窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的 探讨尿内皮素(ET)、尿微量蛋白(a1-M、TRF、Alb)在新生儿窒息肾脏损害中的意义。方法 窒息组在生后第3天、第7天采用放射免疫法测定尿ET，同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。结果 发现窒息组第3天尿ET含量明显高于对照组(P＜0．01)。且重度窒息组＞轻度窒息组＞对照组。第7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组，但统计显示无明显差异(P＞0．05)。尿微量蛋白( a1-M、TRF、Alb)变化与尿ET呈正相关(P＜0．01)。结论 尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系。     

窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的　 探讨尿内皮素 (ET)、尿微量蛋白 (a1 M、TRF、Alb)在新生儿窒息肾脏损害中的意义。 方法 　窒息组在生后第 3天、第 7天采用放射免疫法测定尿ET ,同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。 结果 　发现窒息组第 3天尿ET含量明显高于对照组 (P <0 0 1)。且重度窒息组 >轻度窒息组 >对照组。第 7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组 ,但统计显示无明显差异 (P >0 0 5 )。尿微量蛋白 (a1 M、TRF、Alb)变化与尿ET呈正相关 (P <0 0 1)。 结论 　尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系     

新生儿肾功能损害早期指标分析

目的 探讨血清胱蛋白酶抑制剂C(Cystain C)、尿微量蛋白系列在窒息后新生儿中的变化及意义.评价新生儿肾功能的检测指标.方法 检测2004年9月--2005年9月68例足月窒息新生儿(Apgar评分7分)和40例足月非窒息新生儿的血清Cr、BUN、血β2-微球蛋白(β2-MG)、C、血Cystatin C、尿微量蛋白系列,按不同日龄分3次检测.结果 ①非窒息新生儿血清Cystatin C的平均值为(1.89±0.41)mg/L,血清Cys-tatin C在生后3周内不同日龄间差异无统计学意义,与身高、体重、胆红素之间无相关关系.②窒息组肾小球功能指标中血BUN、Cr、Ccr、Cystatin C、B2-MG明显高于非窒息组;窒息组肾小管功能指标中尿N.乙酰B.D.葡萄糖苷酶(NAG)、α1微球蛋白(α1-MG)明显高于非窒息组.③重度窒息组血BUN、Cr、Ccr、Cystatin C明显高于轻度窒息组;而肾小管功能指标差异无统计学意义.④肾小球功能指标中,尿Alb、IgG与血Cystatin C、血13rMG呈正相关,尿转铁蛋白(TRF)、NAG与Ccr呈正相关;肾小管功能指标中尿NAG、α1-MG与血β2-MG呈正相关.⑤随访发现,血BUN、Cr恢复正常快,尿微量蛋白系列和血β2-MG、血Cystatin C恢复较慢.结论 窒息可引起新生儿肾小球、肾小管功能改变,重度窒息对肾小球功能影响大于轻度窒息,血Cystatin C可作为评价肾小球滤过功能的敏感指标.临床可通过随访尿微量蛋白系列指标来评估肾小管、肾小球损害情况.     

紫癜性肾炎中尿系列微量蛋白及相关因素分析

目的 了解紫癜性肾炎(HSPN)临床各型尿4项特定蛋白排量高低，以早期发现其各型肾功能受损程度。并分析各型间的临床临床及其之间的相关因素。方法 首先对入选的85例HSPN患儿按照特点表现分为5型：其中Ⅰ型20例、Ⅱ型20例、Ⅲ型15例、Ⅳ型15例、Ⅴ型15例，采用免疫散射速率比浊法，对上述85例患儿及25例健康儿童(正常对照组)分别进行尿微量自蛋白(mALb)、转铁蛋白(uTf)、免疫球蛋白(IgG)、α1-微球蛋白(α1-mG)含量测定，同时检测血肌酐(BCr)和尿素氮(BUN)；最后观察HSPN临床各型尿4项微量蛋白的不同变化。结果 在Ⅰ、Ⅱ型HSPN中，当BUN与BCr含量在正常范围时，尿4项特定微量蛋白排量已出现了不同程度的升高，与对照组比较差异显著；在Ⅲ～Ⅴ型HSPN中。当BUN与BCr有明显升高时，尿微量蛋白排出量升高更为显著，两者呈线性正相关。结论 尿特定蛋白可全面地、敏感地反映肾脏的受损情况，尤其是肾小管的损害，故此检测方法可作为评价肾功能早期损害、判断预后、监测治疗效果的有效指标。     

