新生儿窒息后肾损伤监测指标的对比研究

目的 对比研究反映窒息新生儿肾损伤的指标差异。方法 测定48例窒息新生儿(重度25例、轻度23例)血清尿素氮(BUN)、肌酐(Cr)、尿酸(Ua)与尿N-乙酰β-D-氨基葡萄糖苷酶(NAG)、尿γ谷胺酰转肽酶(GGT)、尿β2-微球蛋白(β2MG)和尿常规的变化。结果 重度窒息组各项指标的异常发生率高于轻度窒息组(P<0.05)。重度、轻度窒息组内尿NAG，GGT，β2-MG的异常发生率(83.3%和50.0%，83.3%和50.0%，83.3%和70.0%)高于血清BUN，Cr，Ua异常发生率(33.3%和15.0%，57.1%和40.0%，50.0%和33.3%)。结论 窒息新生儿普遍存在肾功能损害，以肾小管损伤为主为重。早期诊断用尿酶、β2-MG和尿常规反映更为有价值。     

新生儿窒息尿β_2微球蛋白浓度七天内的变化分析

本文检测58例新生儿窒息和8例宫内窘迫而出生后Apgar评分正常者第1、37天尿中β_2微球蛋白(简称β_2MG))浓度,结果窒息组、宫内窘迫组与正常新生儿比较尿β_2MG浓度明显高于对照组,而且呈持续性增高,提示新生儿窒息引起肾小管功能损伤将持续7天。     

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.     

尿六联微量蛋白对新生儿窒息后早期肾损伤的诊断价值

目的探讨新生儿尿中微量白蛋白（Alb）、α1-微球蛋白（α1-MG）、转铁蛋白（TRF）、视黄醇结合蛋白（RBP）、免疫球蛋白（IgG）、纤维连接蛋白（Fn）对窒息新生儿早期肾损害的临床诊断价值。方法采集39例窒息新生儿及39例正常新生儿的新鲜尿液，用酶联免疫测定法检测微量蛋白含量，并用stat Fax-2100型全自动酶标仪比色分析。检测两组新生儿的血肌酐和尿素氮。结果窒息组新生儿尿中α1-MG、TRF、RBP均明显高于对照组（P〈0．01），Alb、Fn、IgG也高于对照组（P〈0．05）。重度窒息组TRF、RBP明显高于轻度窒息组（P〈0．01），α1-MG亦高于轻度窒息组（P〈0．05），Alb、Fn、IgG两组差异无显著性（P〉0．05）。窒息组血肌酐高于对照组，差异有显著性（P〈0．05）。结论新生儿窒息后肾小球、肾小管均有不同程度损伤，尿液中Alb、TRF、Fn、α1-MG、RBP是诊断肾功能早期损害的敏感指标。其中以TRF和RBP最敏感，联合检测有助于早期诊断肾损害的部位和程度。     

尿α1-微球蛋白与肺炎支原体感染致早期肾损害的相关性

目的分析尿α1-微球蛋白与肺炎支原体(MP)感染致早期肾损害的相关性。方法检测24例血冷凝集试验阳性肺炎患儿的尿常规及尿微量蛋白,包括尿微量清蛋白(Alb)、尿α1-微球蛋白(α1-MG)、尿转铁蛋白(TF)和尿IgG。结果24例中仅1例尿蛋白呈阳性。尿α1-MG在血冷凝集试验<1:256与≥1:256两组及病程≤2周与>2周两组差异均具有显著性(P均<0.05),而其他3项尿微量蛋白组间比较均无显著性差异。结论MP感染致早期肾损害多表现为肾小管重吸收障碍,可能与免疫有关。尿α1-MG可用于MP感染致肾损害的早期诊断。     

