新生儿窒息后肾血流与尿微量蛋白关系的研究

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αl-微球蛋白 （αl-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αl-MG、TRF、MA 、IgG均明显高于正常组（P < 0.05） ，重度窒息组TRF、αl-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、αl-MG 、IgG呈负相关（P <0.01），RI、PI与MA、TRF、αl-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。

Relationship between renal blood flow parameters and urine prote in newborns with asphyxia.

Objective　To study the relationship between renal blood flow parameters and urine protein in newborns with asphyxia. Methods　To test the levels of αl-MG， MA， TRF and IgG in fresh urine of 71 cases of neonatal asphyxia and 20 cases of normal newborns， from January 2004 to December 2007 in the People's Hospital of Gansu Province， and to test the blood BUN， Cr， CO2-CP， Ca2+，K +， Na +and Cl-，respectively，to test renal artery blood flow parameters（PSFV， RI， EDFV， TAMX and PI） on the 1st， 3rd and 7th day after birth. Results　（1）The urine αl-MG， TRF， MA and IgG in the newborn asphyxia were significantly higher than the normal group （P < 0.05）； TRF and αl-MG in the severe asphyxia group were significantly higher than those of the mild asphyxia group （P < 0.01 ）. （2 ）The renal artery EDFV in asphyxia group were lower than those of the normal group in 1st， 3rd and 7th day， there being significant differences （P < 0.05）； the renal artery RI and PI were higher than those of the normal group， there being significant differences （P < 0.05）. （3）The renal blood flow parameters EDFV and MA， TRF， αl-MG， IgG were negatively correlated （P < 0.01）， RI， PI and MA， TRF， αl-MG IgG were positivly correlated （P < 0.01）. Conclusion　The test of renal blood flow can estimat the level of protein in urine， which is time-saving， convenient ，with less influence of external factors； in particular ，it can be observed continuously. Similarly， according to the levels of urine protein，we can estimate the situation of renal blood flow and judge whether the newborn is suffering from renal vasospasm， renal ischemia and early kidney damage， which can be supply an evidence for application of the drugs of renal blood vessel.