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目的动态观察高未结合胆红素血症新生儿血清胱抑素C(Cys C)及尿Cys C水平变化,探讨高未结合胆红素血症对新生儿肾功能的影响。方法选取2013年6月至2014年6月入住我院新生儿科的高未结合胆红素血症新生儿为观察组,根据入院第1天总胆红素(TBil)水平分为轻度组(221~255μmol/L)、中度组(256~341μmol/L)及重度组(≥342μmol/L);选取我院产科分娩的健康足月儿为对照组。观察组于入院第1、4、7天检测血、尿Cys C水平,对照组于入院第1天检测上述指标,并进行组间及组内比较。结果观察组共纳入58例,其中轻度组15例,中度组21例,重度组22例;对照组入选20名。入院第1天中度组尿Cys C水平高于对照组(P<0.05),重度组血、尿Cys C水平高于轻、中度组及对照组(P<0.05),其余各组间比较差异均无统计学意义(P>0.05);入院第1天,血、尿Cys C水平与血清TBil值成正相关(P<0.05)。中度组尿Cys C水平随时间变化呈下降趋势,重度组血、尿Cys C水平均随时间变化呈下降趋势。结论中、重度高未结合胆红素血症新生儿可合并肾功能损伤,经积极治疗后,肾功能逐渐恢复。血、尿Cys C水平对评价新生儿早期肾功能损伤有重要临床意义。
Objective To observe the changes of serum cystatin C (Cys C) and urinary Cys C levels in neonates with high unbound bilirubin to investigate the effects of high unbound bilirubin on renal function in neonates. Methods From June 2013 to June 2014, neonates with un-combined hyperbilirubinemia admitted to our department of neonatology were selected as the observation group. According to the level of total bilirubin (TBil) on admission day 1, the patients were divided into mild group 221 ~ 255μmol / L), moderate group (256 ~ 341μmol / L) and severe group (≥342μmol / L). Healthy full-term infants in our hospital were selected as control group. The observation group on the 1st, 4th and 7th day of admission, blood and urine Cys C levels in the control group on the first day of admission to detect the above indicators, and intra-group and intra-group comparison. Results A total of 58 cases were included in the observation group, including 15 mild cases, 21 moderate cases and 22 severe cases. The control group was enrolled in 20 cases. On the first day after admission, urinary Cys C levels were higher in the moderate group than those in the control group (P <0.05), and Cys C levels in the severe group were higher than those in the mild and moderate groups (P <0.05) There was no significant difference between the two groups (P> 0.05). On the first day after admission, serum Cys C levels were positively correlated with serum TBil (P <0.05). The urine Cys C level in the moderate group showed a decreasing trend with time, and the levels of Cys C in the blood and urine of the severe group showed a decreasing trend with time. Conclusions: Neonatal children with moderate or severe unconjugated bilirubin may have renal dysfunction. After active treatment, renal function gradually recovers. Blood, urine Cys C levels in the evaluation of early neonatal renal injury has important clinical significance.