| Objective: By detecting urine IL-18 level and the cystatin C(Cys-C)level of cysteine protease inhibitor liquor between asphyxiated newborns and normal newborns,to explore the changes of urine IL-18 combining Cys-C on asphyxiated newborns,analyze the correlations between each indicators under renal function damage and assess the practical values of urine IL-18 and Cys-C for asphyxiated newborn renal function damage's early diagnosis,illness state identification and prognostic analysis,so as to provide theoretical foundation for early diagnose and treatment of the renal function damage of asphyxiated newborn.Method: 50 cases of full-term asphyxiated newborns(in reference to the newborn asphyxia diagnosis and grading system in the fourth edition of Practical neonatology)are selected,including 32 cases in moderate asphyxia group and 18 cases in severe asphyxia group;and 50 cases of newborns in good general condition are selected as control group.Congenital diseases of urinary system shall be excluded for all selected newborns through urinary ultrasound.Respectively collect urine in 6h,24 h and 48 h after birth,detect the values of urine IL-18 and urine Cys-C through enzyme linked immune sorbent assay(ELISA),the blood Cys-C value of newborn patients at admission and during convalescence,and the traditional indicator values of urine ?2-MG and urinary transferrin.According to the estimateglomerular filtration rate(eGFR)calculated and estimated by Schwartz formula,compare the changes of all indicators above for each groups during various periods.Setting eGFR as the assessment standard of renal function damage,compare the different results of detecting data between asphyxia group and normal group,as well as moderate and severe asphyxia groups,specify the clinical significance of urine IL-18 combining with Cys-C on the early diagnosis for the acute kidney injury of asphyxiated newborn.Process the data obtained with statistical treatment by SPSS18.0 software.Results:1.Analysis of urine IL-18,urine Cys-C,?2-MG,TRF test results in the asphyxia group and the normal control group:Postnatal urine IL-18,Cys-C,?2-MG and TRF transferrin levels of 6h,24 h and 48 h in the asphyxia group were higher than those indicators in normal control group,with a statistical significance(P<0.05),and see table 2 for more details.The indicators in the severe asphyxia group increased more remarkably than those in the mild asphyxia group,with a statistical significance(P<0.05),and see table 3 for more details.There was already a significant difference of urine IL-18 and urine Cys-C between the first group,i.e.,postnatal 6h,and the control group(P<0.01),suggesting that the value of these two indicators in early diagnosis had an advantage over ?2-MG and TRF.2.Analysis of urine IL-18 and urine Cys-C's relevance with blood Cys-C,Scr and BUN with in 24 hours respectively: Urine IL-18 and Cys-C levels had a significant positive correlation with blood Cys-C,Scr and BUN(P<0.05)and a significant negative correlation with GFR(P<0.05).3.Analysis of the diagnosis value of urine IL-18,urine Cys-C,blood Cys-C,?2-MG,TRF,SCr and BUN for asphyxia newborn with renal impairment: It was found that urine IL-18 and Cys-C had highest sensitivity and specificity for combination diagnosis of AKI by comparing the blood and urine Cys-C,urine IL-18,?2-MG,transferrin,Scr and BUN levels of children 1 day after admission.Statistical analysis showed that their sensitivity was higher than that of single Cys-C and blood BUN,and their specificity was higher than that of Scr and BUN,both with a statistical significance.Conclusion:1?Blood Cys-C,urine Cys-C and urine IL-18 embrace significant values on newborns early AKI diagnosis and can be employed to early AKI diagnosis;2?There exists high correlation between the changes of urine Cys-C and blood Cys-C values.Combining urine IL-18 and urine Cys-C in early diagnosis had an advantage over free examination blood Cys-C.3?When compared with blood drawing which can be used for dynamic observation after multiple collections and solve the practical problems of repeated blood drawing difficulty of newborns. |
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