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。     

尿5项蛋白在过敏性紫癜肾炎诊断中的价值

目的：有关过敏性紫癜(HSP)肾脏受累情况国内外尚无统一的实验室指标及判断标准,现临床常用的指标阳性率很低,往往延误诊断及治疗。为了探讨HSP肾损害早期诊断和长期随诊的敏感指标而进行了此项研究。方法：检测尿5项蛋白［α1微球蛋白（α1-MG）、β2微球蛋白(β2-MG)、白蛋白(Alb)、转铁蛋白(TRF)和免疫球蛋白G(IgG)］、尿常规、血尿素氮(BUN)和肌酐(Scr)、肾脏彩色多谱勒超声,综合临床症状和体征,分析HSP肾损害情况并评价上述指标的临床价值。结果：HSP患儿α1-MG 22.4±10.5、β2-MG 4.7 ± 2.1 、Alb 81.3 ± 37.2、TRF 4.9 ± 3.0 和IgG 36.6 ± 12.3 均明显高于正常对照组,依次为 6.8 ± 4.2 , 1.1 ± 0.7 , 10.9 ± 5.1 , 1.2 ±0.5 , 2.9 ± 1.7 ;均 P < 0.01 ,各项指标的阳性率为：BUN和Scr 5.6 % ,肾脏彩色多普勒超声 6.7% ,临床症状和体征 12.2% ,尿常规 40.0% ,尿5项蛋白 80.0% ,尿5项蛋白阳性率明显高于其它4项指标的阳性率(均 P < 0.01 )。尿5项蛋白异常的72例中有38例尿常规正常,而尿5项蛋白正常的18例中,只有2例尿常规异常,两者差异有显著性( P < 0.05 )。结论：尿5项蛋白能敏感反映HSP肾损害情况,可作为其早期诊断和长期随诊的敏感指标。     

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。     

尿胱抑素C对缺氧缺血性脑病新生儿肾功能的诊断价值

目的 探讨尿胱抑素(Cys C)对围生期HIE新生儿肾小管功能损害的诊断价值.方法 选取HIE新生儿47例为HIE组,按照HIE诊断标准又将其分为轻度HIE组(25例)和中重度HIE组(22例).选取无肾功能损害诱因及HIE临床表现及实验室指标的非HIE新生儿23例为对照组.测定各组新生儿日龄3 d内的尿Cys C及尿视黄醇结合蛋白(RBP)、N-乙酰-β-氨基葡萄糖苷酶(NAG)、β2微球蛋白(β2-MG)等尿酶系列,并计算滤过钠排泄分数(FENa%),应用Kolmogorov-Smimov法分析各组间各指标的差异.结果 HIE组尿Cys C、RBP及FENa%较对照组显著增高,中重度HIE组尿Cys C升高更加明显(Pa<0.05).β2-MG、NAG在对照组、轻度HIE组、中重度HIE组间呈逐渐上升,但除中重度HIE组β2-MG较对照组显著增高(P<0.01)外,其他组组间比较无显著性差异.尿Cys C、RBP、β2-MG、NAG与FENa%均呈显著正相关(r=0.572,0.648,0.402,0.368 Pa<0.05).结论 尿Cys C可作为反映肾小管损伤的诊断指标之一,其诊断性能优于β2-MG,而与尿RBP相似.     

新生儿窒息对肾小管功能的影响:附30例分析

本文报道检测74例正常新生儿及30例窒息足月新生儿尿常规、尿肌酐及尿β_2微球蛋白,结果前二项两组无差异;但正常新生儿组β_2微球蛋白为1.28±1.16μg/ml,窒息组为5.79±3.21μg/ml,后者为前者的4.5倍(p值<0.001)。作者认为尿β_2微球蛋白的检测可作为诊断肾小管功能损伤的方法,并认为凡有围产期窒息的新生儿,常规检查尿β_2微球蛋白可作为监测肾小管功能方法之一,利于采取措施,降低死亡率。     

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     

Assessment of bone turnover in term and preterm newborns at birth: measurement of urinary collagen crosslink excretion

We measured urinary excretion of collagen crosslinks, pyridinoline and deoxypyridinoline, in term and preterm newborns at birth and evaluated the developmental changes in bone turnover. Collagen crosslink excretion in newborns was more than 10 times higher than reported adult values and several times higher than those of older children. The values were significantly higher in preterm newborns than in term newborns. In addition, a significant and inverse correlation was found between urinary collagen crosslinks and gestational age in preterm newborns. Excretion of crosslinks during this period did not correlate with beta2-microglobulin, suggesting that the excretion was not directly influenced by renal function in newborns. We conclude that bone turnover assessed by measurement of collagen crosslink excretion is high at birth and that preterm newborns have higher bone turnover than term newborns.     

Kinetics of serum S100B in newborns with intracranial lesions.

