重度窒息新生儿发生急性肾损伤回顾性分析

目的探讨重度窒息新生儿中急性肾损伤（AKI）的发生情况及其诊断标准的适用性。方法回顾性分析2005年1月至2009年12月于北京大学第一医院住院的重度窒息新生儿。根据2005年急性肾损伤协作网提出的AKI诊断标准（包括尿量标准和SCr标准）,将入选患儿分为AKI组和无AKI组。采集患儿一般资料、围生期资料、肾脏损伤情况、治疗和近期预后情况。结果最终纳入患儿30例,AKI组17例,无AKI组13例。①AKI组10/17例仅符合尿量标准,而不符合SCr升高标准,按AKI分期标准分为1期4例、2期5例、3期1例;7/17例同时符合尿量标准和SCr标准,其中3例按照SCr标准和尿量标准分期相同（均为1期）,1例按照SCr标准分期为2期的患儿符合尿量标准1期,余3例按尿量标准分期高于SCr标准。7/17例有SCr一过性升高（SCr〉133μmol.L-1）,达到急性肾功能衰竭诊断标准。②AKI组和无AKI组平均住院时间分别为（14.7±13.9）和（13.7±9.6）d,两组差异无统计学意义（P=0.83）。AKI组预后不良5/17例（29.4%）,包括死亡1例（同时符合尿量标准和SCr标准）,放弃治疗4例（3例同时符合尿量标准和SCr标准,1例仅符合尿量标准）;无AKI组预后不良2/13例（15.4%）,均为死亡病例（均仅符合尿量标准）,两组差异无统计学意义（P=0.368）。按照SCr升高标准,符合AKI诊断的4/7例（57.1%）患儿预后不良,不符合SCr升高标准的3/23例（13.0%）患儿预后不良,差异有统计学意义（P=0.016）。结论在重度窒息新生儿中存在AKI的病例。SCr升高可能提示预后不良,但由于样本量小,无长期随访资料,目前尚不能评价SCr和尿量是否为诊断新生儿AKI的最适宜指标。

Retrospective analysis of acute kidney injury in neonates with severe asphyxia

Objective The purpose of this study was to analyze the features and short-term outcomes in severe asphyxiated neonates with or without acute kidney injury（AKI） in order to validate the applicability of the criteria and classification of AKI.Methods Severe asphyxiated neonates with SCr values twice and records of urine output were enrolled and retrospectively analyzed.The criteria proposed by Acute Kidney Injury Network were applied to diagnose the occurence of AKI.All neonates enrolled were divided into two groups,AKI group and non-AKI group.Clinical features and short-term outcomes were compared between the two groups.Results A total of 17/30（56.7%） patients were diagnosed to be with AKI,the rest of 13/30 patients who did not meet the criteria of AKI were divided into non-AKI group.Ten of 17 AKI patients only fulfilled urine criteria but not SCr criteria,7 patient fulfilled both criteria.For 13 out of 17 patients in AKI group,the grade of the classification by urine output was higher than those calssified by creatinine criteria.Three patients had the same urine stage as SCr stage,3 had higher urine stage than SCr stage and 1 had lower urine stage than SCr stage.Seven patients with high SCr（SCr133 μmol·L-1） and fulfilled the diagnostic criteria of acute renal failure.The proportion of bad prognosis（29.4% vs 15.4% for AKI group and non-AKI group,P=0.368） and the average days of hospital stay [（14.7±13.9） d vs（13.7±9.6） d,P=0.83] were not statistically different between the AKI and non-AKI groups.According to the creatinine criteria,there were 7 neonates diagnosed as AKI,and the prognosis was statistically different between AKI-scr group and non AKI-scr group（P=0.016）.Conclusions More than a half of severe asphyxia neonates reached the criteria of AKI.The criteria by measuring urine output seemed more sensitive than that by detecting the increase of serum creatinine.The increase of serum creatinine might suggest bad prognosis.Studies with large sample size and long term follow-up are needed for further investigation on AKI in neonates.