尿白细胞介素18和血清高迁移率族蛋白1对新生儿窒息后急性肾损伤的诊断价值
|
摘要
目的探讨尿白细胞介素(IL)-18和血清高迁移率族蛋白1(HMGB1)对新生儿窒息后急性肾损伤的诊断价值。方法选取本院儿科2015年6月—2017年12月诊治的128例窒息新生儿(轻度窒息组80例,重度窒息组48例)作为研究组,根据出生后1周内是否发生急性肾损伤(AKI)情况分为急性肾损伤组(AKI组,56例)和非急性肾损伤组(非AKI组,72例);选取本院产科同期出生的64例健康新生儿作为对照组。检测出生后24 h内尿IL-18、血清HMGB1、肌酐(Scr)和尿素氮(BUN)水平;应用受试者工作特征曲线(ROC)评价尿IL-18和血清HMGB1对新生儿窒息后AKI的诊断价值。结果轻度窒息组和重度窒息组尿IL-18、血清HMGB1、Scr和BUN的水平高于对照组(P<0.05);轻度窒息组尿IL-18、血清HMGB1、Scr和BUN的水平低于重度窒息组(P<0.05)。AKI组尿IL-18、血清HMGB1、Scr和BUN的水平高于非AKI组(P<0.05);尿IL-18和血清HMGB1与Scr和BUN呈正相关(P<0.05)。ROC曲线分析结果显示,尿IL-18和血清HMGB1对新生儿窒息后AKI的诊断价值优于血清Scr和BUN。结论尿IL-18和血清HMGB1可作为早期诊断新生儿窒息后AKI的标志物。
Objective To investigate the diagnostic value of urinary interleukin-18(IL-18) and serum high mobility group protein-1(HMGB1) in acute renal injury after neonatal asphyxia.Methods A total of 128 asphyxiated newborns(80 cases in mild asphyxia group and 48 cases in severe asphyxia group) hospitalized in our hospital from June 2015 to December 2017 were selected as the study group. According to the occurrence of acute kidney injury(AKI) within one week after birth, they were divided into acute kidney injury group(AKI group, 56 cases) and non-acute kidney injury group(nonAKI group, 72 cases). At the same time,64 healthy newborns were selected as control group. The levels of urinary IL-18,serum HMGB1, creatinine(Scr) and urea nitrogen(BUN) were measured within 24 hours after birth. The diagnostic value of urinary IL-18 and HMGB1 for AKI after neonatal asphyxia were evaluated by using receiver operating curve(ROC).Results The levels of urinary IL-18, serum HMGB1, Scr and BUN were significantly higher in mild asphyxia group and severe asphyxia group than those in control group(P<0.05). The levels of urinary IL-18, serum HMGB1, Scr and BUN were significantly lower in mild asphyxia group than those in severe asphyxia group(P<0.05). The levels of urinary IL-18, serum HMGB1, Scr and BUN were significantly higher in AKI group than those in non-AKI group(P<0.05). The urinary IL-18 and serum HMGB1 were positively correlated with Scr and BUN(P<0.05). The ROC curve analysis showed that the diagnostic value of urinary IL-18 and serum HMGB1 were superior to serum Scr and BUN for AKI after neonatal asphyxia.Conclusion Urinary IL-18 and serum HMGB1 can be used as a marker for the early diagnosis of AKI after neonatal asphyxia.
Objective To investigate the diagnostic value of urinary interleukin-18(IL-18) and serum high mobility group protein-1(HMGB1) in acute renal injury after neonatal asphyxia.Methods A total of 128 asphyxiated newborns(80 cases in mild asphyxia group and 48 cases in severe asphyxia group) hospitalized in our hospital from June 2015 to December 2017 were selected as the study group. According to the occurrence of acute kidney injury(AKI) within one week after birth, they were divided into acute kidney injury group(AKI group, 56 cases) and non-acute kidney injury group(nonAKI group, 72 cases). At the same time,64 healthy newborns were selected as control group. The levels of urinary IL-18,serum HMGB1, creatinine(Scr) and urea nitrogen(BUN) were measured within 24 hours after birth. The diagnostic value of urinary IL-18 and HMGB1 for AKI after neonatal asphyxia were evaluated by using receiver operating curve(ROC).Results The levels of urinary IL-18, serum HMGB1, Scr and BUN were significantly higher in mild asphyxia group and severe asphyxia group than those in control group(P<0.05). The levels of urinary IL-18, serum HMGB1, Scr and BUN were significantly lower in mild asphyxia group than those in severe asphyxia group(P<0.05). The levels of urinary IL-18, serum HMGB1, Scr and BUN were significantly higher in AKI group than those in non-AKI group(P<0.05). The urinary IL-18 and serum HMGB1 were positively correlated with Scr and BUN(P<0.05). The ROC curve analysis showed that the diagnostic value of urinary IL-18 and serum HMGB1 were superior to serum Scr and BUN for AKI after neonatal asphyxia.Conclusion Urinary IL-18 and serum HMGB1 can be used as a marker for the early diagnosis of AKI after neonatal asphyxia.