BACKGROUND: The purpose of the present study was to evaluate the usefulness of serum S100B as a clinical marker of intracranial lesions in newborns. METHODS: The study involved 22 normal and 40 diseased newborns. Serum S100B level was measured on days 1 and 6 in normal newborns. Diseased newborns were classified into four groups: birth asphyxia with hypoxic-ischemic encephalopathy (HIE); birth asphyxia without HIE; intracranial hemorrhage (mainly subarachnoid); and brain malformation. In each group the serum S100B level was measured on days 1, 2 and 6. Development was also assessed to investigate the relation between serum S100B level and prognosis at 18 months after birth. RESULTS: In normal newborns, serum S100B level was significantly higher in those with liquor to meconium stain than in those without. In diseased newborns, serum S100B level on day 1 was significantly higher in the HIE group than in all other groups (P < 0.05). There was no significant difference in serum S100B level between control and intracranial hemorrhage, or brain malformation. In newborns with birth asphyxia, serum S100B level was significantly higher in severe birth asphyxia than in mild or moderate birth asphyxia; two newborns with serum S100B level > or =10 microg/L on days 1 and 2 developed cerebral palsy, others with no increase of S100B were all developing normally. CONCLUSIONS: Serum S100B level is a useful marker of acute perinatal brain damage, and is particularly valuable for fetal distress. In newborns with birth asphyxia, serum S100B levels serve as a biochemical marker of HIE.     

Evaluation of renal functions in asphyxiated newborns

Renal injury due to perinatal asphyxia has not been systematically evaluated. The available studies have used variable definitions, incomplete investigations and none had a control group. The aim of this study was to evaluate systematically the renal functions in severely asphyxiated newborns and to find if abnormal renal function tests can predict adverse outcome (death or neurologic abnormality at discharge). In a prospective case-control design, 25 inborn babies>or=34 weeks gestation having asphyxia (5 min Apgaror=5 min) were enrolled as 'cases'. Simultaneously 25 gestation and weight matched babies with no asphyxia were enrolled as 'controls'. Renal function tests, calculated renal indices using timed urine collections and excretion of beta2-microglobulin and N-acetyl-beta-D-glucosaminidase (NAG) were monitored in both the groups for first 4 days of life. Fourteen (56 per cent) asphyxiated babies had acute renal failure (ARF) as compared to 1 (4 per cent) control (p=0.002). Blood urea and serum creatinine values were significantly higher in asphyxiated babies on day 4 but not on day 2. Renal failure index and FeNa were higher in asphyxiated babies on both day 2 and day 4, but creatinine clearance was not different. Urinary excretion of both beta2-microglobulin and NAG was higher in the asphyxiated babies on day 2 as well as day 4. Five minute Apgar1.5 mg/dl alone had the best specificity and positive predictive value. The renal parameters were however poorer predictors of adverse outcome in comparison to clinical markers like 5 min Apgar相似文献   

宫内窘迫与产时窒息对新生儿甲状腺功能的不同影响

目的 探讨宫内窘迫和产时窒息对甲状腺功能的影响.方法 将近5年我院儿科诊治的宫内窘迫及产时窒息新生儿分为宫内窘迫组(B组,87例)、产时窒息组(C组,36例)和宫内窘迫+产时窒息组(D组,75例),选择同期出生的正常新生儿为对照组(A组,30例).均采用放射免疫分析法检测血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)和促甲状腺素(TSH)水平.结果 A、B、C、D4组血清T3、T4及TSH的水平分别为(0.86±0.22)μg/L、(0.62±0.21)μg/L、(0.46±0.19)μg/L、(0.54±0.19)μg/L;(125.13±36.37)μg/L、(107.46±32.21)μg/L、(74.60±26.52)μg/L、(102.23±30.29)μg/L;(6.28±1.96)mIU/L、(4.91±1.69)mIU/L、(8.66±2.02)mIU/L、(5.64±1.17)mIU/L.B、C、D组血清T3、T4水平明显低于A组,差异均有显著性(P<0.01,P<0.05).D组TSH水平较A组无明显变化,B组较A组降低,C组较A组升高,差异有非常显著性(P<0.01).结论 宫内窘迫与生后窒息均可使新生儿血清T3、T4水平降低,宫内窘迫者出生后TSH多降低,产时窒息者TSH多升高.     

