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目的探讨新生儿AB0溶血高胆红素血症血、尿胱抑素C(Cys C)变化及其临床价值。方法 2008年1月至2010年1月本科确诊为AB0溶血症引起高胆红素血症(TBil≥220.6μmol/L)的新生儿为观察组,根据胆红素水平分为轻度组(T Bil<256.5μmol/L)和中重度组(TBil≥256.5μmol/L)。同期自然分娩、无黄疸的新生儿为对照组。测定观察组入院24 h内及黄疸消退期、对照组生后2～3 d血清胆红素、血尿Cys C、β_2-微球蛋白(β_2-MG)、BUN、Scr值,并对资料进行统计学分析。结果轻度组18例,中重度组22例,对照组20例。中重度组血清Cys C、β_2-MG值高于对照组(P<0.05);轻度组、中重度组尿Cys C、β_2-MG值均高于对照组(P<0.05);中重度组血、尿Cys C、β_2-MG值均高于轻度组(P<0.05);血清胆红素与血、尿Cys C水平呈正相关(r= 0.627、0.538,P<0.01);血、尿Cys C水平分别与血、尿β_2-MG水平呈正相关(r=0.385、0.368,P<0.05)。观察组治疗后,血、尿Cys C值较治疗前明显下降(P<0.01)。结论高胆红素血症对新生儿肾功能有不同程度的损害,且对肾小管的损害早于肾小球,但肾损伤短暂、可逆;血、尿Cys C测定对新生儿早期肾功能损害的诊断、治疗及疗效判断均具有十分重要的临床指导价值。
Objective To investigate the changes and clinical value of serum and urinary cystatin C (Cys C) levels in neonates with hemolytic hyperbilirubinemia. Methods From January 2008 to January 2010, neonates with hyperbilirubinemia (TBil≥220.6μmol / L) who were diagnosed as AB0 haemolytic disease were selected as the observation group and divided into mild group (T Bil <256.5μmol / L) and moderate to severe group (TBil≥256.5μmol / L). The same period of natural childbirth, neonatal jaundice as a control group. The levels of serum bilirubin, Cys C, β 2-microglobulin (β 2-MG), BUN and Scr in 24 hours after admission and the regression of jaundice in the observation group and 2 to 3 days after birth in the control group were measured and the data were statistically analyzed Analysis. Results: Mild group of 18 cases, moderate and severe group of 22 cases, control group of 20 cases. Serum levels of Cys C and β_2-MG in the moderate and severe groups were higher than those in the control group (P <0.05). The levels of Cys C and β 2-MG in the moderate and severe groups were significantly higher than those in the control group (P <0.05) Cys C and β_2-MG in blood and urine were significantly higher than those in mild group (P <0.05). There was a positive correlation between serum bilirubin and Cys C level in blood and urine (r = 0.627,0.538, P <0.01) Cys C levels were positively correlated with blood and urine β 2-MG levels (r = 0.385,0.368, P <0.05). After treatment, the Cys C values of blood and urine in observation group decreased significantly (P <0.01). Conclusions Hyperbilirubinemia has different degrees of damage to neonatal renal function, and its damage to the renal tubules is earlier than that of the glomerulus. However, renal damage is transient and reversible. Cys C, The diagnosis, treatment and efficacy of judgment have very important clinical guidance value.