相比,两组术后2 h血清Cr、尿β2-MG,术后2 h及12 h血清β2-MG,术后2 h,12 h,24 h,48 h尿RBP,及术后2 h,12 h,24 h尿NAG水平升高（P<0.05）。氨溴索组术后2 h时血清Cr,术后2 h及12 h血清β2-MG、尿β2-MG,术后2 h,12 h,24 h,48 h尿RBP,以及术后12 h和24 h尿NAG的水平明显低于对照组（P<0.05）。结论：盐酸氨溴索可减轻体外循环所致患儿的肾损伤,其作用机制有待进一步研究。［中国当代儿科杂志,2009,11（8）：656-658］     

Renal resistive indexes and some renal functions in liver cirrhotic children

BACKGROUND: The aim of the present study was to investigate renal vascular resistive changes in children with different stages of liver cirrhosis without obvious renal failure. METHODS: Twenty-nine children (14 girls, 15 boys, mean age 11.6 years) with cirrhosis and 20 healthy children (mean age 10.3 years) were investigated for renal vascular resistance with Doppler ultrasonography, urinary sodium, N-acetyl-beta-D glucosaminidase (NAG) and microalbuminuria excretion. RESULTS: The measurements of renal resistive indexes (RRI) were significantly higher in cirrhotic patients than the control group (0.69 +/- 0.07 vs 0.62 +/- 0.02, P < 0.0001). RRI measurement was found to be increased in decompensated cirrhotic patients than in compensated cirrhotic patients (0.73 +/- 0.05 vs 0.67 +/- 0.08, P < 0.0001). A significant positive relationship was observed between RRI and child score (r = 0.53). Urine NAG/Cr ratio was significantly higher in cirrhotic patients than in the control subjects (P < 0.001). Microalbumin concentrations were increased in the patients with decompensated cirrhosis than in the controls (P = 0.02). Patients with ascites and portal hypertension showed increased RRI values. CONCLUSIONS: We conclude that patients with cirrhosis are at risk of renal deterioration, which can not be detected by serum urea, creatinine, and glomerular filtration rate. The increase of RRI is associated with the progress of hepatocellular disease, and also the development of ascites and portal hypertension. Elevated urinary sodium excretion, elevated urinary NAG/Cr ratio and microalbuminuria might have a prognostic value especially in patients with Child scores> 6. Hence, monitoring RRI is a non-invasive means of studying early renal hemodynamic alteration in childhood cirrhosis.     

Anemia and iron deficiency among schoolchildren in the Aral Sea region,Kazakhstan

The objectives of this study were to estimate the prevalence of anemia and iron deficiency among schoolchildren in the Aral Sea region of Kazakhstan and to determine the various factors associated with anemia in this population. We conducted a cross-sectional study of randomly selected schoolchildren. Blood samples were collected for measuring hemoglobin (Hb), serum ferritin (SF), total iron binding capacity (TIBC), and other hematological indices, and subjects were screened for anemia and iron deficiency. Associations between Hb concentration and SF, TIBC, anthropometric, and socioeconomic data were evaluated using regression analysis. The prevalence of anemia was 49.8 per cent although levels were mostly mild. Twenty-two per cent of the children were iron depleted (SF < 12 microg/l). Of the anemic children, 32.4 per cent were found to have iron deficiency anemia (anemia with SF < 12 microg/l). There were significant positive correlations between the levels of Hb and SF, but a negative correlation with serum TIBC. Age, mean corpuscular volume (MCV) and SF were found to be significantly related to Hb by stepwise multiple regression analysis. Multiple logistic regression analysis revealed that anemia was independently related to living district, education of father, and child's age. The results suggest that iron deficiency is an important determinant of anemia in this population; however, whole anemia cannot be solely explained by iron deficiency. Further studies are needed for consideration of micronutrients status, parasite infestation, hereditary disorders, and exposure to environmental pollutants.     

Absence of effect of dipyridamole on renal and platelet function in diabetes mellitus.

We evaluated the effect of dipyridamole (5 mg/kg/day) for 12 months on renal and platelet function in 53 children with insulin dependent diabetes mellitus (IDDM) in a prospective double blind placebo controlled trial. Urine albumin excretion (expressed as the geometric mean albumin to creatinine concentration ratio (UA/UC) was measured every three months throughout the study. At 12 months, the geometric mean UA/UC was no different in diabetic children receiving dipyridamole, 0.60 mg/mmol, when compared with those receiving placebo, 0.87 mg/mmol. Glomerular filtration rate, urinary excretion of retinol binding protein, and N-acetyl-beta-D-glucosaminidase (NAG), blood pressure, and spontaneous platelet aggregation in response to stirring whole blood did not differ between the two groups at 12 months. Subgroup analysis to include only those children with high UA/UC before entry into the study also failed to show an effect of the drug on UA/UC. Eleven children had either persistently high UA/UC (n = 8: four on dipyridamole, four on placebo) or progression to high UA/UC (n = 3: two on dipyridamole, one on placebo). These children had significantly higher urinary excretion of retinol binding protein and NAG, bigger kidneys, and higher diastolic blood pressure both before and after treatment than the remaining 42 children, whereas there was no difference in spontaneous platelet aggregation between the two groups. These observations on the associations between UA/UC and other parameters of renal function suggest that measurement of ''tubular'' proteins and diastolic blood pressure as well as UA/UC may contribute to the identification of those at risk of developing nephropathy.     

