窒息新生儿尿中尿酸/肌酐比值的变化及意义

Change of the Urinary Uric Acid/Creatinine Ratioin Neonates with Asphyxia

摘要:

目的：探讨尿中尿酸/肌酐比值的变化在新生儿窒息及窒息后肾损伤中的意义。方法：对38例足月窒息新生儿(轻度窒息13例，重度窒息25例)和15例正常新生儿的尿中尿酸/肌酐比值及反映肾损伤指标N-乙酰-β-D-氨基葡萄糖苷酶(NAG)活性和β2-微球蛋白 (β2-MG)水平进行了检测。结果：与正常组［(0.56±0.20)，(2.73±2.50) U/L，(0.10±0.01) mg/L］相比，轻度窒息组尿中尿酸/肌酐比值、NAG，β2-MG水平［(1.19±0.53)，(10.34±8.72) U/L，(2.80±1.95) mg/L］显著升高(P<0.01)，重度窒息组尿中上述指标［(2.60±1.23)，(26.53±10.54) U/L，(5.05±2.19) mg/L］也显著升高(P<0.01)，且重度窒息组高于轻度窒息组(P<0.01)。在窒息组内，尿酸/肌酐比值与Apgar评分呈显著负相关关系(r为-0.63，P<0.01)，与NAG活性及β2-MG水平之间均呈显著正相关关系(r分别为 0.62，0.89，P<0.01)。结论：窒息新生儿尿中有较高的尿酸/肌酐比值，该比值有望成为反映新生儿窒息程度和窒息后肾损伤的早期指标。

Abstract:

OBJECTIVE: To study the change and significance of the urinary uric acid (UA)/creatinine ratio (Cr) in neonatal asphyxia and postasphyxial renal injuries. METHODS: The uric acid /creatinine ratio, the activity of Nacety β D amino glucosidase (NAG) and the level of β 2 microglobulin (β 2 MG) in urine were detected in 38 term neonates with asphyxia (13 cases of mild asphyxia and 25 cases of severe asphyxia) and 15 healthy newborns (controls). RESULTS: Compared with the controls [( 0.56 ± 0.20 ), ( 2.73 ± 2.50 ) U/L, ( 0.10 ± 0.01 ) mg/L], the UA/Cr ratio, and NAG and β 2 MG levels obviously increased in the mild asphyxia group [( 1.19 ± 0.53 ), ( 10.34 ± 8.72 ) U/L, ( 2.80 ± 1.95 ) mg/L](P< 0.01 ). In the severe asphyxia group, the above parameters [( 2.60 ± 1.23 ), ( 26.53 ± 10.54 ) U/L, ( 5.05 ± 2.19 ) mg/L] significantly increased compared with the mild asphyxia group and controls (P< 0.01 ). A significantly negative correlation was found in the asphyxia group between the UA/Cr ratio and the Apgar score (r= -0.63 , P< 0.01 ); while the obviously positive correlation was found between the UA/Cr ratio and NAG activity or β 2 MG level (r= 0.62 or 0.89 , both P< 0.01 ). CONCLUSIONS: Infants with asphyxia have a higher urinary UA/Cr ratio. It might be used as an indicator for early assessment of the severity of asphyxia and postasphyxial renal injuries in neonates.