摘要
目的探讨尿液中胱抑素C(Cys C)、肾损伤分子-1(KIM-1)及中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在高胆红素血症早产儿早期肾损伤诊断中的价值。方法选择2011年12月至2015年12月郑州儿童医院新生儿内科住院治疗的115例高胆红素血症早产儿为研究对象,根据患儿血清总胆红素(TBIL)水平分为重度组(n=31)、中度组(n=38)和轻度组(n=46);另选择同期非高胆红素血症早产儿30例为对照组。检测各组患儿尿Cys C、KIM-1、NGAL和血肌酐(SCr)、血尿素氮(BUN)水平,并进行比较分析。结果 4组患儿BUN水平比较差异均无统计学意义(F=2.124,P=0.099)。重度组患儿SCr水平显著高于对照组和轻度组(P<0.05),重度组与中度组患儿SCr水平比较差异无统计学意义(P>0.05);轻度组、中度组和对照组患儿SCr水平比较差异均无统计学意义(P>0.05)。轻度组、中度组、重度组患儿尿NGAL、Cys C、KIM-1水平均高于对照组(F=161.939、966.211、166.684,P=0.000)。轻度组、中度组、重度组患儿尿NGAL、Cys C、KIM-1水平逐渐升高,组间两两比较差异均有统计学意义(P<0.05)。高胆红素血症早产儿血清TBIL水平与尿NGAL、Cys C、KIM-1水平呈正相关(r=0.649、0.869、0.744,P<0.01),与SCr和BUN水平无显著相关(r=-0.010、0.098,P>0.05)。当尿NGAL水平以3.91μg·L^(-1)为截点时,其诊断高胆红素血症早产儿肾损伤的敏感度和特异度分别为94.6%和90.0%;当尿Cys C水平以0.063 mg·L^(-1)为截点时,其诊断高胆红素血症早产儿肾损伤的敏感度和特异度分别为93.0%和98.5%;当尿KIM-1水平以3.28 ng·L^(-1)为截点时,其诊断高胆红素血症早产儿肾损伤的敏感度和特异度分别为78.3%和82.1%。结论尿NGAL、Cys C水平在高胆红素血症早产儿肾损伤的诊断中敏感度和特异度均较高。
Objective To investigate the diagnosis value of urinary cystatin C（ Cys C）,kidney injury molecule-1（ KIM-1） and neutrophil gelatinase-associated lipocalin（ NGAL） in early kidney injury induced by hyperbilirubinemia in preterm infants. Methods A total of 115 preterm infants with hyperbilirubinemia hospitalized in the Department of Neonatology,Zhengzhou Children’s Hospital from December 2011 to December 2015 were selected. All preterm infants were divided into severe group（ n = 31）,moderate group（ n = 38） and mild group（ n = 46） according to the level of serum total bilirubin（ TBIL）.Thirty preterm infants without hyperbilirubinemia in the same time were selected as control group. The levels of urinary Cys C,urinary KIM-1,urinary NGAL,serum creatinine（ SCr） and serum urea nitrogen（ BUN） in each group were detected and compared. Results There was no significant difference in BUN levels between any two groups among the four groups（ F = 2. 124,P = 0. 099）. The SCr level in the severe group was significantly higher than that in the control group and the mild group（ P 〈0. 05）; there was no significant difference in SCr level between the moderate group and the severe group（ P 〉 0. 05）. There was no significant difference in SCr levels among the mild group,moderate group and severe group（ P 〉 0. 05）. Compared with the control group,the levels of urinary NGAL,Cys C and KIM-1 in the mild group,moderate group and severe group were significant higher than those in the control group（ F = 161. 939,966. 211,166. 684; P = 0. 000）. The level of urinary NGAL,Cys C and KIM-1 increased gradually in the mild group,moderate group and severe group,and the differences were statistically significant between any two groups（ P 〈 0. 05）. The urinary NGAL,Cys C,KIM-1 levels were positively correlated with TBIL in the preterm infants with hyperbilirubinemia（ r = 0. 649,0. 869,0. 744; P 〈 0. 01）. The BUN and SCr levels had no correlation with TBIL（ r = 0. 098,-0. 010; P 〉 0. 05）. When the urinary NGAL level was 3. 91 μg·L-1,the sensitivity and specificity of it in diagnosing early renal injury induced by hyperbilirubinemia in premature infants was 94. 6% and 90. 0% respectively.When the urinary Cys C level was 0. 063 mg·L-1,the sensitivity and specificity of it in diagnosing early renal injury induced by hyperbilirubinemia in premature infants was 93. 0% and 98. 5% respectively. When the urinary KIM-1 level was 3. 28 ng·L-1,the sensitivity and specificity of it in diagnosing early renal injury induced by hyperbilirubinemia in premature infants was 78. 3% and 82. 1% respectively. Conclusion The sensitivity and specificity of urinary NGAL and Cys C in diagnosing early renal injury induced by hyperbilirubinemia in premature infants is high.
作者
和东阳
张迎辉
吴跃伟
HE Dong-yang;ZHANG Ying-hui;WU Yue-wei(Department of Nephrology and Rheumatology,Children＇s Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,Henan Province,China;Department of Rehabilitation,Children＇s Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2018年第5期385-388,392,共5页
Journal of Xinxiang Medical University
