窒息新生儿尿液KIM-1变化与窒息后肾损伤的关系研究

目的探讨窒息新生儿尿液KIM-1变化与窒息后肾损伤的关系。方法收集2010年5月至2012年1月我院新生儿科收治的窒息新生儿40例,按窒息严重程度分为2组：轻度窒息组（出生1分钟Apgar评分4～7分）;重度窒息组（出生1分钟Apgar评分0～3分）,每组各20例。另选取同期无窒息的健康新生儿20例（出生1分钟Apgar评分8～10分）。三组新生儿均于生后第一天用婴幼儿集尿袋收集尿标本4mL。分别采用酶联免疫法（ELISA）和放射免疫法（RIA）法检测尿中KIM-1和β2-MG的水平,同时抽取外周静脉血检测血清尿素氮（BUN）以及肌酐（Cr）水平。结果①三组新生儿的一般情况无明显差异（P〈0.05）;②与对照组比较：两组窒息新生儿尿液中KIM-1和β2-MG水平、重度窒息组的血清BUN和Cr水平均显著增高（P〈0.05）;重度窒息组尿液中KIM-1和β2-MG水平、血清BUN和Cr水平均比轻度窒息组显著增高（P〈0.05）;③窒息新生儿后尿液KIM-1与尿液β2-MG、血清BUN、血清Cr分别呈明显正相关（P〈0.05）。结论窒息新生儿肾损伤时尿液KIM-1水平明显增高;尿液KIM-1可作为判断早期肾小管损伤的敏感指标。

The Relationship between Kidney Injury Molecule-1 in Asphyxiated Newborn and Post-asphyxia Renal Injury

Objective To explore the relationship between kidney injury molecule-1（KIM-1） in asphyxiated newborn and post-asphyxia renal injury. Methods 40 newborns from May 2010 to Feb 2012 were selected and divided into two groups： mild asphyxia （Apgar scores 4 ~ 7 at 1 min） and severe asphyxia （Apgar scores 0 ~ 3 at 1 min）. Besides, 20 newborns with no history of hypoxia or severe infection were selected as the control group. The urine and blood samples from neonates were collected in neonatal day 1. The KIM-1 and β2-MG in urine in serum were all detected by enzyme-linked immuno sorbent assay （ELISA） and radioimmunoassay （RIA） respectively. The BUN and Cr in peripheral venous blood were detected at the same time. Results ①There was no significant difference among the three groups （P 0.05）. ②Compared with control group, the urine KIM-1 and β2-MG after neonatal asphyxia, serum BUN and Cr in severe asphyxia all increased significantly （P 0.05）. ③There were significant differences between urine KIM-1 and urine β2-MG, or serum BUN, or serum Cr respectively （all P 0.05）. Conclusions The urine KIM-1 increases significantly after neonatal asphyxia, which can be used as a sensitive index to predict the renal injury after neonatal asphyxia.