目的 探讨血清胱抑素C(Cys C)检测在新生儿窒息肾功能评估中的价值,为临床诊治提供依据。方法 选取陕西省某三级甲等医院新生儿窒息患儿共79例(男37例、女42例),按新生儿窒息Apgar评分标准分为轻度窒息组(55例)和重度窒息组(24例);同期选择健康足月新生儿共50例(男23例、女27例)作为对照组。检测各组新生儿血清Cys C水平,并与血清尿素氮(BUN)、肌酐(Cr)等指标水平进行对比分析。结果 轻度窒息组Cys C水平显著高于对照组(P<0.05);轻度窒息组Cr、BUN水平与对照组比较,差异均无统计学意义(P均>0.05);重度窒息组Cys C、Cr和BUN水平较轻度组均显著增高,差异有统计学意义(P<0.01)。轻度窒息组中Cys C、Cr和BUN的异常检出率分别为29.0%、25.5%、21.8%,各项间差异无统计学意义;而重度窒息组中Cys C的异常率为87.5%,显著高于Cr和BUN的异常率(分别为41.7%和33.3%),差异有统计学意义 (χ2=6.97,P<0.01)。血清Cys C与BUN和Cr水平之间呈显著正相关性(r=0.84,0.88,P<0.05)。结论 血清Cys C水平可作为评价新生儿窒息致肾损害的敏感指标,且对早期肾损害的诊断价值较血清BUN、Cr更高,对临床窒息新生儿肾功能监测、病情判断和预后分析具有重要意义。
Abstract
Objective To investigate the value of serum cystatin C (Cys C) in the renal function evaluation of neonatal asphyxia,and to provide evidence for clinical diagnosis and treatment. Methods A total of 79 newborns with neonatal asphyxia were collected in a Grade Ⅲ Level A hospital in Shaanxi,including 37 males and 42 females.According to the Apgar score of neonatal asphyxia,55 cases were divided into mild asphyxia group and 24 cases as severe asphyxia group.Another 50 healthy newborns (27 male and 23 female) were selected as control group.The serum levels of Cys C,creatinine (Cr),and blood urea nitrogen (BUN) were compared among three groups. Results The level of serum Cys C in mild asphyxia group was significantly higher than that in control group (P<0.01),but there was no significant difference on the levels of BUN and Cr between mild asphyxia group and control group (both P>0.05);Compared with the mild asphyxia group,the levels of BUN,Cr and Cys C in severe asphyxia group were significantly higher and the differences were statistically significant (all P<0.05).The abnormal rates of BUN,Cr and Cys C in mild asphyxia group were 29.0%,25.5% and 21.8% respectively,among which there was no statistical difference.However,the abnormal rate of Cys C (87.5%) was significantly higher than that of BUN and Cr (41.7% and 33.3%,respectively) in severe asphyxia group (χ2=6.97,P<0.01).Serum Cys C was positively correlated with the level of BUN and Cr (r=0.84,0.88,both P<0.05). Conclusions Serum Cys C could be used as a sensitive index for evaluation of kidney damage after neonatal asphyxia,and its diagnostic value for early renal damage would be higher than that of serum BUN or Cr.The results might be of great significance in monitoring renal function for asphyxia newborns,evaluating the disease progress and analyzing the prognosis in clinical practice.
关键词
新生儿窒息 /
胱抑素C /
肾功能损伤
Key words
neonatal asphyxia /
cystatin C /
renal function impairment
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基金
中国博士后科学基金特别资助(2015T81036);中国博士后科学基金面上项目(2014M560790)
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