Child health and environmental pollution in the Aral Sea region in Kazakhstan.

Environmental pollutants, which may occur in breast milk and in various food products and drinking water, and which are also transferred to the foetus, constitute a severe threat to the health of infants and children. Among such compounds, various organochlorines, such as pesticides for the control of parasites (DDTs, HCHs), and products of industry and agriculture, such as dioxins and dioxin-like compounds (PCBs), are much discussed, in addition to organic mercury and heavy metals, such as lead and cadmium. The consequences of acute exposure to PCB have been documented in Japan following the ingestion of rice oil contaminated by PCBs. In Sweden birthweight has been found to be reduced and the perinatal mortality rate higher than expected in regions with high consumption of fatty fish from the Baltic Sea. In addition, from studies around Lake Michigan, it has been shown that children who have been exposed to PCBs in utero have retarded cognitive development. In the Aral Sea basin in Central Asia people have been subjected to long-term exposure to various pesticides, which have been distributed over the cotton fields in huge quantities. Organochlorines are resistant to breakdown in nature, thus they enter the food chain, eventually entering the human diet, and they may also be inhaled from dust. Such compounds accumulate in the foetus by placental transport and continue to do so postnatally if the infants are breastfed, as they may be present in high concentrations in human milk. The health of children living in the Aral Sea region is reported to be poor, with high morbidity and mortality and a high rate of chronic diseases and retarded mental and physical development. However, in addition to being subjected to environmental pollution, these children also suffer from health hazards related to poverty. Through epidemiological studies it may be possible to obtain information about to what extent exposure to environmental pollution from organochlorines contributes to the poor health of people living in the Aral Sea region.     

Urinary N-acetyl-beta-D-glucosaminidase activity in patients with cystic fibrosis on long-term gentamicin inhalation

OBJECTIVE: To investigate possible renal toxicity of long-term gentamicin inhalation in patients with cystic fibrosis. METHODS: Urinary N-acetyl-beta-D-glucosaminidase (NAG) activity was measured during routine respiratory clinic visits. Outpatient records were reviewed for data on long-term gentamicin inhalation, and parents and patients were interviewed for compliance. Exclusion criteria were irregular gentamicin inhalation, urinary infection or other febrile illness, intravenous aminoglycoside treatment during the previous three months, and diabetes mellitus. Patients were assigned to three groups: group 1, current gentamicin inhalation; group 2, previous gentamicin inhalation that had been stopped at least three months ago; and group 3, never any gentamicin inhalation. RESULTS: 52 patients (34 girls, 18 boys), mean (SD) age 11.5 (5.7) years, entered the study. Patients currently on gentamicin inhalation (n = 20) were significantly younger and had higher urinary NAG activity (0.83 (0.57) U/mmol creatinine) than the 23 patients without gentamicin inhalation (0.26 (0.10) (p = 0.0001) and the nine patients with previous gentamicin inhalation (0.32 (0.15) (p = 0.0125). Twelve patients on current gentamicin inhalation had raised NAG values but all those in groups 2 and 3 had NAG values within the normal range. In patients currently on gentamicin inhalation, there was a positive correlation between urinary NAG activity and cumulative dose of nebulised gentamicin (r = 0.60, p = 0.0049). CONCLUSIONS: Long-term gentamicin inhalation in patients with cystic fibrosis poses a risk of renal toxicity. It is not known whether further treatment might result in more severe renal damage.     

肾病综合征患儿血清抗增殖蛋白水平

目的研究肾病综合征患儿血清抗增殖蛋白(prohibitin,PHB)蛋白水平及其在肾小管间质早期损伤中的意义。方法应用Western blot对36例原发性肾病综合征患儿血清进行PHB蛋白水平检测,同期正常体检儿童30例为对照组。同时检测两组血清肌酐(Scr)、血尿素氮(BUN)、尿微量蛋白系列[白蛋白/肌酐(ALBU/Cr)、N-乙酰β-D-葡萄糖苷酶/肌酐(NAGU/Cr)、免疫球蛋白G/肌酐(IgGU/Cr)、α1微球蛋白/肌酐(α1-MU/Cr)等]。肾小球及肾小管间质损伤评分参照Katafuchi半定量法进行。结果正常对照组儿童血中未检测到PHB蛋白,肾病综合征患儿血PHB蛋白水平不同程度增高(0.203±0.032比0±0,P<0.05)。伴增生性病变肾病综合征患儿血PHB水平明显高于非增生性患儿。血PHB水平与肾小管间质损伤程度以及肾小球损伤程度均呈明显正相关(r=0.868、0.753,P均<0.001);患儿血PHB水平与尿微量蛋白NAG、IgG呈正相关(r=0.586、0.341,P均<0.001)。结论肾脏疾病患儿血PHB表达明显增高,而且血PHB水平与肾小球及肾小管间质损伤程度明显相关...     

