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目的探讨围产期新生儿高胆红素血症血胆红素、血胱抑素C的变化及其对肾脏损害的评估价值。方法选择2009年10月-2010年10月在本院住院的新生儿高胆红素血症患儿44例为观察组,按黄疸程度分为轻度黄疸,220-265μmol/L,中度黄疸265-342μmol/L,重度黄疸≥342μmol/L,对照组为同期在本科住院的无新生儿高胆红素血症的新生儿40例,所有患儿在入院当天抽股静脉血3毫升,查肝功、肌酐、尿素氮、β2微球蛋白及胱抑素C,黄疸消退后复查血胆红素及胱抑素C,并做统计学处理。结果轻度组21例,中重度组23例,对照组40例,观察组与对照组在总胆红素及间接胆红素数值有显著性差异(P<0.01);观察组与对照组肌酐、尿素氮无显著性差异(P>0.05);观察组胱抑素C、β2微球蛋白显著高于对照组(P<0.01,P<0.05),提示黄疸程度越重,血胱抑素C及β2微球蛋白值越高,肾脏损害越重,经治疗后,观察组总胆红素、胱抑素C及β2微球蛋白水平明显下降,与治疗前比较有显著性差异(P<0.01,P<0.05),观察组治疗后血胱抑素C显著下降,与对照组比较无显著性差异(P>0.05),观察组血胱抑素C、β2微球蛋白、尿素氮与总胆红素值之间的关系:血清CysC、β2-MG与TBil值呈正相关(r分别为0.71、0.42,P均<0.01);尿素氮、肌酐与总胆红素值之间无相关性(r=0.24,P>0.05)。结论新生儿高胆红素血症可造成肾脏损害,围产儿尤其明显,但它对肾脏损害是暂时的,可逆的,通过对新生儿高胆红素血症的患儿检测血胱抑素C,可以早期发现肾损害,避免使用肾损伤药物,及早进行干预,提高本病的治愈率。
Objective To investigate the changes of serum bilirubin and serum cystatin C in neonates with perinatal neonatal hyperbilirubinemia and evaluate the value of renal damage. Methods Forty-four neonates with hyperbilirubinemia admitted to our hospital from October 2009 to October 2010 were selected as the observation group. According to the degree of jaundice, 44 cases were divided into mild jaundice, 220-265μmol / L, moderate jaundice 265-342μmol / L, severe jaundice ≥342μmol / L, the control group for the same period in hospital undergraduate neonatal hyperbilirubinemia 40 newborns, all children on the day of admission pumping 3 ml of venous blood, check Liver function, creatinine, urea nitrogen, β2 microglobulin and cystatin C, jaundice subsided after the review of serum bilirubin and cystatin C, and statistical analysis. Results There were 21 cases in mild group, 23 cases in moderate and severe group and 40 cases in control group. There was significant difference between total bilirubin and indirect bilirubin in observation group and control group (P <0.01) (P <0.05). The levels of cystatin C and β2 microglobulin in the observation group were significantly higher than those in the control group (P <0.01, P <0.05), suggesting that the more severe the jaundice, the higher the level of cystatin C And the higher the value of β2-microglobulin, the more damage the kidneys. After treatment, the levels of total bilirubin, cystatin C and β2-microglobulin in the observation group decreased significantly compared with those before treatment (P <0.01 , P <0.05). The level of cystatin C in the observation group decreased significantly compared with the control group (P> 0.05). The levels of cystatin C, β2 microglobulin, urea nitrogen and total gall There was a positive correlation between serum CysC, β2-MG and TBil (r = 0.71, 0.42, P <0.01 respectively). There was no correlation between urea nitrogen, creatinine and total bilirubin = 0.24, P> 0.05). Conclusion neonatal hyperbilirubinemia can cause kidney damage, perinatal children is particularly evident, but it is temporary and reversible renal damage, through the detection of neonatal hyperbilirubinemia in children with cystatin C , Early detection of renal damage, avoid the use of kidney injury drugs, early intervention to improve the cure rate of the disease.