脓毒症新生儿早期肾损伤临床分析  

Clinical analysis of early renal injury in neonates with sepsis

作　　者：张宁[1] 陈蓉[2] 李博[3] 张春磊[2] 马常建[2] 高健[2] ZHANG Ning;CHEN Rong;LI Bo;ZHANG Chunlei;MA Changjian;GAO Jian(Department of Pediatrics,Weifang Medical University,Weifang 261053,China;Department of Neonatology,Weifang Maternal and Child Health Hospital;Department of Pediatrics,Zaozhuang Municipal Hospital)

机构地区：[1]潍坊医学院儿科学教研室,山东潍坊261053 [2]潍坊市妇幼保健院儿科 [3]枣庄市立医院儿科

出　　处：《潍坊医学院学报》2021年第3期230-233,共4页Acta Academiae Medicinae Weifang

基　　金：山东省医药卫生科技发展计划项目(项目编号:2018WS089)。

摘　　要：目的评估脓毒症新生儿伴早期肾损伤的发生情况以便及早预防和干预,以降低脓毒症肾损伤新生儿的发病率和死亡率。方法选取潍坊市妇幼保健院新生儿科收治的确诊为脓毒症的新生儿61例为观察组,同期正常新生儿10例作为对照组,其中,将脓毒症新生儿组分为肾小球损伤组和肾小球无损伤组。收集各组新生儿临床资料及血液和尿液标本,并估算新生儿肾小球滤过率(eGFR)以评估肾损伤。结果 (1)两组新生儿的性别、胎龄、出生体重、分娩方式及日龄等比较,差异无统计学意义(P>0.05)。(2)脓毒症组新生儿eGFR较正常对照组明显降低,差异有统计学意义(Z=-2.562,P=0.010);脓毒症组新生儿血肌酐(SCr)、血清胱抑素C(CysC)、尿微量白蛋白(UmAlb)及尿微量白蛋白(UmAlb)/尿肌酐(UCr)水平显著高于正常对照组,差异有统计学意义(P<0.05);两组新生儿血尿素氮(BUN)、尿酸(UA)及尿β2-微球蛋白(β2-MG)比较,差异无统计学意义(P>0.05)。(3)根据UmAlb升高与否,将脓毒症组新生儿组分为肾小球损伤组和肾小球无损伤组,其中61例脓毒症组新生儿伴肾小球损伤者21例(34.43%),无肾小球损伤者40例(65.57%),10例正常新生儿UmAlb均在正常范围;与正常新生儿比较,脓毒症组新生儿伴肾小球损伤者比例显著增高,差异有统计学意义(P<0.05)。结论脓毒症可导致新生儿不同程度的肾功能损害,联合SCr、CysC、UmAlb及UmAlb/UCr水平检测可及早发现新生儿脓毒症肾损伤。Objective To evaluate the incidence rate of early sepsis in neonates with sepsis, so as to prevent and intervene early, so as to reduce the incidence and mortality of neonatal sepsis.Methods Sixty-one cases of neonatal sepsis admitted to the Department of Neonatology of Weifang Maternal and Child Health Hospital were selected as the observation group, and 10 cases of normal newborns in the same period were selected as the control group.Clinical data, blood and urine samples were collected, and glomerular filtration rate(EGFR) was estimated to evaluate renal injury.Results(1)There were no significant differences in gender, gestational age, birth weight, delivery mode and age between the two groups(P>0.05).(2)The levels of serum creatinine(SCR),Cystatin C(CysC),urinary microalbumin(umalb) and urinary microalbumin(umalb)/urinary creatinine(UCR) in sepsis group were significantly higher than those in normal control group(P<0.05).There was no significant difference in blood urea nitrogen(BUN),uric acid(UA) and urine β2-microglobulin(β2-MG) between the two groups(P>0.05).(3)According to the increase of umalb, the neonatal group of sepsis was divided into glomerular injury group and glomerular non injury group.In 61 cases of sepsis group, 21 cases(34.43%) had glomerular injury, 40 cases(65.57%) had no glomerular injury, and 10 cases of normal newborns had umalb in the normal range;compared with normal newborns, the proportion of newborns with glomerular injury in sepsis group was significantly higher The difference was statistically significant(P<0.05).Conclusion Sepsis can lead to different degrees of renal damage in newborns.Combined detection of SCR,CysC,umalb and umalb/UCR levels can early detect neonatal sepsis renal injury.

关 键 词：新生儿 脓毒症 肾损伤 临床评估 

分 类 号：R726.9[医药卫生—儿科]