高胆红素血症足月新生儿血清胱抑素C及尿β<sub>2</sub>-微球蛋白水平变化及临床意义

doi:10.3877/cma.j.issn.1673-5250.2013.06.020

目的

观察高胆红素血症足月新生儿血清胱抑素C(CysC)及尿β₂-微球蛋白(β₂-MG)水平变化，探讨高胆红素血症对足月新生儿肾功能的影响。

方法

选择2011年6月至2013年6月广元市中心医院新生儿科住院的患高胆红素血症的足月新生儿70例为研究对象（为高胆红素血症组）。再将其按照血清胆红素(TBIL)水平值进一步分为：轻度亚组(n = 32)，血清TBIL为(220. 6～342.0)μmol/L_；重度亚组（n = 38）,TBIL>342.0 μmol/L。按照入院顺序号随机选取同期广元市中心医院分娩的正常足月新生儿（血清未结合胆红素<85.5 μmol/L）为对照组(n = 30)（本研究遵循的程序符合广元市中心医院人体试验委员会制定的伦理学标准，得到该委员会批准，征得受试对象监护人知情同意，并与监护人签署临床研究知情同意书）。高胆红素血症组及对照组均排除先天畸形、感染及窒息等新生儿。高胆红素血症组与对照组新生儿性别、孕龄、分娩方式、Apgar评分、出生体重及日龄等比较，差异无统计学意义(P>0.05)。采用全自动生化仪测定血清CysC含量；采用化学发光免疫分析法测定尿β₂-MG含量。采用SPSS13. 0统计学软件包进行统计学处理。

结果

重度亚组新生儿血清CysC、尿β₂-MG平均值显著高于轻度亚组新生儿，差异有统计学意义(P<0.01)；轻度亚组血清CysC、尿β₂-MG与对照组平均值比较，差异无统计学意义(P>0.05)；重度亚组血清CysC、尿β₂-MG与对照组平均值比较，差异有统计学意义(P<0.01)；轻度亚组新生儿治疗前后血清CysC、尿β₂-MG比较，差异无统计学意义(P>0. 05)；重度亚组新生儿治疗前后血清CysC、尿β₂-MG比较，差异有统计学意义(P<0.01)。高胆红素血症新生儿血清TBIL与血清CysC、尿β₂-MG存在正相关性，血清CysC与尿β₂-MG亦存在正相关性。

结论

在患高胆红素血症的足月新生儿中，重度高胆红素血症可造成新生儿肾脏损害。血清CysC及尿β₂-MG可作为高胆红素血症新生儿肾功能早期损害的检测指标。

关键词: 新生儿高胆红素血症, 胱抑素C, β₂-微球蛋白, 新生儿

Objective

Investigate the changes of levels of serum cystatin C (CysC) and urinary β₂-Microglobulin (β₂-MG) in full-term neonates with hyperbilirubinemia. To explore the effect of hyperbilirubinemia on renal function in full-term neonates with hyperbilirubinemia.

Methods

A total of 70 full-term neonates with hyperbilirubinemia from June 2011 to June 2013 in our hospital were divided into two sub-groups:mild sub-group (n = 32) with serum bilirubin levels (220. 6 ~342. 0) μmol/L and severe subgroup (n = 38) with serum bilirubin levels more than 342. 0 μmol/L. 30 healthy full-term neonates with serum bilirubin levels less than 85. 5 μmol/L were recruited as control group. The general clinical data had no significant difference (P>0. 05). The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Central Hospital of Guangyuan. Informed consent was obtained from the parents of each participating patient. CysC were determined by processing Biology and Chemistry, β₂-MG were determined by chemiluminescence immunoassay(CLIA). SPSS 13. 0 software was used to analyze the data.

Results

Levels of serum CysC and urinary β₂-MG in the severe hyperbilirubinemia group were obviously higher than but those in severe hyperbilirubinemia group were significantly higher (P<0. 01) ; CysC and β₂-MG decreased significantly after therapy in severe hyperbilirubinemia (P<0. 01) , but there had no significant difference after therapy in mild hyperbilirubinemia (P>0.05). By linear correlation analysis, there had positive correlations between the levels of the serum CysC and urinary β₂-MG, serum CysC and serum bilirubin, urinary β₂-MG and serum bilirubin.

Conclusions

Severe hyperbilirubinemia can induce renal damage in neonates. Serum CysC and urinary β₂-MG can be as sensitive indicators for diagnosis of early renal dysfunction in hyperbilirubinemia.

