摘要目的 探讨新生儿硬肿症(SN)尿绒毛膜酶、血胱抑素C(Cys C)的改变能否作为评价肾功能的指标.方法 2009年6月至2013年3月我院收诊69例硬肿症新生儿作为硬肿症组(轻度39例和中重度30例).利用单克隆抗体,用免疫催化方法检测69例硬肿症组治疗前及30例正常新生儿(对照组)尿绒毛膜酶的浓度,并测定两组尿β2微球蛋白(β2-MG)浓度.同时,检测两组血Cys C、尿素氮(BUN)、肌酐(Cr)浓度.结果 硬肿症组尿绒毛膜酶、β2微球蛋白和血Cys C浓度[(40.09±7.29)U/L,(4.65±1.33) mg/L和(1.84±0.32) mg/L]高于对照组[(23.19±5.62) U/L,(2.49±0.77) mg/L和(1.07±0.25) mg/L](t值分别为10.34,7.47和10.55,P均＜0.01),且中重度硬肿症组尿绒毛膜酶、血Cys C浓度[(42.06±7.59) U/L,(1.93±0.34) mg/L]高于轻度组[(38.57±6.70) U/L,(1.77±0.29) mg/L](t值分别为2.24,2.11,P均＜0.05);硬肿症组尿绒毛膜酶、血Cys C的异常发生率分别为79.7％ (55/69)、72.5％ (50/69),显著高于尿β2微球蛋白52.2％ (36/69)(x2分别为12.95、12.11,P均＜0.01);硬肿症组中,尿绒毛膜酶与β2微球蛋白正相关(r=0.560,P＜0.01);血Cys C与BUN、Cr亦有正相关关系(r =0.314,0.287,P均＜0.05).结论 SN患儿肾功能损害多见,尿绒毛膜酶、血Cys C能灵敏地早期发现SN肾损害.

abstractsObjective To investigate the changes of urinary brush border membrane enzymes and serum cystatin C (Cys C) in newborns in order to develop early diagnostic indicators for sclerema neonatorum (SN) renal dysfunction.Methods Sixty-night cases with sclerema neonatorum and 30 cases of normal newborns were enrolled in this study.Of all sclerema neonatorum cases,39 cases were mild and 30 cases were moderate to severe sclerema neonatorum.Immunoca talytic assay method was adapted to detect the level of urinary brush border membrane.The levels of serum Cys C,blood urea nitrogen (BUN),creatinine (Cr) and urinary β32 microglobulin (β2-MG) in two groups were also measured.Results The levels of urinary brush border membrane enzyme,β2-MG and serum Cys C in sclerema neonatorum group were (40.09 ± 7.29) U/L,(4.65 ± 1.33) mg/L and (1.84 ± 0.32) mg/L,higher than those in control group ((23.19 ± 5.62) U/L,(2.49 ± 0.77) mg/L and (1.07 ± 0.25) mg/L; t =10.34,7.47 and 10.55,P ＜ 0.01).The levels of urinary brush border membrane enzyme and serum Cys C in moderate to severe sclerema neonatorum group were (42.06 ± 7.59) U/L and (1.93 ± 0.34) mg/L,higher than those in the mild group ((38.57 ± 6.70) U/L,(1.77 s0.29) mg/L;t =2.24,2.11,P ＜0.05).The abnormality rates of urinary brush border membrane enzyme and serum Cys C in sclerema neonatorum group were 79.7％ (55/69) and 72.5％ (50/69),higher than β2-MG abnormal rate (52.2％ (36/69),x2 =12.95,12.11,P ＜ 0.01).In sclerema neonatorum group,urinary brush border membrane enzyme was positively correlated with β2-MG (r =0.560,P ＜ 0.01),and serum Cys C was positively correlated with BUN,Cr (r =0.314,0.287,P ＜ 0.05).Conclusion Renal injury is common in SN.Urinary brush border membrane enzyme and serum Cys C are served as the diagnostic parameters for early detection of renal injury in SN.