早产儿高胆红素血症与肾损伤的关系及相关影响因素  

Association between hyperbilirubinemia and kidney injury in preterm infants and related influencing factors

作　　者：古丽[1] 黄薇[1] 王模奎[1] 彭宇生[2] 王鹏[2] GU Li;HUANG Wei;WANG Mukui;PENG Yusheng;WANG Peng(Department of Newborns, Yibin First People's Hospital,Yibin644000,Sichuan Province,China;Department of Clinical labor-atory,the First People's Hospital of Yibin,Yibin644000,Sichuan Province,China)

机构地区：[1]宜宾市第一人民医院新生儿科,四川宜宾644000 [2]宜宾市第一人民医院检验科,四川宜宾644000

出　　处：《西南医科大学学报》2018年第6期514-521,共8页Journal of Southwest Medical University

基　　金：四川省教育厅重点基金项目(08ZA150);宜宾市卫生和计划生育委员会资助项目[宜卫发(2016)238号]

摘　　要：目的:探讨早产儿高胆红素血症与肾损伤的关系及相关影响因素,评价血清胱抑素C(cystatin c, Cys-C)、尿微量白蛋白(microalbumin, m Alb)、尿α1-微球蛋白(alpha 1-microglobulin,α1-MG)和β2-微球蛋白(beta 2-microglobulin,β2-MG)联合检测在早产儿高胆红素血症性肾损伤中的临床应用价值。方法:选择2017年3月至2018年5月在宜宾市第一人民医院新生儿科住院治疗的100例高胆红素血症早产患儿(黄疸组)和76例无黄疸早产患儿(对照组)作为研究对象。首先根据入院时血清总胆红素(total serum bilirubin, TSB)浓度,将黄疸组进一步分为轻度黄疸亚组(n=44)、中度黄疸亚组(n=34)和重度黄疸亚组(n=22)。其次根据是否发生肾损伤及损伤类型,将黄疸组分为无肾损伤组(n=62)、单纯肾小管损伤组(n=18)和混合型肾损伤组(n=20)。采集受试者静脉血及尿液检测血清TSB浓度、Cys-C、尿m Alb、尿α1-MG及尿β2-MG含量。统计学比较黄疸组与对照组间血清Cys-C及上述3项尿微量蛋白含量差异,比较黄疸组不同类型肾损伤患儿11项一般临床资料差异,将有统计学意义的结果代入Logistic回归方程进行多因素分析,确定与早产儿高胆红素血症肾损伤发生有关的主要影响因素。结果:(1)轻度、中度黄疸亚组的尿α1-MG和β2-MG含量高于对照组;重度黄疸亚组的尿mAlb、α1-MG和β2-MG含量均高于对照组;重度黄疸亚组的尿α1-MG和β2-MG含量高于轻度黄疸亚组,上述差异均有统计学意义(P <0.05);轻度、中度和重度黄疸亚组及对照组之间血清Cys-C含量比较,差异无统计学意义(P> 0.05)。(2)100例黄疸早产患儿中发生肾损伤38例,肾损伤发生率为38%;从轻度黄疸亚组到重度黄疸亚组,TSB越高,肾损伤发生率越高,差异有统计学意义(P <0.05)。(3)单纯肾小管损伤组与无肾损伤组比较,日龄小,病程短,出生后首次出现黄疸时间早;混合型肾损伤组与无肾损伤组比较,血清TSB�Objective: To investigate the association between hyperbilirubinemia and kidney injury in preterm infants and related influencing factors, as well as the clinical value of combined measurement of serum cystatin C(Cys-C), urinary microalbumin(mAIb), urinary α1-microglobulin(α1-MG), and β2-microglobulin(β2-MG) in thediagnosis of hyperbilirubinemic kidney injury in preterm infants.Methods:A total of 100 preterm infants with hy-perbilirubinemia(enrolled as jaundice group) and 76 preterm infants without jaundice(enrolled as control group),who were hospitalized and treated in The First People’s Hospital of Yibin from March 2017 to May 2018, were en-rolled as subjects. According to total serum bilirubin(TSB) on admission, the jaundice group was further divided intomild jaundice subgroup with 44 infants, moderate jaundice subgroup with 34 infants, and severe jaundice subgroupwith 22 infants; according to the presence or absence of kidney injury and its type, the jaundice group was divided in-to non-injury group with 62 infants, simple renal tubular injury group with 18 infants, and mixed injury group with20 infants. Venous blood samples and urine samples were collected form all subjects to measure the levels of TSB,serum Cys-C, urinary mAIb, urinary α1-MG, and urinary β2-MG. A statistical analysis was performed to comparethe differences in serum Cys-C, urinary m AIb, urinary α1-MG, and urinary β2-MG between the jaundice group andthe control group. A total of 11 items of general clinical data were compared between the infants in the jaundicegroup with different types of kidney injury, and the indices with statistical difference were included in the logistic re-gression for multivariate analysis to determine the main influencing factors for kidney injury in preterm infants withhyperbilirubinemia. Results: Compared with the control group, the mild and moderate jaundice subgroups had sig-nificantly higher levels of urinary α1-MG and β2-MG(P < 0.05); compared with the control group, the severe jaun-dice subgroup h

关 键 词：高胆红素血症 胱抑素C 蛋白尿 Α1-微球蛋白 Β2-微球蛋白 急性肾损伤 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]