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目的探讨窒息新生儿尿乙酰-β-D氨基葡萄糖苷酶(NAG)活性和尿视黄醇结合蛋白(RBP)、β_2微球蛋白(β_2-MG)水平与肾功能损害的关系。方法选取2013年8月至2015年8月产科出生的120例窒息新生儿(窒息组)和同期出生的50例正常新生儿(对照组)。采用酶联免疫吸附法(ELISA)和对硝基苯酚比色法检测窒息组与对照组新生儿出生后1、3、7 d时的尿RBP、β_2-MG水平及NAG活性。结果窒息组120例患儿中,重度窒息患儿48例,轻度窒息患儿72例,其中死亡18例。57例发生急性肾功能损伤,发生率47.5%,死亡12例。尿NAG活性和尿RBP、β_2-MG水平出生后1、3、7 d在正常对照组无明显变化(P均>0.05),在窒息组逐次递降(P<0.01,P<0.05);组间比较,出生后1、3 d时三项指标在窒息组不同程度高于对照组,在7 d时窒息组均降至与正常对照组相近水平(P均>0.05)。尿NAG活性和尿RBP、β_2-MG水平出生后1、3、7 d在窒息组肾损伤与无肾损伤患儿均逐次递降(P<0.01,P<0.05);但无肾损伤患儿在出生后3 dβ_2-MG水平即恢复至与正常对照组相近水平,而肾损伤患儿在出生后不同时点直至7 d时三项指标仍均高于无肾损伤患儿(P均<0.01)。结论窒息新生儿尿NAG活性和尿RBP、β_2-MG水平显著高于健康儿童,但无肾损伤患儿会逐渐降低接近正常水平而肾损伤患儿仍保持较高水平。
Objective To investigate the relationship between urinary acetyl-β-D-glucosaminidase (NAG) activity, urinary retinol binding protein (RBP), β 2-microglobulin (β 2-MG) levels and renal dysfunction in neonatal asphyxia. Methods 120 asphyxial newborns (asphyxia group) and 50 normal newborn infants (control group) were selected from August 2013 to August 2015 in obstetrics. The urinary RBP, β 2-MG levels and NAG activity of neonatal asphyxia group and control group were detected at 1, 3, 7 days after birth by enzyme-linked immunosorbent assay (ELISA) and p-nitrophenol colorimetry. Results Asphyxia group of 120 patients, 48 cases of severe asphyxia, mild asphyxia in 72 cases, of which 18 died. 57 cases of acute renal injury, the incidence rate of 47.5%, 12 deaths. Urine NAG activity and urinary RBP, β 2-MG levels at 1, 3, 7 days after birth in the normal control group had no significant changes (P> 0.05), in the asphyxia group decreased successively (P <0.01, P < Compared with the control group, the three indexes in the asphyxia group were lower than those in the control group at 1 and 3 days after birth, and the levels in the asphyxia group dropped to similar level with the normal control group on the 7th day (all P> 0.05). Urine NAG activity and urinary RBP and β_2-MG levels decreased gradually in children with and without renal injury at 1, 3 and 7 days after birth (P <0.01, P <0.05) The levels ofβ_2-MG at 3 days after birth recovered to the same level as those in the normal control group. However, the indexes of children with renal injury were still higher than those without renal injury at different time points after birth until 7 days (P <0.01) . Conclusions The urinary NAG activity and urinary RBP and β_2-MG levels in neonates with asphyxia were significantly higher than those in healthy children, but the children without renal injury gradually decreased to near normal level while the children with renal injury maintained a high level.