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目的探讨动态检测血清胱抑素C(ScysC)评估新生儿窒息(asphyxia of the newborn)患者肾小球滤过率(GFR)的应用价值。方法收集30例新生儿窒息病例,分别于生后30min和1、3、5、7d,采集血标本,分别测定Scy-sC、血清肌酐(Scr)、血清尿素(Urea)、内生肌酐清除率(CCr),比较Apgar评分与Scys、CScr、Urea、CCr的相关性。结果新生儿窒息患者ScysC、Scr、Urea、CCr治疗后1、3、5、7与治疗前比较均有显著差异(P<0.05);随着肾功能的恢复,ScysC、Scr、Urea第1天分别下降了48.44%、33.68%、34.60%,Ccr提高了31.65%;新生儿窒息患者Apgar评分与ScysC、Scr、Urea、CCr具有明显的相关性,其相关系数和P值分别为:r=-0.820和P=0.000;r=-0.812和P=0.000;r=-0.809和P=0.000;r=0.753和P=0.000;Scys、CScr、Urea、CCr评估新生儿窒息的敏感性分别为92.7%、83.3%、78.7%、80.7%;特异性分别为86.6%、82.2%、77.6%、80.1%;阳性预期值分别为83.4%、72.8%、69.5%、63.8%。结论 ScysC检测能比较准确评价新生儿窒息后的肾小球滤过率,优于Scr,具有临床应用价值。
Objective To investigate the value of dynamic detection of glomerular filtration rate (GFR) in asphyxia of the newborn by using serum cystatin C (ScysC). Methods Thirty cases of neonatal asphyxia were collected. Blood samples were taken at 30 min and 1, 3, 5 and 7 days after birth to determine the levels of Scy-sC, Scr, Urea and endogenous creatinine clearance (CCr) were compared between Apgar score and Scys, CScr, Urea, CCr correlation. Results There were significant differences in the levels of ScysC, Scr, Urea and CCr at 1, 3, 5, and 7 days after neonatal asphyxia (P <0.05). With the recovery of renal function, ScysC, Scr, Decreased 48.44%, 33.68%, 34.60%, 31.65% respectively. Apgar score was positively correlated with ScysC, Scr, Urea and CCr in neonates with asphyxia, the correlation coefficients and P values were r = - 0.820 and P = 0.000; r = -0.812 and P = 0.000; r = -0.809 and P = 0.000; r = 0.753 and P = 0.000 respectively. The sensitivity of Scys, CScr, Urea and CCr in assessing neonatal asphyxia were 92.7% , 83.3%, 78.7% and 80.7% respectively; the specificity were 86.6%, 82.2%, 77.6% and 80.1% respectively; the positive predictive values were 83.4%, 72.8%, 69.5% and 63.8% respectively. Conclusion ScysC can be more accurate evaluation of neonatal asphyxia after glomerular filtration rate, superior to Scr, with clinical value.