庆大霉素致新生儿急性肾功能衰竭一例

庆大霉素致新生儿急性肾功能衰竭一例尹华英，刘于嫣，孙学禹患儿男，１４天，足月顺产。入院前４天因发热于当地卫生室肌注庆大霉素，每次２０ｍｇ，每天２次，连用３天（总量１２０ｍｇ）。用药３次后热退，但出现阵发性哭闹、拒乳、无尿转入我院。体检：体温３７．２℃...     

新生儿高胆红素血症尿视黄醇结合蛋白测定及临床意义

为探讨高胆红素血症对新生儿肾功能影响，应用双抗体夹心酶免疫测定法测定了２７例高胆红素血症患儿尿视黄醇结合蛋白（ＲＢＰ）水平。高胆患儿尿ＲＢＰ水平明显高于正常组。１６例患儿当血总胆小于１５３．９μｍｏｌ／Ｌ时，复查尿ＲＢＰ，有７５％的病例恢复较好。１４例患儿同时测定了血肌酐，其结果均在正常范围内。提示：高胆红素血症可造成新生儿短暂性肾小管功能受损。尿ＲＢＰ是早期肾功能损伤敏感而可靠的检测指标。     

妥布霉素或头孢噻甲羧肟治疗时尿酶测定

氨基糖甙类在成人的毒性了解得颇多,然而对新生儿肾的影响报道甚少。近来有报道新生儿用庆大或妥布霉素治疗可能发生来源于肾小管细胞的尿酶活性增高,特别是丙氨酸氨基肽酶(AAP)和N-乙酰-β-氨基葡萄糖苷酶(NAG)的增高。虽然尿酶的临床重要性尚未确定,但尿酶增高是临床肾损害的早期征象。本文研究新生儿用妥布霉素和头孢噻甲羧肟治疗期间的尿酶(AAP和NAG)活性改变,以了解其对肾脏的毒性。作者随机选择了66例怀疑新生儿败血症的病例,用妥布霉素和头孢噻甲羧肟与氨苄青霉素配     

血清胱抑素C检测对新生儿肾功能评估的临床研究

近年来临床研究和试验表明,血清胱抑素C(Cystatin-C,Cys-C)与传统的血肌酐及尿素测定相比是更好的是检测肾小球滤过率(GFR)的标志物.本研究检测200例危重新生儿及109例非危重住院新生儿血清尿素、肌酐及Cys-C及尿微量蛋白,并对检测结果进行对比分析,探讨Cys-C及尿微量蛋白在评估新生儿肾功能中的临床价值.     

血乳酸在判断新生儿败血症预后中的临床价值

目的 探讨动脉血乳酸水平在判断新生儿败血症预后中的临床价值。方法 收集301例败血症新生儿的临床资料，主要包括入院时血乳酸、C反应蛋白、降钙素原等生化指标。通过ROC曲线分析，评估入院时血乳酸水平对判断新生儿败血症预后的价值。结果 足月儿血乳酸重度升高组病死率（26.1%）较轻度升高组（3.1%）和乳酸正常组（0%）明显升高（P < 0.017）。预后不良组入院时血乳酸水平（6.5±5.1 mmol/L）较预后良好组（3.6±1.7 mmol/L）明显升高（P < 0.05）。入院时血乳酸水平（临界值为6.15 mmol/L）对判断新生儿败血症预后的敏感性和特异性分别为0.545、0.919。结论 早期血乳酸水平可作为判断新生儿败血症预后的生化指标，特异性高，但敏感性较低。     

