摘要
目的探讨尿白细胞介素-18(IL-18)、半胱氨酸蛋白酶抑制剂C(Cys-C)对窒息新生儿急性肾损伤(AKI)早期诊断的价值。方法选取2017年1月-2019年2月住院治疗的足月窒息新生患儿65例(其中轻度窒息38例、重度窒息27例)作为窒息组;选择同期正常的足月新生儿65例(均经超声检查无先天性泌尿系统疾病)为对照组。收集新生儿出生后6、24、48 h的新鲜尿液,采用酶联免疫吸附法(ELISA)测定新生儿尿液标本中IL-18及Cys-C水平;应用Logistic回归分析法分析校正混杂因素后尿IL-18及Cys-C水平与窒息新生儿AKI的相关性。应用受试者工作特征(ROC)曲线与其曲线下面积(AUC)评估新生儿尿液标本中IL-18及Cys-C水平对窒息新生儿AKI的早期预测价值。结果窒息组新生儿出生后6、24、48 h的尿液样本中IL-18及Cys-C水平明显高于对照组,差异有统计学意义(P<0.01);重度窒息组、轻度窒息组、对照组新生儿出生后24 h尿液标本中IL-18、Cys-C水平与血液Cys-C、血清肌酐(Scr)、血尿素氮(BUN)水平差异有统计学意义(P<0.01或0.05)。Logistic回归分析表明,校正胎龄、日龄、出生时身体质量及急性生理学(SNAP)评分等因素,尿液样本中IL-18及Cys-C水平与AKI间有明显相关性;尿液标本中IL-18及Cys-C的ROC曲线下面积(AUC)分别为0.691(95%CI:0.688~0.871)与0.898(95%CI:0.789~0.939)。结论检测尿液标本中IL-18及Cys-C水平在新生儿AKI早期诊断中具有重要意义,IL-18及Cys-C可作为窒息新生儿AKI早期临床诊断的可靠指标。
Objective To investigate the value of urinary IL-18(IL-18) and cysteinase inhibitor C(Cys-C) in the early diagnosis of acute renal injury in asphyxiated neonates. Methods Sixty-five full-term neonates with asphyxia(including 38 cases of mild asphyxia and 27 cases of severe asphyxia) admitted to the hospital from January 2017 to February 2019 were selected as the Asphyxia Group while another 65 cases of normal full-term neonates(without congenital urinary system diseases) of the same period were selected as the Control Group. The fresh urine of neonates was collected at 6, 24 and 48 hours after birth, and the levels of IL-18 and Cys-C in neonatal urine samples were measured with enzyme-linked immunosorbent assay(Elisa). The correlation between urinary IL-18 and Cys-C levels and AKI of asphyxiated neonates was analyzed with Logistic regression analysis after correction of confounding factors. The early predictive value of IL-18 and Cys-C levels in urine samples of asphyxiated neonates was evaluated by using the(ROC) curve of working characteristics of the subjects and the area(AUC) under the curve. Results The levels of IL-18 and Cys-C in 6, 24 and 48 h urine samples of the Asphyxia Group were significantly higher than those of the Control Group, the difference was statistically significant(P<0.01). There was significant difference in the levels of IL-18 and Cys-C in 24 h urine sample and serum levels of Cys-C, Scr and BUN among the Severe Asphyxia Group, Mild Asphyxia Group and Control Group(P<0.01 or 0.05). Logistic regression analysis showed that the levels of IL-18 and Cys-C in urine samples were significantly correlated with AKI after correction of gestational age, age in days, birth weight and acute physiological(SNAP) score. The areas under the ROC curve of IL-18 and Cys-C in urine samples were 0.691(95% CI:0.688-0.871) and 0.898(95% CI:0.789-0.939), respectively. Conclusion The detection of IL-18 and Cys-C levels in urine samples is of great significance in the early diagnosis of neonatal AKI. IL-18 and Cys
作者
杨雯
幸黔鲁
谢颖
YANG Wen;XING Qian-lu;XIE Ying(Zunyi Maternal and Child Health Center,Zunyi 563000,China;Department of Pediatrics,the Second Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)
出处
《广东医科大学学报》
2019年第6期696-699,共4页
Journal of Guangdong Medical University