窒息新生儿尿酶改变及与外周血白细胞计数的关系

目的 探讨窒息新生儿尿酶改变及其与外周血白细胞计数的关系。方法 28例窒息新生儿,分为轻度窒息组(10例)和重度窒息组(18例);另外选择9例正常新生儿作对照组,检测各组外周血白细胞计数、尿N乙酰β氨基酸葡萄糖苷酶(NAG)和γ谷胺酰转肽酶(GGT),比较各组间白细胞计数及其与NAG、GGT的关系。结果 外周血白细胞计数、NAG、GGT重度窒息组分别为(27.42±10.95)×109/L,(34.28±26.18) U/L,(30.50±21.10) U/L,轻度窒息组分别为(10.24±4.10)×109/L,(10.34±8.72) U/L,(16.80±6.48) U/L,对照组分别为(15.70±3.21)×109/L,(2.73±2.50) U/L,(8.75±2.43) U/L。重度窒息组与轻度窒息组和对照组比较,外周血白细胞计数、NAG、GGT均显著升高(P<0.05)。轻度窒息组与正常组比较,除外周血白细胞计数外,NAG和GGT也显著升高(P<0.05)。直线相关分析显示：重度窒息组外周血白细胞计数与尿NAG呈显著正相关关系(γ=0.41,P<0.05),与GGT呈正相关关系,但无显著性(P>0.05)。结论 外周血白细胞计数升高与新生儿窒息程度和尿酶升高程度密切相关,在临床上可将外周血白细胞计数作为窒息后肾损伤的预警参数。     

窒息新生儿尿酶改变及与外周血白细胞计数的关系

目的 探讨窒息新生儿尿酶改变及其与外周血白细胞计数的关系。方法 28例窒息新生儿,分为轻度窒息组(10例)和重度窒息组(18例);另外选择9例正常新生儿作对照组,检测各组外周血白细胞计数、尿N乙酰β氨基酸葡萄糖苷酶(NAG)和γ谷胺酰转肽酶(GGT),比较各组间白细胞计数及其与NAG、GGT的关系。结果 外周血白细胞计数、NAG、GGT重度窒息组分别为(27.42±10.95)×109/L,(34.28±26.18) U/L,(30.50±21.10) U/L,轻度窒息组分别为(10.24±4.10)×109/L,(10.34±8.72) U/L,(16.80±6.48) U/L,对照组分别为(15.70±3.21)×109/L,(2.73±2.50) U/L,(8.75±2.43) U/L。重度窒息组与轻度窒息组和对照组比较,外周血白细胞计数、NAG、GGT均显著升高(P<0.05)。轻度窒息组与正常组比较,除外周血白细胞计数外,NAG和GGT也显著升高(P<0.05)。直线相关分析显示：重度窒息组外周血白细胞计数与尿NAG呈显著正相关关系(γ=0.41,P<0.05),与GGT呈正相关关系,但无显著性(P>0.05)。结论 外周血白细胞计数升高与新生儿窒息程度和尿酶升高程度密切相关,在临床上可将外周血白细胞计数作为窒息后肾损伤的预警参数。     

婴儿先天性心脏病体外循环术后肾损伤分析

目的：探讨婴儿先天性心脏病（简称先心病）体外循环（CPB）术后肾损伤情况。方法：选取我院2009年10月至2010年7月期间CPB下行先心病手术的婴儿40 例，分别于转流前、手术结束时、术后2 h、术后6 h、术后24 h用酶联免疫吸附法（ELISA）检测血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、半胱氨酸蛋白酶抑制剂C (CysC)和尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)浓度。常规生化方法检测术前及术后血清肌酐（Cr）及尿素氮（BUN）浓度。结果：术前与术后血清Cr及BUN均在正常范围内；血清TNF-α、IL-6和尿NAG浓度在CPB后均有显著性升高（P<0.05）。相关性分析提示血清TNF-α分别与尿NAG、血清CysC呈正相关（r分别为0.195，0.190，均P<0.05），血清IL-6与尿NAG亦呈正相关（r=0.278，P<0.01）；血清CysC和尿NAG检测出肾损伤的阳性率显著高于血清Cr或BUN(均P<0.01)。结论：CPB能引起婴儿急性肾损伤，可能与血清中TNF-α和IL-6的浓度增高相关。血清CysC和尿NAG可作为反映肾功能变化较敏感的指标。