Glomerular dysfunction, independent of tubular dysfunction, induced by antineoplastic chemotherapy in children

BACKGROUND: For the purpose of studying renal side-effects induced by antineoplastic agents, the authors examined glomerular injury as well as tubular injury of patients with chemotherapy. METHODS: Thirteen patients underwent a combined total of 64 courses of chemotherapy. Urinary albumin, beta2-microglobulin (beta2-MG), N-acetyl-beta-glucosaminidase (NAG) and urinary protein were measured before and serially after chemotherapy. RESULTS: The values of albumin/creatinine (albumin/cre) ratio and beta2-MG/creatinine (beta2-MG/cre) ratio after chemotherapy were higher than those before chemotherapy (P <0.01). NAG/creatinine (NAG/cre) ratio and creatinine clearance (Ccr) were not different. These were also examined before the next course of chemotherapy and were compared with those of control children. Albumin/cre ratio was significantly different (P <0.01). beta2-MG/cre ratio and NAG/cre were not different. Furthermore, in patients with normal beta2-MG/cre, the albumin/cre ratio was significantly higher than in control children. CONCLUSIONS: These results indicate that antineoplastic agents can not only induce tubular dysfunction but also glomerular dysfunction, which is persistent and independent of tubular dysfunction.     

Renal function of neonates during gentamicin treatment.

Thirteen newborn infants, 8 term and 5 preterm (gestational age 31 to 36 weeks), were treated for between 3 and 7 days with gentamicin and ampicillin or cloxacillin because of suspected bacterial infection. The dosage of gentamicin was carefully monitored by serum concentration assays. Urinary alanine aminopeptidase, urinary beta 2-microglobulin, serum urea, and serum beta 2-microglobulin were measured during and after the end of treatment to detect signs of renal toxicity. Levels of urinary aminopeptidase increased in 12 of them, indicating damage to the cells of the proximal tubuli. Changes in urinary beta 2-microglobulin followed the normal physiological course seen in neonates after birth. Serum levels of urea and beta 2-microglobulin did not indicate any drug-associated depression of glomerular filtration rate.     

儿童重度肾积水肾造瘘术后尿蛋白水平与肾功能的关系

目的 探讨儿童重度肾积水肾造瘘术后肾盂尿液中分子量大小不等的尿微量白蛋白(mAlb)、α1微球蛋白(α1-MG)、β2微球蛋白(β2-MG)、转铁蛋白(Trf)、免疫球蛋白G(IgG)的改变及其临床意义,分析其与肾功能的关系. 方法 收集2017年3月至2020年10月由浙江大学医学院附属儿童医院泌尿外科收治的17例单...     

头颅CT影像在判断新生儿缺氧性脑损伤时的作用

目的：围生期缺氧可致新生儿脑损伤。该文探讨头颅CT对新生儿缺氧后脑损伤程度判断的作用。方法：收集有缺氧过程的足月新生儿114例,分为HIE组、窒息组、窘迫组;取同期正常新生儿20例为对照组,于生后2~7d做头部CT检测及NBNA评分。结果：HIE组、窒息组、窘迫组、对照组NBNA评分异常率及组间NBNA评分分值比较差异有显著性(均P<0.05)。4组间CT异常率比较及HIE组与其他3组CT异常率比较差异有显著性(均P<0.01),对照组、窘迫组、窒息组之间两两比较CT异常率没有差异(均P>0.05)。HIE组25例患儿中,临床分度为轻度HIE15例,中度HIE6例,重度HIE4例。CT分度为正常3例,轻度10例,中度7例、重度5例。HIE的CT分度与临床分度不完全吻合。CT对于轻、中、重度HIE诊断的灵敏度分别为47%,33%,50%,特异度为70%,74%,86%,准确度为48%,64%,80%。结论：头颅CT对HIE临床分度的判断存在不确定性,对宫内窘迫、窒息所致轻微脑损伤的判断更无把握。     

Theophylline for renal function in term neonates with perinatal asphyxia: a randomized, placebo-controlled trial

OBJECTIVE: To study whether prophylactic theophylline can reduce the incidence and/or severity of renal failure in term infants with perinatal asphyxia. STUDY DESIGN: Term neonates with severe perinatal asphyxia were randomized to receive a single dose of either theophylline (study group, n = 40) or placebo (control group, n = 30) during the first hour of life. Daily weight, output/input ratio, 24-hour fluid intake, and urine volumes were recorded during the first 5 days of life. Those infants with asphyxial renal failure were followed up for 1 year. RESULTS: The incidence of severe renal dysfunction was increased in the control group. Creatinine clearance was higher and excretion of beta 2 microglobulin (beta2M) was lower in the theophylline group. Conversely, the glomerular filtration rate was lower in the control group. In infants with renal failure, serum creatinine and creatinine clearance returned to normal in the neonatal period, and the increased beta2M excretion normalized by age 6 weeks. CONCLUSIONS: A single dose of theophylline within the first hour of birth in term neonates with perinatal asphyxia results in a significant decrease in serum creatinine level and urinary excretion of beta2M, along with an increase in creatinine clearance.