窒息新生儿尿微量蛋白和血BUN、Cr的检测和临床意义

目的通过检测窒息新生儿尿微量蛋白和血BUN、Cr的变化探讨尿微量蛋白在窒息新生儿肾脏损害早期诊断的意义。方法窒息组新生儿30例（轻度窒息组15例,重度窒息组15例）,对照组为15例健康新生儿,于生后48h内留取新鲜尿液检测尿微量蛋白：尿α1微球蛋白（α1-MG）、β2微球蛋白（β2-MG）、N-乙酰-β-D-氨基葡萄糖苷酸酶（NAG）、转铁蛋白（TRF）、免疫球蛋白（IgG）;采静脉血检测血BUN、Cr。结果轻度窒息组与对照组比较：尿α1-MG（8.92±1.25）mg/L、β2-MG（3.06±1.62）mg/L、NAG（14.76±4.69）mg/L水平升高（P（0.01）;尿TRF（2.65±1.94）mg/L、IgG（7.39±1.88）mg/L、血BUN（5.23±2.04）mg/L、Cr（64.22±25.11）mg/L水平差异无统计学意义（P（0.05）。重度窒息组与对照组比较：尿α1-MG（12.55±2.44）mg/L、β2-MG（9.35±2.86）mg/L、NAG（29.64±7.43）mg/L、TRF（9.27±2.11）mg/L、IgG（11.97±3.57）mg/L、血BUN（14.36±3.11）mg/L、Cr（120.78±42.19）mg/L水平均显著升高（P（0.01）。重度窒息组与轻度窒息组比较：尿α1-MG、β2-MG、NAG水平差异均无统计学意义（P（0.05）,尿TRF、IgG和血BUN、Cr水平显著升高（P（0.01）。单项指标阳性率：尿α1-MG80.0%、β2-MG71.1%、NAG64.4%、TRF37.8%、IgG40.0%,均明显高于血BUN、Cr24.4%,差异有统计学意义（P（0.01）。结论窒息新生儿尿微量蛋白水平有明显变化,其检测阳性率明显高于血BUN、Cr,可以作为新生儿窒息肾脏损害早期的判断指标。

Testing of Urinary Microprotein, Blood Urea Nitrogen and Creatinine in Neonatal with Asphyxia and its Clinical Significance

Objective To test the urinary microprotein,blood blood urea nitrogen（BUN） and creatinine（Cr）,and investigate the significance of microprotein in the early diagnosis of kidney damage in asphyxial neonates.Methods Thirty neonates with asphyxia（15 mild cases and 15 severe cases） and 15 healthy newborns were as asphyxia group and control group,respectively.The fresh urine specimens were collected within 48 hours after birth and used to test the urinary microprotein：urine α1-microglobulin（α1-MG）,β2-microglobulin（β2-MG）,N-acetyl-β-D-amino-glucuronidase（NAG）,transferrin（TRF）,immunoglobulins（IgG）;and the venous blood was sampled to test serum BUN and Cr.Results As compared with control group,urinary α1-MG（8.92±1.25）mg/L,β2-MG（3.06±1.62）mg/L and NAG（14.76±4.69）mg/L levels of mild asphyxia group increased,the difference had statistical significant（P﹤0.01）;While urinary TRF（2.65±1.94）mg/L,IgG（7.39±1.88）mg/L,blood BUN（5.23±2.04）mg/L and Cr（64.22±25.11）mg/L levels had not statistical significant difference（P0.05） between the both group.The urinary α1-MG（12.55±2.44）mg/L,β2-MG（9.35±2.86）mg/L,NAG（29.64±7.43）mg/L,TRF（9.27±2.11）mg/L,IgG（11.97±3.57）mg/L,blood BUN（14.36±3.11）mg/L and Cr（120.78±42.19）mg/L levels of the severe asphyxia group were significantly higher（P0.01）.As compared severe asphyxia group to mild asphyxia group：urinary α1-MG,β2-MG,NAG levels had not statistical significant difference（P0.05）.TRF,IgG,blood BUN and Cr levels were significantly higher（P0.01）.The positive rate of individual indicators were 80.0% for α1-MG,71.1% for β2-MG,64.4% for NAG,37.8% for TRF,40.0% for IgG,and significantly higher than that（24.4%） of BUN and Cr（P0.01）.Conclusion There is a significant change in urinary microprotein and its positive rate was significantly higher than serum BUN and Cr.The urinary microprotein level can be used as early diagnostic indicators of kidney damage in neonates with asphyxia.