母乳性黄疸对肾功能的影响及其早期干预

目的探讨母乳性黄疸(BMJ)患儿肾功能变化及早期干预对肾功能的影响。方法测定50例BMJ患儿入院后12 h内血清胆红素和尿β2-徽球蛋白(β2-MG)、α1-MG、清蛋白(Alb)、IgG及出院前尿β2-MG、α1-MG、Alb、IgG,与20例足月新生儿生理性黄疽(对照组)对比。结果BMJ患儿随血清总胆红素升高,尿微量蛋白有升高趋势,血清胆红素205.2-256.5 μmol/ L时尿β2-MG较对照组明显升高(P<0.05);血清胆红素>256.6-342.O μmol/L,β2-MG、α1-MG显著升高(P均<0.01),Alb 较对照组明显升高(P<0.05)。出院前尿β2-MG、α1-MG、Alb恢复正常。结论BMJ可引起暂时肾功能损害,予早期干预治疗后肾功能很快恢复正常。     

别嘌呤醇对未成熟鼠脑白质损伤保护作用的研究

目的探讨别嘌呤醇对未成熟鼠脑白质损伤的保护作用。方法将新生1日龄SD大鼠84只随机分为假手术组(Sham)(n=28)、双侧颈总动脉结扎(BCAO)组(n=28)及别嘌呤醇干预组(ALLO)(n=28),BCAO制作脑白质损伤模型。观察BCAO后7d(P7,每组各6只)和14d(P14,每组8只)脑组织病理改变及MBP免疫组化变化;RT-PCR荧光定量法检测P7(每组6只)和P14(每组8只)脑组织MBP-mRNA的表达。结果BCAO组白质改变明显,ALLO组较之明显减轻;P14平均脑室大小指数,ALLO组较(2.44±0.71)%BCAO组(3.27±0.73)%明显减小(P<0.05)。P14MBP阳性染色光密度值,BCAO组(6.60±0.68)较Sham组(9.40±0.53)明显降低(P<0.01),而ALLO组(7.10±0.18)较BCAO组明显升高(P<0.05);P7、P14MBP-mRNA拷贝数(log10),BCAO组和ALLO组均明显低于Sham组(P<0.01),而ALLO组则较BCAO组明显升高(P<0.05)。结论利用1日龄大鼠行BCAO可较好地制作早产儿脑白质损伤模型。别嘌呤醇对缺血引起的未成熟大鼠脑白质损伤具有保护作用。     

川崎病合并无菌性高白细胞尿相关研究

目的分析川崎病(KD)合并无菌性高白细胞尿的临床特征及相关发病机制。方法选取住院治疗的420例KD患儿作为研究对象,根据入院尿常规检查将其分为高白细胞尿组(95例)和对照组(325例),对比分析两组的临床资料。结果两组患儿的性别、年龄及不典型KD发生比例的差异均无统计学意义(P均0.05)。高白细胞尿组的C反应蛋白、D-二聚体、纤维蛋白原降解产物、谷丙转氨酶、谷草转氨酶、尿视黄醇结合蛋白等均高于对照组,差异均有统计学意义(P均0.05)。两组患儿在入院前平均热程的差异无统计学意义(P?0.05),但高白细胞尿组入院行丙种球蛋白治疗后发热持续时间更久,差异有统计学意义(P0.05)。两组患儿在冠状动脉扩张及丙种球蛋白首剂治疗无反应方面的差异也无统计学意义(P0.05)。结论 KD患儿无菌性高白细胞尿的发病率约为22.6%,伴有高白细胞尿患儿具有更强烈的炎症反应,存在更明显的高凝状态,可能有轻微或亚临床肾损害。     

