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。     

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。     

支气管哮喘患儿尿5项微量蛋白测定及其临床意义

目的　探讨支气管哮喘患儿肾脏受损情况。方法　采用速率免疫散射比浊法和化学显色终点法分别测定 6 6例轻、中、重度支气管哮喘急性发作期患儿的尿视黄醇结合蛋白 (RBP)、白蛋白 (Alb)、转铁蛋白 (TRF)、免疫球蛋白G(IgG)和N 乙酰 β D 氨基葡萄糖苷酶 (NAG)含量 ,并与 32例正常儿童对照组对照。 结果　轻、中、重度哮喘患儿尿RBP、Alb、TRF、NAG含量均高于对照组 (均P <0 0 1) ,尿IgG含量与对照组差别无显著性意义(P >0 0 5 )。尿RBP、NAG含量重度哮喘患儿高于轻、中度哮喘患儿 (均P <0 0 5 ) ,轻度与中度哮喘患儿差别无显著性意义 (均 P >0 0 5 )。尿TRF、Alb含量在轻、中、重度哮喘患儿差别均无显著性意义 (均 P >0 0 5 )。结论　支气管哮喘患儿急性发作期存在肾小球和肾小管轻度或早期损害。     

新生儿窒息尿Alb,IgG,β2—MG RIA的测定

蛋白尿是肾脏功能受损的重要表现。我们应用放射免疫法测定正常息窒和新生儿的尿三蛋白以观察窒息新生儿因缺氧、酸中毒等对肾功能的影响。材料和方法一、观察对象1．正常新生儿组（对照组）共24例，男15例，女9例。足月顺产，且分钟Argar评分9～10分，年龄2～5天。2．新生儿窒息组共46例，男28例，女18例，年龄2～5天。Apgar评分≤3分考20例（重度窒息组），4～7分考28例（轻度窒息组）。二、方法1．均于生后第2～5天留取新鲜尿，用0．1NNaOH调节尿液PH＞65，－20℃保存不超过5天。2．采用中国原子能科学研究院提供的Alb、IgG、民一M…     

新生儿窒息尿微量蛋白的检测及临床意义

为了解窒息后肾损害的尿微量蛋白变化 ,我们对 5 6例窒息新生儿进行了尿微量蛋白的检测 ,现报告如下。资料和方法一、检测对象1 窒息组 :出生七天内 ,不分民族、不分性别、孕龄在 32～ 42周 ,出生体重 1 6 5 0～ 40 0 0ｇ ,出生后Ａｐｇａｒ评分均为 7分以下共 5 6例 ,其中重度 1 5例 ,轻度 41例。2 正常对照组 :正常新生儿 40例、年龄为生后 7天内 ,不分性别及民族、孕龄 37～ 41周 ,体重 2 6 0 0～ 380 0ｇ ,Ａｐｇａｒ评分 8～ 1 0分无心、脑、肺、肾及感染性疾病者。日龄与窒息组比较无显著性差异 (Ｐ >0 .0 5 )。二、测定方法全部均…     

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.     

小儿尿系列微量蛋白正常值测定及其临床意义

为建立小儿尿系列微量蛋白正常值并初步探讨各型肾脏疾病肾小球和肾小管受累情况，应用酶联免疫法(ELISA法)测定正常小儿及不同型肾脏疾病患儿尿视黄醇结合蛋白(RBP)、转铁蛋白(TRF)、白蛋白(Alb)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)和N-乙酰-β-D氨基葡萄糖苷酶(NAG)共7种微量蛋白水平。结果：以单侧95％百分位数确定尿RBP、TRF、Alb、IgG、IgA、IgM和NAG的正常上限值分别为13．5μ／mmolCr、140μg／mmolCr、2.8mg／mmolCr、0．8mg／mmolCr、0．1mg／mmolCr、0．03mg／mmolCr和1．7U／mmolCr。提示小儿尿系列微量蛋白正常值的建立为临床提供了检测各型肾脏疾病客观、准确、有效的辅助诊断指标。     

