窒息宫内窘迫对早期新生儿肾功能的影响

Effects of birth asphyxia or intrauterine distress on renal functions in newborns in the first week of life

摘要:

目的：该文通过测定尿α1微球蛋白(α1-MG)、β2微球蛋白(β2-MG)、白蛋白(Alb)含量,探讨窒息、宫内窘迫对早期新生儿肾功能的影响,以期对窒息、宫内窘迫后肾损伤的临床动态监护和防治提供依据。方法：用放射免疫法测定窒息组、宫内窘迫组新生儿生后0~2d,3~4d,6~7d尿α1-MG,β2-MG,Alb含量。结果：窒息组3个时段尿α1-MG,β2-MG,Alb均高于正常对照组,以3~4d最高,差异有显著性(P<0.05)。重度窒息组3个时段尿α1-MG,β2-MG,Alb均高于轻度窒息组,差异有显著性(P<0.05)。尿α1-MG,β2-MG,Alb在宫内窘迫组3个时段之间比较差异无显著性(P>0.05)。宫内窘迫组3个时段尿α1-MG,β2-MG,Alb与正常对照组比较差异无显著性(P>0.05)。结论：窒息可导致新生儿肾小球、肾小管功能损伤,3~4d损伤最严重,损伤程度与窒息程度呈正相关。宫内窘迫新生儿生后1周内肾小球、肾小管功能无明显损伤。

Abstract:

OBJECTIVE: To investigate the renal function in newborns with birth asphyxia or intrauterine distress in the first week of life. METHODS: Sixty full-term newborns born between June 2002 and February 2003 were assigned into three groups: Control group (healthy newborns), Intrauterine distress group (Apgar score > 7), and Birth asphyxia group without intrauterine distress (12 mild asphyxia and 8 severe asphyxia) (n=20 each). Urinary levels of α_1-microglobulin (α_ 1 -MG), β_ 2 -microglobulin (β_ 2 -MG) and albumin (Alb) were detected by radioimmunoassay at 0-2, 3-4 and 6-7 days after birth. RESULTS: The urinary levels of α_1-MG, β_2-MG and Alb in the Asphyxia group were significantly higher than those in the Control group at all time points (P<0.05), peaking at 3-4 days after birth. Statistically significant differences were found between the severely and mildly asphyxiated newborns for the urinary levels of α_ 1 -MG, β_ 2 -MG and Alb at all time points (P<0.05). There were no significant differences in the urinary levels of α_ 1 -MG, β_ 2 -MG and Alb between the Intrauterine distress and the Control groups at each time point. CONCLUSIONS: Birth asphyxia may lead to renal glomerular and tubular impairments and it is speculated that the most serious impairment occurs at the 3rd and 4th days of life. The severity of renal impairments is associated with the degree of asphyxia. The renal function of the newborn appears to be normal following intrauterine distress.