角质细胞生长因子对吸入高体积分数氧新生大鼠肺组织的影响

目的 研究角质细胞生长因子(KGF)对高体积分数氧(高氧)暴露下新生大鼠肺组织结构的影响.方法 将新生的108只SD大鼠随机分为空气组、高氧组和KGF干预组,每组36只.每组又分为3d、7d、14d3个亚组.高氧组、KGF干预组大鼠持续暴露于氧体积分数＞950mL·L-1氧箱中,KGF干预组于吸氧同时背部皮下注射重组人角质细胞生长因子(rhKGF)1mg·d-1,连用3d后改为0.5mg·d-1直至实验结束.空气组和高氧组给予等量9g·L-1盐水.空气组大鼠呼吸空气.3d、7d、14d亚组在相应时间点取肺组织,通过肉眼及光镜下观察其肺组织病理学变化,并作肺泡辐射状计数(RAC).结果 空气组7d时出现肺泡化,14d时肺泡化成熟.高氧组时小血管扩张充血,肺间质细胞增多,7d时肺间隔变厚,肺泡腔大小不一,肺泡数减少,14d时肺泡数明显减少,肺泡大小不等,出现明显纤维化.KGF干预组7d时可见肺泡结构较完整,14d时少数肺泡融合,间质细胞增生不严重.高氧组3d时RAC与空气组相比差异无统计学意义(P＞0.05),7d、14d时RAC与空气组相比差异均有统计学意义(Pa＞0.01).KGF干预组各时间点RAC与空气组比较差异均无统计学意义(Pa＞0.05).结论 长时间暴露于高氧环境,可导致新生大鼠肺组织发育障碍,但KGF能促进肺泡的发育,减轻纤维化,可有效减轻高氧吸入对新生大鼠肺组织的损伤.     

Decreased growth rate of low-birth-weight infants with prolonged maximum renal acid stimulation

In a prospective randomized study, the urine pH of 170 premature and small-for-gestational-age (SGA) newborns was routinely screened to detect patients with spontaneously developing maximum renal acid stimulation, an obligatory early stage in the development of late metabolic acidosis. Nitrogen assimilation was evaluated from the ratio of urinary nitrogen excretion and intake. Forty-two premature infants and 10 SGA prematures and newborns after intensive care therapy with body weights greater than 1.5 kg and 25 prematures (including 7 SGA infants) with body weights less than 1.5 kg, spontaneously showed urine pH values below 5.4 on two consecutive days, suggesting maximum renal acid stimulation. These patients were randomly given either oral alkali therapy with sodium bicarbonate 2 mmol/kg/day or no therapy for a period of seven days. In both groups, urine pH was controlled daily. Patients in the control group without alkali therapy and with urine pH values less than 5.4 for seven days showed a significant decrease in weight gain and a tendency to decreased nitrogen assimilation. We assume that a regular check of urine pH in low-birth-weight infants is a useful non-invasive method of detecting patients in the early stages of development of late metabolic acidosis, i.e. in the stage of "incipient late metabolic acidosis". This would procide the possibility of starting early effective therapy and thereby reduce the mean duration of admission to neonatal wards. Regarding the risk of a high renal acid load causing the development of late metabolic acidosis in very low-birth-weight infants, standard formulas for premature infants should be re-evaluated with the aim of reducing renal acid load leaving a larger renal surplus capacity for renal acid excretion.     

建立新生鼠缺氧缺血性脑病模型的一种简单可靠的方法

目的探讨建立新生鼠缺氧缺血性脑病(HIE)动物模型快速可靠的方法。方法新生7 d SD乳鼠21只随机分为正常对照组、单纯缺氧组及缺氧缺血组。每组7只。每组又根据处死时间点随机分成3,6 h,1,3,7,14,21 d时7个小组。缺氧缺血组:结扎新生7 d SD大鼠左颈总动脉,置于8%浓度的低氧环境中2.5 h。单纯缺氧组缺氧2.5 h。采用HE染色及光镜技术观察3组SD大鼠脑组织结构改变。结果缺氧缺血组3 h出现轻度脑损伤,d1病变最严重,d3出现胶质细胞增生,142、1 d出现神经元大量丢失,皮层、纹状体、海马丘脑等部位形成胶质瘢痕,病灶中心仍可见大量固缩核和核碎片,7 d病灶中心仅见少量固缩核,周围增生的星形胶质细胞较3 d时增多。结论左颈总动脉结扎后置8%浓度低氧环境是简单、快速、可靠制备HIE模型的方法,且重复性好。     

The effect of assisted ventilation on creatinine clearance and hormonal control of electrolyte balance in very low birth weight infants