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目的 探讨新生儿窒息后肾血流参数与尿微量蛋白的关系.方法 测定分析2004年1月至2007年12月甘肃省人民医院71例窒息新生儿及20名正常新生儿新鲜尿液中尿α1-微球蛋白(α1-MG)、微量白蛋白(MA)、转铁蛋白(TRF)、免疫球蛋白(IgG)水平.同时抽取全部新生儿静脉血测血尿素氮(BUN)、肌酐(Cr)、二氧化碳结合力(CO2-CP)、Ca2+、K+、Na+、Cl-,并分别在出生后第1、3、7天测定肾动脉血流参数,包括收缩期峰值流速(PSFV)、阻力指数(RI)、舒张末血流速度(EDFV)、时间平均流速(TAMX)、搏动指数(PI).结果 (1)窒息新生儿尿中α1-MG、TRF、MA、IgC均明显高于正常组(P<0.05),重度窒息组TRF、α1-MG明显高于轻度窒息组(P<0.01).(2)窒息组肾动脉EDFV在第1、3、7天均低于正常组.差异有统计学意义(P<0.05),各日龄组肾动脉RI和PI均高于正常组,差异有统计学意义(P<0.05).(3)肾血流参数EDFV与MA、TRF、α1-MG、IgG呈负相关(P<0.01),RI、PI与MA、TRF、α1-MG、IgG呈正相关性(P<0.01).结论 通过肾血流检测可估计尿微量蛋白的高低,肾血流检测具有省时、方便、外界影响因素少、可连续观察等优点;通过尿微量蛋白的高低评估患儿肾血流,判断有无肾血管痉挛、肾缺血及早期肾损害,可为早期使用肾血管扩张药物提供依据.     

新生儿窒息时血清镁变化与临床的关系

目的　 探讨新生儿窒息时血清镁变化与临床的关系。 方法 　窒息组与对照组均于生后第 1天和第 7天抽取股静脉血 ,测出血清镁值 ,进行对比分析。 结果 　新生儿轻度窒息患儿的血清镁 ,生后第 1天有所降低 ,但在正常范围内 ,与对照组无显著性差异 (P >0 0 5 ) ,至第 7天有所升高 ,仍在正常范围。重度窒息患儿血清镁明显降低 ,且至第 7天仍呈下降趋势 ,与对照组有显著性差异 (P <0 0 5 ) ,治愈组与对照组血清镁第 1天均在正常范围 ,且两者间无显著性差异 (P >0 0 5 ) ,而后遗症及死亡组则明显降低 ,与对照组比较有显著性差异 (P <0 0 5 )。 结论 　新生儿窒息时血清镁变化与临床密切相关。     

窒息新生儿血浆内皮素与血小板参数检测的意义

目的　探讨检测窒息新生儿血浆内皮素 (ET)与血小板参数的临床意义。方法　窒息新生儿 5 6例分为轻度窒息组 2 0例和重度窒息组 36例 ;另选择 2 0例正常新生儿作为对照组。检测各组血浆ET、血小板参数 [血小板计数 (PLT)、血小板平均体积 (MPV)、血小板分布宽度 (PDW ) ],比较治疗前后各组指标变化及其与新生儿窒息程度的关系。结果　治疗前轻度窒息组ET较对照组显著降低 (P <0 .0 5 ) ,各项血小板参数无差异。重度窒息组ET、MPV及PDW较余两组升高 ,PLT较其余两组降低 ,有显著差异。治疗后重度组PDW仍高于其他两组 (P <0 .0 5 ) ,余指标均恢复正常。结论　血浆ET、血小板参数变化与新生儿窒息程度密切相关 ,对窒息新生儿病情严重程度及病情演变判定具有重要价值     