Key words: hyperbilirubinemia, neonatal, cystatin C, beta 2-microglobulin, infant, newborn

表1 各组间血清CysC、尿β₂-MG比较(mg/L, ±s)

Table 1 Comparison of the Levels of CysC and β₂-MG among three groups(mg,/L, ±s)

组别	n	血清TBIL (?μmol?/L)	血清?CysC?	尿β₂-MG
轻度亚组	32	307. 81 ± 45. 26^a	2. 18±0. 47^d	1. 65 ± 0. 32^g
重度亚组	38	402. 29±143. 87^b	3. 15±0. 51^e	2. 49±0. 46^h
对照组	30	67. 32 ± 27. 42^c	1. 64 ± 0. 44^f	1. 23±0. 24ⁱ
t		^a vs.^b, 4. 11	^d vs. ^e ,5. 37	^g vs. ^h, 4. 88
		^a vs. ^c,4. 52	^d vs. ^f, 2. 35	^g vs. ⁱ, 2. 78
		^b vs. ^c, 6. 57	^e vs. ^f, 5. 33	^h vs. ⁱ, 4. 65
P		^a vs. ^b, <0.05	^d vs. ^e, <0.01	^g vs. ^h, <0. 01
		^a vs. ^c, <0.01	^d vs. ^f, >0. 05	^g vs. ⁱ, >0. 05
		^b vs. ^c, <0.01	^e vs. ^f, <0.01	^h vs. ⁱ, <0.01

表1 各组间血清CysC、尿β₂-MG比较(mg/L, ±s)

Table 1 Comparison of the Levels of CysC and β₂-MG among three groups(mg,/L, ±s)

组别	n	血清TBIL (?μmol?/L)	血清?CysC?	尿β₂-MG
轻度亚组	32	307. 81 ± 45. 26^a	2. 18±0. 47^d	1. 65 ± 0. 32^g
重度亚组	38	402. 29±143. 87^b	3. 15±0. 51^e	2. 49±0. 46^h
对照组	30	67. 32 ± 27. 42^c	1. 64 ± 0. 44^f	1. 23±0. 24ⁱ
t		^a vs.^b, 4. 11	^d vs. ^e ,5. 37	^g vs. ^h, 4. 88
		^a vs. ^c,4. 52	^d vs. ^f, 2. 35	^g vs. ⁱ, 2. 78
		^b vs. ^c, 6. 57	^e vs. ^f, 5. 33	^h vs. ⁱ, 4. 65
P		^a vs. ^b, <0.05	^d vs. ^e, <0.01	^g vs. ^h, <0. 01
		^a vs. ^c, <0.01	^d vs. ^f, >0. 05	^g vs. ⁱ, >0. 05
		^b vs. ^c, <0.01	^e vs. ^f, <0.01	^h vs. ⁱ, <0.01

表2 高胆红素血症治疗前后CysC、β₂-MG比较（mg/L，±s）

Table 2 Comparison of the levels of CysC and β₂-MG in the hyperbilirubinemia groups before and after therapy(mg/L, ±s)

组别	?	?CysC?				β₂-MG
组别	?	治疗前	治疗后	t	P	治疗前	治疗后	t	P
轻度亚组	32	2. 18±0. 47	1. 83 ± 0. 42	2. 34	>0. 05	1. 65 ± 0. 32	1. 41±0. 34	1. 97	>0. 05
重度亚组	38	3. 15±0. 51	1. 94 ± 0. 39	6. 345	<0.01	2. 49 ± 0. 46	1. 53 ± 0. 38	7. 534	<0.01

表2 高胆红素血症治疗前后CysC、β₂-MG比较（mg/L，±s）

Table 2 Comparison of the levels of CysC and β₂-MG in the hyperbilirubinemia groups before and after therapy(mg/L, ±s)

组别	?	?CysC?				β₂-MG
组别	?	治疗前	治疗后	t	P	治疗前	治疗后	t	P
轻度亚组	32	2. 18±0. 47	1. 83 ± 0. 42	2. 34	>0. 05	1. 65 ± 0. 32	1. 41±0. 34	1. 97	>0. 05
重度亚组	38	3. 15±0. 51	1. 94 ± 0. 39	6. 345	<0.01	2. 49 ± 0. 46	1. 53 ± 0. 38	7. 534	<0.01

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The Changes and Its Clinical Significance of Serum Cystatin C and Urinary β₂-Microglobulin Levels in Full-Term Neonates With Hyperbilirubinemia

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The Changes and Its Clinical Significance of Serum Cystatin C and Urinary β2-Microglobulin Levels in Full-Term Neonates With Hyperbilirubinemia

The Changes and Its Clinical Significance of Serum Cystatin C and Urinary β₂-Microglobulin Levels in Full-Term Neonates With Hyperbilirubinemia