窒息新生儿血NGAL、CysC 和尿微量 蛋白的水平变化及临床意义

Changes of blood NGAL, CysC and urinary microprotein in asphyxiated neonates and their clinical significance

摘要:

目的 探讨窒息新生儿尿α1 微球蛋白（α1-m）、β2 微球蛋白（β2-m）、白蛋白（Alb）、免 疫球蛋白G（IgG）、转铁蛋白（TRF）、血中性粒细胞明胶酶相关脂质运载蛋白（NGAL）及半胱氨酸蛋白酶 抑制剂（CysC）水平的变化及对新生儿早期肾损伤的诊断价值。方法 取187 例窒息新生儿（轻度窒息90 例， 重度窒息97 例）及95 例同期入院的健康新生儿出生后24 h 内取尿液作α1-m、β2-m、Alb、IgG 及TRF 检测；取12 h 内静脉血检测NGAL、CysC、BUN 及血肌酐（Scr），并进行比较分析。结果 轻、重度窒息 组α1-m、β2-m、Alb、IgG、TRF、NGAL 及CysC 含量均较对照组升高（P <0.05），重度窒息组α1-m、 β2-m、Alb、IgG、TRF、NGAL 及CysC 异常率高于轻度窒息组（P <0.05）。结论 α1-m、β2-m、Alb、 IgG、TRF、NGAL 及CysC 含量是窒息新生儿早期肾功能损伤监测的有效指标。而传统指标Scr 及BUN 在 窒息新生儿早期肾损伤的诊断中优越性不明显。

Abstract:

Objective To explore the changes of urine alpha1-microglobulin (α1-m), beta 2-microglobulin (β2- m), albumin (Alb), IgG, transferrin (TRF) and blood neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), blood urea nitrogen (BUN), and serum creatinine (Scr) levels and their value in the diagnosis of newborn early renal damage. Methods The 24-h urine samples from 187 cases of suffocation newborns (90 cases of mild asphyxia and 97 cases of severe asphyxia) and 95 cases of healthy neonates in the same period for determination of α1-m, β2-m, Alb, IgG and TRF. Blood samples were taken within 12 h to check NGAL, CysC, BUN and Scr. Results Urine α1-m, β2-m, Alb, IgG and TRF, and blood NGAL and CysC in the mild asphyxia group and the severe asphyxia group were higher than those in the control group (P < 0.05). The abnormal rates of urine α1-m, β2-m, Alb, IgG, TRF, and blood NGAL and CysC in the severe asphyxia group were higher than those in the mild asphyxia group (P < 0.05). Conclusions The levels of urine α1-m, β2-m, Alb, IgG, TRF, and blood NGAL and CysC are sensitive and effective indexes to monitor early renal damage in neonates with asphyxia. Traditional indexes Scr and BUN do not have significant advantage in diagnosis of early renal damage.