窒息宫内窘迫对早期新生儿肾功能的影响

目的：该文通过测定尿α1微球蛋白(α1-MG)、β2微球蛋白(β2-MG)、白蛋白(Alb)含量,探讨窒息、宫内窘迫对早期新生儿肾功能的影响,以期对窒息、宫内窘迫后肾损伤的临床动态监护和防治提供依据。方法：用放射免疫法测定窒息组、宫内窘迫组新生儿生后0~2d,3~4d,6~7d尿α1-MG,β2-MG,Alb含量。结果：窒息组3个时段尿α1-MG,β2-MG,Alb均高于正常对照组,以3~4d最高,差异有显著性(P<0.05)。重度窒息组3个时段尿α1-MG,β2-MG,Alb均高于轻度窒息组,差异有显著性(P<0.05)。尿α1-MG,β2-MG,Alb在宫内窘迫组3个时段之间比较差异无显著性(P>0.05)。宫内窘迫组3个时段尿α1-MG,β2-MG,Alb与正常对照组比较差异无显著性(P>0.05)。结论：窒息可导致新生儿肾小球、肾小管功能损伤,3~4d损伤最严重,损伤程度与窒息程度呈正相关。宫内窘迫新生儿生后1周内肾小球、肾小管功能无明显损伤。     

尿神经导向因子-1和肾损伤分子-1对窒息后新生儿急性肾损伤的诊断价值探讨

目的 分析尿神经导向因子-1(Netrin-1)和肾损伤分子-1(Kim-1)的变化对新生儿窒息引起的急性肾损伤(AKI)的早期诊断价值。方法 选取足月窒息新生儿80 例(轻度窒息组34 例,重度窒息组46 例),以及正常足月新生儿40 例(无窒息组)。分别收集三组新生儿出生后12 h、13~48 h 内尿标本,采用酶联免疫法(ELISA)检测尿Netrin-1 及Kim-1 的水平,同时抽取外周静脉血检测血肌酐(Scr)水平。结果 窒息组患儿生后48 h 内的尿Netrin-1 及Kim-1 水平明显高于无窒息组,生后13~48 h 内的Scr 水平高于无窒息组(P<0.05);AKI 组患儿生后48 h 内的尿Netrin-1、Kim-1、Scr 均高于非AKI 组(P<0.05);12 h 内的尿Netrin-1、Kim-1 预测窒息后AKI 的AUC 值分别为0.878(95%CI 0.775~0.981,P<0.01)和0.899(95%CI 0.829~0.969,P<0.01);新生儿窒息后12 h 内的尿Netrin-1、尿Kim-1、Scr 分别呈明显正相关(P<0.05)。结论 窒息新生儿发生AKI时尿Netrin-1 和Kim-1 水平明显增高;尿Netrin-1 和Kim-1 可作为早期判断窒息后AKI 的指标。     

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.     

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。     

Urinary S-100B concentrations in term and preterm infants at risk for brain damage

BACKGROUND: Elevated serum concentrations of S-100B, a 21-kDa protein expressed in astroglial cells, has been used to assess cerebral damage after head trauma, infection, ischemia, and perinatal asphyxia. OBJECTIVE: As S-100B is eliminated by the kidneys, we investigated the feasibility of measuring S-100B in urine of newborns with severe perinatal asphyxia, and in very low birth weight (VLBW) preterm infants at risk for neurodevelopmental impairment. METHODS: We first analyzed urine samples of 8 term or near-term newborns without major medical problems, followed by urine samples of 2 term newborns with severe birth asphyxia, and finally urine samples of 8 VLBW (gestational age 24-28 weeks) infants collected every 4 h for up to 10 days. RESULTS: Urinary S-100B concentrations in 8 term or near-term newborns without major medical problems were consistently <1 microg/l. In 2 term newborns with severe asphyxia (Apgar 0/0/0 and 0/2/4) who subsequently had widespread cerebral damage on magnetic resonance imaging, peak urinary S-100B concentrations on the first day of life were 28.1 and 28.4 microg/l, respectively. In 5/8 VLBW infants, urinary S-100B was> microg/l in samples obtained on the first day of life (range 1.2-44.9 microg/l, median 6.8 microg/l). Peak S-100B in urine samples collected during the first 12 h of life were negatively related to gestational age (R(s)=-0.882, p=0.009). Three of the 8 preterm infants had peak urinary concentrations>0 microg/l but neither ultrasound signs of brain damage nor neurodevelopmental delay at 1 year corrected age. CONCLUSIONS: The determination of urinary S-100B concentrations might be helpful in term infants with severe asphyxia, while high urinary S-100B concentrations in preterm infants are to be attributed to immaturity.     

