尿IL-18、转铁蛋白和β2微球蛋白在新生儿窒息致急性肾损伤早期诊断中的价值  

Urinary IL-18,TRF and β2-MG levels for early diagnosis of asphyxia-induced acute renal injury in neonates

作　　者：张丽亚[1] 陈黎丽[1] 罗芳[1] ZHANG Liya;CHEN Lili;LUO Fang(Department of Neonatology,Ningbo Women and Children’s Hospital,Ningbo 315000,China)

机构地区：[1]宁波市妇女儿童医院新生儿科

出　　处：《浙江医学》2019年第18期1932-1937,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2018KY718)

摘　　要：目的探讨尿IL-18、转铁蛋白(TRF)、β2微球蛋白(β2-MG)在新生儿窒息致急性肾损伤(AKI)早期诊断中的价值。方法选取发生窒息未诊断AKI足月新生儿50例、发生窒息合并AKI足月新生儿50例、同期健康的足月新生儿50例为研究对象。采集新生儿出生后、间隔48h静脉血检测血清肌酐(Scr);收集出生后0~6h、6~12h、12~24h、24~48h尿液,采用ELISA法检测尿IL-18,免疫比浊法检测尿TRF和β2-MG。比较3组对象各项指标不同时段检测结果的变化,同时对不同时段3项指标诊断新生儿窒息致AKI的效能进行ROC曲线分析。结果除出生后0~6h尿TRF外,其余不同时段尿IL-18、β2-MG、TRF 3组对象比较,差异均有统计学意义(均P<0.05)。窒息合并AKI组4个时段尿IL-18、β2-MG、TRF比较,以及窒息未诊断AKI组4个时段尿β2-MG、TRF比较,差异均有统计学意义(均P<0.05);正常对照组4个时段尿IL-18、β2-MG、TRF比较,以及窒息未诊断AKI组4个时段尿IL-18比较,差异均无统计学意义(均P>0.05)。随着AKI分级增高,各时段尿IL-18、β2-MG及TRF不断增高;随着尿标本留取时间的延长,AKI患者尿IL-18、β2-MG及TRF不断增高。0~6h尿IL-18的诊断效能最高(AUC为0.65);6~12h尿β2-MG的诊断效能最高(AUC为0.85);12~24h尿β2-MG、TRF的诊断效能最高(AUC均为0.96);24~48h尿β2-MG、TRF的诊断效能最高(AUC均为1.00)。3者联合诊断效能均优于单项指标,0~6h、6~12h、12~24h、24~48h的AUC分别为0.77、0.96、1.00、1.00。结论尿IL-18、β2-MG和TRF在新生儿窒息致AKI早期诊断中具有一定的临床价值,0~6h尿IL-18诊断效能最高,之后其诊断效能低于TRF和β2-MG,3者联合诊断效能优于单项指标,可明显缩短诊断时间。Objective To explore the value of urinary IL-18,TRF andβ2-MG levels for early diagnosis of acute kidney injury(AKI)caused by neonatal asphyxia.Methods Fifty full term newborns with neonatal asphyxia and without AKI and 50 full term newborns with neonatal asphyxia and AKI,and 50 normal term neonates(normal control)were enrolled in the study.Serum creatinine(Scr)was measured 48 h after birth.Urine samples were collected at 0~6 h,6~12 h,12~24 h and 24~48 h after birth.Scr was detected by UV spectrophotometry,urinary IL-18 was detected by ELISA,TRF andβ2-MG were detected by immunoturbidimetry.The diagnostic value of urinary IL-18,TRF andβ2-MG for acute renal injury was analyzed by ROC curve.Results Except urinary TRF at 0~6 h after birth,there were significant differences in urinary IL-18,β2-MG and TRF levels at different time points among three groups(P<0.05).The urinary IL-18,β2-MG and TRF levels in neonates with asphyxia and AKI;and urinaryβ2-MG and TRF levels in neonates with asphyxia and without AKI were significantly different among different time points after birth(both P<0.05).The urinary IL-18,β2-MG and TRF in normal control group and IL-18 in newborns with asphyxia and without AKI at all time points after birth were not significantly different(both P>0.05).The urinary IL-18,β2-MG and TRF levels increased with the increasing of AKI grading;and increased with the prolonged time points after birth in AKI patients.The urinary IL-18 levels at 0~6 h after birth had the highest diagnostic efficiency(AUC was 0.65);the urinaryβ2-MG levels at 6~12 h after birth had the highest diagnostic efficiency(AUC of 0.85);the AUCs of urinaryβ2-MG combined with TRF at 12~24 h and at 24~48 h after birth were 0.96 and 1.00,respectively.The diagnostic efficacy of combined IL-18,TRF andβ2-MG was higher than that of the single index,with the AUCs of 0.77,0.96,1.00 and 1.00 at 0~6 h,6~12 h,12~24 h and 24-48 h,respectively.Conclusion Urinary IL-18,β2-MG and TRF have certain clinical value in the early diagnosis of AKI cause

关 键 词：急性肾损伤 新生儿窒息 IL-18 转铁蛋白 Β2微球蛋白 

分 类 号：R722.1[医药卫生—儿科] R446.12[医药卫生—临床医学]