Because renal function and electrolyte balance are commonly altered in premature infants, particularly those requiring ventilatory support, we studied the influence of assisted ventilation on renal electrolyte and water excretion in infants with birth weights less than 1501 g during the 2 days after birth. Twenty-two infants receiving assisted ventilation, either as intermittent mandatory ventilation or nasal continuous positive airway pressure, were compared with 21 spontaneously ventilating infants of similar birthweight and gestational age. Mean (and SEM) creatinine clearance was lower (p less than 0.05) in the assisted ventilation group on day 1 (2.9 +/- 0.4 versus 4.1 +/- 0.4 ml/min/1.73 m2) and on day 2 (4.1 +/- 1.0 versus 6.8 +/- 0.8 ml/min/1.73 m2, p = 0.05), and there was a correlation between creatinine clearance and mean blood pressure in both groups. Mean urine vasopressin was higher in the assisted ventilation group on the first day (360 +/- 86 versus 123 +/- 30 pg/mg creatinine; p less than 0.02) and correlated with higher urine osmolality. There were no differences in urine volume, in osmolar or free water clearances, or in the intake and urine excretion of sodium, potassium, and chloride. Plasma renin activity, urine aldosterone, and urine prostaglandin E2 were similar in both groups on both days. Neither the mode of assisted ventilation nor the cause of respiratory failure appeared to affect these results.     

Renal functional impairment in preterm neonates related to intrauterine indomethacin exposure

Renal function was measured during the first 4 postnatal days in 9 preterm neonates (gestational age 26.2 to 31 wk) exposed to indomethacin during the last 2 days of pregnancy (group I). The data were compared to those obtained from nine control neonates (gestational age 28 to 34.5 wk) (group II). Five of the nine neonates in group I were markedly edematous at birth, none of group II were edematous. Urine production in group I was low (32.2 +/- 16.8 ml/kg.day on day 1 increasing to 68.6 +/- 21.4 ml/kg.day on day 4) and differed significantly from group II [75.2 +/- 26.8 ml/kg.day on day 1 increasing to 84.8 +/- 20.9 ml/kg.day on day 4 (p less than 0.001)]. Fluid intake was adapted to urine production when necessary. A continuous inulin infusion was started directly after admission and continued for 5 days. Renal function was evaluated for 3 consecutive days after at least 48 h of insulin infusion. The values of the inulin clearance, serum creatinine, urine osmolarity, osmolar clearance, and free water clearance were stable in both groups during the study period. Inulin clearance was lower in group I than in group II (p less than 0.001), whereas serum creatinine was higher in group I than in group II (p less than 0.0001). Urine osmolarity was higher in group I (p less than 0.01), whereas osmolar clearance and free water clearance were lower in group I (p less than 0.02, respectively, p less than 0.01). There was no difference in fractional sodium excretion between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trace mineral balance during acute diarrhea in infants

To evaluate the magnitude of copper and zinc losses during acute diarrhea requiring hospitalization, we studied 14 infants, 3 to 14 months of age, and compared them with a control group of 15 infants of similar age, birth weight, and nutritional status. Metabolic balance studies were conducted in the study group during an initial 48 hours (period 1) and on days 6 and 7 after admission (period 2). The control group was studied after recovery from respiratory disease. Copper and zinc content of feces, urine, and food samples was measured by atomic absorption spectrophotometry. Mean (+/- SD) fecal losses were higher for period 1 in the diarrhea group than in control subjects: Cu 55.7 +/- 21.2 versus 28.8 +/- 6.7 micrograms/kg/body weight/day (p less than 0.01); Zn 159.4 +/- 59.9 versus 47.4 +/- 6.4 micrograms/kg/day (p less than 0.0001). For period 2, Zn losses were similar in both groups, but Cu balance remained negative only in the study group. Retention of Zn for the study group went from -21.2 +/- 46.7 in period 1 to 204.5 +/- 103.0 micrograms/kg/day in period 2 (p less than 0.0001), and fecal weight decreased from 70.5 +/- 20.6 in period 1 to 36.8 +/- 20.0 gm/kg/day in period 2. Fecal weight and fecal losses were correlated: r = 0.71 (p less than 0.01) for Cu and r = 0.81 (p less than 0.001) for Zn. Plasma mean Cu and Zn levels were low in period 1 but rose in period 2, especially for Zn. A negative correlation was found between fecal Zn losses and plasma Zn: r = 0.74 (p less than 0.001). We conclude that acute diarrhea leads to Cu and Zn depletion and that plasma levels and Cu balance remain abnormal a week after admission.     