窒息新生儿肾功能损害尿NAG和RBP的变化

目的：探讨窒息新生儿肾功能损害尿N-乙酰-β-D氨基葡萄糖苷酶(NAG),尿视黄醇结合蛋白(RBP)的变化。方法：采用对硝基苯酚比色法及ELISA测定窒息足月儿、早产儿和正常足月儿、早产儿生后第1,3,7天尿NAG活性和尿RBP含量。结果：重度窒息足月儿、早产儿生后第3,7天尿NAG水平均明显高于对照组(P0.05)。结论：尿NAG,RBP可作为早期监测肾功能损害的常规方法,尿RBP是一项较尿NAG更敏感的肾功能损害的早期诊断指标。     

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.     

Effect of perinatal asphyxia on thyroid-stimulating hormone and thyroid hormone levels

AIM: To compare serum concentrations of thyroid hormones--T4, T3, free T4 (FT4) and reverse T3 (rT3)--and thyroid-stimulating hormone (TSH) found in the umbilical cord blood of term newborns with and without asphyxia and those found in their arterial blood collected between 18 and 24 h after birth. A further aim of the study was to assess the association between severity of hypoxic-ischemic encephalopathy and altered thyroid hormone and TSH levels, and between mortality and FT4 levels in the arterial blood of newborns between 18 and 24 h of life. METHODS: A case-control study was carried out. The case group comprised 17 term newborns (Apgar score < or = 3 and < or = 5 at the first and fifth minutes; umbilical cord blood pH < or = 7.15) who required bag and mask ventilation for at least one minute immediately after birth. The control group consisted of 17 normal, term newborns (Apgar score > or = 8 and > or = 9 at the first and fifth minutes; umbilical cord blood pH > or = 7.2). Cord blood and arterial blood samples were collected immediately after birth and 18 to 24 h after birth, respectively, and were used in the blood gas analysis and to determine serum concentrations of T4, T3, FT4, rT3 and TSH by radioimmunoassay. All newborns were followed-up until hospital discharge or death. RESULTS: Gestational age, birthweight, sex, size for gestational age, mode of delivery and skin color (white and non-white) were similar for both groups. No differences were found in mean levels of cord blood TSH, T4, T3 and FT4 between the groups. In the samples collected 18 to 24 h after birth, mean levels of TSH, T4, T3 and FT4 were significantly lower in the asphyxiated group than in the control group. Mean concentrations of arterial TSH, T4 and T3 between 18 and 24 h of life were lower than concentrations found in the cord blood analysis in asphyxiated newborns, but not in controls. In addition, asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy presented significantly lower mean levels of TSH, T4, T3 and FT4 than those of controls. None of the asphyxiated newborns with FT4 > or = 2.0 ng/dl died; 6 out of the 11 asphyxiated newborns with FT4 < 2.0 ng/dl died. CONCLUSIONS: Serum concentrations of TSH, T4, T3 and FT4 are lower in asphyxiated newborns than in normal newborns between 18 and 24 h of life; this suggests central hypothyroidism secondary to asphyxia. Asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy present a greater involvement of the thyroid function and consequently a greater risk of death.