引文
[1]Boskabadi H,Zakerihamidi M,Heidarzadeh M,et al.The value of serum pro-oxidant/antioxidant balance in the assessment of asphyxia in term neonates[J].J Matern Fetal Neonatal Med,2017,30(13):1556-1561.doi:10.1080/14767058.2016.1209655.
[2]曹晓燕,张惠荣,章伟,等.尿神经导向因子-1和肾损伤分子-1对窒息后新生儿急性肾损伤的诊断价值探讨[J].中国当代儿科杂志,2016,18(1):24-28.Cao XY,Zhang HR,Zhang W,et al.Diagnostic values of urinary netrin-1 and kidney injury molecule-1for acute kidney injury induced by neonatal asphyxia[J].Chin JContemp Pediatr,2016,18(1):24-28.doi:10.7499/j.issn.1008-8830.2016.01.006.
[3]Alaro D,Bashir A,Musoke R,et al.Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia[J].Afr Health Sci,2014,14(3):682-688.doi:10.4314/ahs.v14i3.26.
[4]Tanigasalam V,Bhat BV,Adhisivam B,et al.Predicting severity of acute kidney injury in term neonates with perinatal asphyxia using urinary neutrophil gelatinase associated lipocalin[J].Indian JPediatr,2016,83(12/13):1374-1378.doi:10.1007/s12098-016-2178-z.
[5]Hjortrup PB,Haase N,Wetterslev M,et al.Clinical review:Predictive value of neutrophil gelatinase-associated lipocalin for acute kidney injury in intensive care patients[J].Crit Care,2013,17(2):211.doi:10.1186/cc11855.
[6]Choudhary A,Basu S,Dey SK,et al.Association and prognostic value of serum Cystatin C,IL-18 and Uric acid in urological patients with acute kidney injury[J].Clin Chim Acta,2018,482:144-148.doi:10.1016/j.cca.2018.04.005.
[7]Lin X,Yuan J,Zhao YT,et al.Urinary interleukin-18 in prediction of acute kidney injury:a systemic review and meta-analysis[J].JNephrol,2015,28(1):7-16.doi:10.1007/s40620-014-0113-9.
[8]Chen QJ,Guan XF,Zuo XC,et al.The role of high mobility group box 1(HMGB1)in the pathogenesis of kidney diseases[J].Acta Pharm Sin B,2016,6(3):183-188.doi:10.1016/j.apsb.2016.02.004.
[9]中国医师协会新生儿专业委员会.新生儿窒息诊断和分度标准建议[J].中国当代儿科杂志,2013,15(1):1.The neonatal professional committee of chinese medical doctor association.Suggestions on diagnosis and grading criteria of neonatal asphyxia[J].Chin J Contemp Pediatr,2013,15(1):1.doi:10.7499/j.issn.1008-8830.2013.01.001.
[10]Khwaja A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-c184.doi:10.1159/000339789.
[11]Jetton JG.Neonatal acute kidney injury:the signal is clear.It is time to move the field forward[J].Pediatr Crit Care Med,2016,17(4):376-378.doi:10.1097/PCC.0000000000000686.
[12]张慧娜.尿α1-微球蛋白、尿β2-微球蛋白及尿微量白蛋白联合检测在新生儿窒息肾损伤诊断中的价值[J].中国妇幼保健,2017,32(22):5629-5631.Zhang HN.Diagnostic value of combined detection of urinary alpha-1-microglobulin,urinary beta-2-microglobulin and urinary microalbumin in neonatal asphyxiated kidney injury[J].Chin Matern Child Health Care,2017,32(22):5629-5631.doi:10.7620/zgfybj.j.issn.1001-4411.2017.22.47.
