胎儿血清β_2-微球蛋白及α_1-微球蛋白评估泌尿系畸形胎儿肾功能  

Evaluation of fetal renal function by serum β_2-microglobulin and α_1 -microglobulin in the fetuses with urinary tract anomalies

作　　者：冯穗华[1] 方群[1] 陈健生[1] 王昌云[2] 

机构地区：[1]中山大学附属第一医院妇产科胎儿医学中心 [2]中山医科大学附属第一医院肾科

出　　处：《中华小儿外科杂志》2005年第9期467-471,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨胎儿血清β2-微球蛋白(β2-microglobulin,β2-MG)及α1-微球蛋白(α1-microglobulin,α1-MG)对评估胎儿肾功能的价值.方法通过脐带穿刺取得胎儿血,对134例产前诊断结果正常的胎儿(对照组)以及50例泌尿系畸形的胎儿,采用放射免疫分析法检测血清β2-MG及α1-MG含量.将对照组测得的结果建立参考值,通过与参考值比较,评价泌尿系畸形胎儿的肾功能.同时配对检测30例孕母和胎儿血清β2-MG、α1-MG、尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)含量.结果妊娠16～33周正常胎儿血清β2-MG、α1-MG含量分别为(4.77±0.86)mg/L、(47.86±9.88)mg/L,与孕周变化无相关;妊娠34周后含量下降,分别为(3.68±0.49)mg/L、(38.36±6.32)mg/L;严重泌尿系畸形或生后肾功能异常的胎儿β2-MG、α1-MG含量明显升高.作为评估胎儿肾功能的指标,α1-MG比β2-MG具有更高的敏感性和特异性.BUN和Cr在母、胎血清的含量呈正相关;而β2-MG、α1-MG的母、胎血清含量无相关.结论泌尿系畸形胎儿血清β2-MG、α1-MG含量的增高反映了肾小球滤过率的下降,它们均可作为产前检测胎儿肾功能和预测生后肾功能的指标.二者比较,α1-MG更为有效.血清BUN和Xr不能反映胎儿肾功能.Objective To investigate the values of serum β2-microglobulin （β2-MG） and αl-microglobulin （α1-MG） in evaluating fetal renal function. Methods Fetal blood samples were collected by cordocentesis from 50 fetuses with congenital urinary tract anomalies （UTAs）. One hundred and thirty-four fetuses without congenital anomalies detected by both ultrasonography and prenatal diagnosis were as control. Serum β2-MG and α1-MG concentrations were measured by radioimmunoassay in the control fetuses to establish a reference. Comparing the concentrations obtained in the fetuses with UTAs to this reference, fetal renal function was evaluated. Thirty pairs of maternal and normal fetal blood samples were collected to detect serum β2-MG, α1-MG, creatinine （Cr） and blood urea nitrogen （BUN）. Results During 16 to 33 weeks＇ gestation, fetal β2 MG and α1-MG concentrations were 4. 77 ± 0. 86 mg/L and 47.86 ± 9.88 mg/L respectively, which were independent on gestational age. After 34 weeks＇ gestation, both β2-MG and α1 MG were significantly decreased （3. 68 ± 0. 49 mg/L and 38. 36± 6. 32 mg/L, respectively）. However, the levels of these serum markers were significantly higher in these fetuses with severe UTAs or abnormal renal function after birth. As an indicator for fetal renal function, higher sensitivity and specificity were found in αl -MG than those in β2-MG （ sensitivity： 83. 33% vs 75.01%, specificity： 94. 74% vs 89. 47%. By studying 30 pairs of maternal-fetal serum samples, the results showed that there were positive correlations between maternal and fetal Cr and BUN concentrations, but no correlation in β2-MG and α1-MG was found between maternal and fetal serum concentrations. Conclusions The levels of fetal serum β2-MG and α1 MG are useful to predict fetal renal function, whereas Cr and BUN can not be used as the indicators for fetal renal function.

关 键 词：胎儿 泌尿系疾病 先天性 β2-微球蛋白 血清Β2-微球蛋白 Α1-微球蛋白 肾功能异常 泌尿系畸形 畸形胎儿 胎儿血清 

分 类 号：R714.5[医药卫生—妇产科学]