先天性肾积水患儿尿液水通道蛋白1表达的意义

目的研究先天性肾积水患儿尿液水通道蛋白1(AQP1)的表达情况及其临床意义。方法选取26例不同程度肾积水患儿作为试验组。其中轻度组7例,中度组10例,重度组9例。均经彩超、电子计算机X射线断层扫描技术(CT)或MRI证实,并排除其他泌尿系统疾病。对照组选取10例无泌尿系统疾病的儿童。在严格选定条件下,收集试验组患儿术前晨尿、术中肾盂尿液、梗阻解除术后第3、7天患肾晨尿,同时收集对照组患儿晨尿,采用间接ELISA法测定其尿液AQP1水平。结果与对照组比较,中、重度积水组患儿术前尿液中AQP1水平均明显下降(Pa<0.05),且重度积水组尿液AQP1水平与中度积水组比较,明显降低(P<0.05);轻度积水组与对照组比较,差异无统计学意义(P>0.05)。试验组术后第3天尿液AQP1水平与术中比较,差异无统计学意义(P>0.05),术后第7天尿液AQP1水平与术中比较均明显上升,但仍低于对照组(Pa<0.05)。对照组、试验组术前及术后第7天尿液AQP1水平与尿渗透压呈正相关,实验组术中及术后第3天尿液AQP1水平和尿渗透压之间无相关性。结论尿液AQP1水平可能是新型的评价先天性肾积水患儿肾浓缩功能的指标之一。     

碱性成纤维细胞生长因子对缺氧缺血性脑损伤新生鼠骨形态发生蛋白4及其mRNA表达的影响

目的 探讨碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)对新生鼠HIBD骨形态发生蛋白4蛋白及其mRNA表达的影响.方法 新生7日SD乳鼠120只,随机分①bFGF组、②HIBD组、③正常对照组,每组40只.HIBD模型建立后①组予以bFGF干预,腹腔注射,连用5 d,根据处死时相点各组又分为7、14、21、28 d等4个小组.采用免疫组化技术检测各组骨形态发生蛋白4(BMP4)蛋白在海马的表达;采用原位杂交技术检测各组BMP4 mRNA在海马的表达;采用TUNEL实验检测各组神经细胞的凋亡.采用随机组设计资料的方差分析进行组间及组内比较.结果 在7 d和14 d时相点,bFGF组BMP4蛋白在海马的表达较H1BD组多;2组在14 d时相点BMP4蛋白在海马的表达较7 d时相点弱.21 d小组、28 d小组等BMP4蛋白在海马的表达3组之间数量无明显变化.在7 d时相点,HIBD组、bFGF组CA1区BMP4 mRNA表达明显,较正常对照组明显增加;在14 d时相点,HIBD组BMP4 mRNA在病侧海马广泛表达,bFGF组仅病侧海马CA1区BMP4 mRNA表达明显,但2组较正常对照组明显增加;21 d时相点BMP4 mRNA在HIBD组、bFGF组海马的表达均显著;28 d时相点BMP4 mRNA在HIBD组病侧海马的表达开始减少,而bFGF组BMP4mRNA在病侧海马的表达无变化.bFGF组凋亡神经细胞在7 d时相点较HIBD组少[(20.10±0.35)vs(29.12±0.31);F=9.010,P<0.01];在14、21、28 d 3个时相点,HIBD组和bFGF组凋亡神经细胞均较7 d时相点增多,bFGF组凋亡神经细胞仍较HIBD组少[(28.09±0.26) vs (37.46±0.23);(18.75±0.71) vs (35.36±0.77);(12.26±0.57) vs (25.70±0.21);F=9.202,7.932,14.985,P<0.01].结论 bFGF对HIBD具有神经修复作用,其作用机制足促进BMP4蛋白及其mRNA在新生鼠HIBD海马的表达,并抑制神经细胞的凋亡.