[13]Yang YB,Zhang ZX,Lian DM,et al.IL-37 inhibits IL-18-induced tubular epithelial cell expression of pro-inflammatory cytokines and renal ischemia-reperfusion injury[J].Kidney Int,2015,87(2):396-408.doi:10.1038/ki.2014.295.
[14]Parikh CR,Jani A,Melnikov VY,et al.Urinary interleukin-18 is a marker of human acute tubular necrosis[J].Am J Kidney Dis,2004,43(3):405-414.
[15]Ren HQ,Zhou X,Dai DS,et al.Assessment of urinary kidney injury molecule-1 and interleukin-18 in the early post-burn period to predict acute kidney injury for various degrees of burn injury[J].BMC Nephrol,2015,16:142.doi:10.1186/s12882-015-0140-3.
[16]Chen CB,Liu LS,Zhou J,et al.Up-Regulation of HMGB1exacerbates renal ischemia-reperfusion injury by stimulating inflammatory and immune responses through the TLR4 signaling pathway in mice[J].Cell Physiol Biochem,2017,41(6):2447-2460.doi:10.1159/000475914.
[17]黄仁发,梁群卿,黄国东,等.高迁移率蛋白1相关信号通路在肾脏疾病中的作用[J].医学综述,2016,22(18):3545-3549.Huang RF,Liang QQ,Huang GD,et al.The role of high mobility group box-1 protein associated pathway in kidney disease[J].Med Recapi,2016,22(18):3545-3549.doi:10.3969/j.issn.1006-2084.2016.18.003.
[18]Oncel MY,Canpolat FE,Arayici S,et al.Urinary markers of acute kidney injury in newborns with perinatal asphyxia[J].Ren Fail,2016,38(6):882-888.doi:10.3109/0886022X.2016.1165070.
[19]Zakiyanov O,Kriha V,Vachek J,et al.Placental growth factor,pregnancy-associated plasma protein-A,soluble receptor for advanced glycation end products,extracellular newly identified receptor for receptor for advanced glycation end products binding protein and high mobility group box 1 levels in patients with acute kidney injury:a cross sectional study[J].BMC Nephrol,2013,14:245.doi:10.1186/1471-2369-14-245.
[20]张莹,张碧丽,王丹.尿NGAL在新生儿窒息后急性肾损伤诊治中的临床价值[J].天津医药,2018,46(11):1226-1229.Zhang Y,Zhang BL,Wang D.The clinical value of urinary NGAL in the diagnosis and treatment of acute renal injury after neonatal asphyxia[J].Tianjin Med J,2018,46(11):1226-1229.doi:10.11958/20180997.
[2]曹晓燕,张惠荣,章伟,等.尿神经导向因子-1和肾损伤分子-1对窒息后新生儿急性肾损伤的诊断价值探讨[J].中国当代儿科杂志,2016,18(1):24-28.Cao XY,Zhang HR,Zhang W,et al.Diagnostic values of urinary netrin-1 and kidney injury molecule-1for acute kidney injury induced by neonatal asphyxia[J].Chin JContemp Pediatr,2016,18(1):24-28.doi:10.7499/j.issn.1008-8830.2016.01.006.
[3]Alaro D,Bashir A,Musoke R,et al.Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia[J].Afr Health Sci,2014,14(3):682-688.doi:10.4314/ahs.v14i3.26.
[4]Tanigasalam V,Bhat BV,Adhisivam B,et al.Predicting severity of acute kidney injury in term neonates with perinatal asphyxia using urinary neutrophil gelatinase associated lipocalin[J].Indian JPediatr,2016,83(12/13):1374-1378.doi:10.1007/s12098-016-2178-z.
[5]Hjortrup PB,Haase N,Wetterslev M,et al.Clinical review:Predictive value of neutrophil gelatinase-associated lipocalin for acute kidney injury in intensive care patients[J].Crit Care,2013,17(2):211.doi:10.1186/cc11855.
[6]Choudhary A,Basu S,Dey SK,et al.Association and prognostic value of serum Cystatin C,IL-18 and Uric acid in urological patients with acute kidney injury[J].Clin Chim Acta,2018,482:144-148.doi:10.1016/j.cca.2018.04.005.
[7]Lin X,Yuan J,Zhao YT,et al.Urinary interleukin-18 in prediction of acute kidney injury:a systemic review and meta-analysis[J].JNephrol,2015,28(1):7-16.doi:10.1007/s40620-014-0113-9.
[8]Chen QJ,Guan XF,Zuo XC,et al.The role of high mobility group box 1(HMGB1)in the pathogenesis of kidney diseases[J].Acta Pharm Sin B,2016,6(3):183-188.doi:10.1016/j.apsb.2016.02.004.
[9]中国医师协会新生儿专业委员会.新生儿窒息诊断和分度标准建议[J].中国当代儿科杂志,2013,15(1):1.The neonatal professional committee of chinese medical doctor association.Suggestions on diagnosis and grading criteria of neonatal asphyxia[J].Chin J Contemp Pediatr,2013,15(1):1.doi:10.7499/j.issn.1008-8830.2013.01.001.
[10]Khwaja A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-c184.doi:10.1159/000339789.
[11]Jetton JG.Neonatal acute kidney injury:the signal is clear.It is time to move the field forward[J].Pediatr Crit Care Med,2016,17(4):376-378.doi:10.1097/PCC.0000000000000686.
[12]张慧娜.尿α1-微球蛋白、尿β2-微球蛋白及尿微量白蛋白联合检测在新生儿窒息肾损伤诊断中的价值[J].中国妇幼保健,2017,32(22):5629-5631.Zhang HN.Diagnostic value of combined detection of urinary alpha-1-microglobulin,urinary beta-2-microglobulin and urinary microalbumin in neonatal asphyxiated kidney injury[J].Chin Matern Child Health Care,2017,32(22):5629-5631.doi:10.7620/zgfybj.j.issn.1001-4411.2017.22.47.
[13]Yang YB,Zhang ZX,Lian DM,et al.IL-37 inhibits IL-18-induced tubular epithelial cell expression of pro-inflammatory cytokines and renal ischemia-reperfusion injury[J].Kidney Int,2015,87(2):396-408.doi:10.1038/ki.2014.295.
[14]Parikh CR,Jani A,Melnikov VY,et al.Urinary interleukin-18 is a marker of human acute tubular necrosis[J].Am J Kidney Dis,2004,43(3):405-414.
[15]Ren HQ,Zhou X,Dai DS,et al.Assessment of urinary kidney injury molecule-1 and interleukin-18 in the early post-burn period to predict acute kidney injury for various degrees of burn injury[J].BMC Nephrol,2015,16:142.doi:10.1186/s12882-015-0140-3.
[16]Chen CB,Liu LS,Zhou J,et al.Up-Regulation of HMGB1exacerbates renal ischemia-reperfusion injury by stimulating inflammatory and immune responses through the TLR4 signaling pathway in mice[J].Cell Physiol Biochem,2017,41(6):2447-2460.doi:10.1159/000475914.
[17]黄仁发,梁群卿,黄国东,等.高迁移率蛋白1相关信号通路在肾脏疾病中的作用[J].医学综述,2016,22(18):3545-3549.Huang RF,Liang QQ,Huang GD,et al.The role of high mobility group box-1 protein associated pathway in kidney disease[J].Med Recapi,2016,22(18):3545-3549.doi:10.3969/j.issn.1006-2084.2016.18.003.
[18]Oncel MY,Canpolat FE,Arayici S,et al.Urinary markers of acute kidney injury in newborns with perinatal asphyxia[J].Ren Fail,2016,38(6):882-888.doi:10.3109/0886022X.2016.1165070.
[19]Zakiyanov O,Kriha V,Vachek J,et al.Placental growth factor,pregnancy-associated plasma protein-A,soluble receptor for advanced glycation end products,extracellular newly identified receptor for receptor for advanced glycation end products binding protein and high mobility group box 1 levels in patients with acute kidney injury:a cross sectional study[J].BMC Nephrol,2013,14:245.doi:10.1186/1471-2369-14-245.
[20]张莹,张碧丽,王丹.尿NGAL在新生儿窒息后急性肾损伤诊治中的临床价值[J].天津医药,2018,46(11):1226-1229.Zhang Y,Zhang BL,Wang D.The clinical value of urinary NGAL in the diagnosis and treatment of acute renal injury after neonatal asphyxia[J].Tianjin Med J,2018,46(11):1226-1229.doi:10.11958/20180997.