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目的研究缺氧缺血性脑病(HIE)新生儿尿大分子碱性磷酸酶(HMAP)水平的变化及其早期诊断肾功能损害的价值。方法HIE组包括轻度脑病52例和中重度脑病40例。利用抗HMAP的单克隆抗体,用免疫催化方法检测92例HIE患儿治疗前后及30例正常新生儿(对照组)尿HMAP水平,并测定两组尿β2-微球蛋白(β2-MG)水平。结果HIE组治疗前尿HMAP、β2-MG水平高于治疗后(t=28.15、t=16.12,P<0.01)和对照组(t=11.89、t=12.34,P<0.01),且中重度HIE组尿HMAP高于轻度组(t=2.35,P<0.05);HIE组尿HMAP的异常发生率(85.9%)显著高于β2-MG(65.2%)(χ2=10.62,P<0.01);HIE组尿HMAP与β2-MG呈直线正相关(r=0.56,P<0.01)。结论HIE新生儿大多存在肾功能损害,尿HMAP比β2-MG更灵敏地反映HIE时肾损害的程度,可早期发现HIE新生儿肾损害。
Objective To investigate the changes of urine alkaline phosphatase (HMAP) in neonates with hypoxic-ischemic encephalopathy (HIE) and the value of early diagnosis of renal damage. Methods HIE group included mild encephalopathy in 52 cases and moderate to severe encephalopathy in 40 cases. Urinary HMAP levels in 92 HIE children before and after treatment and in 30 normal newborns (control group) were detected by immunocatalytic assay using anti-HMAP monoclonal antibody. Urinary β2-microglobulin (β2-MG) levels were measured in both groups . Results The levels of HMAP and β2-MG in urine before treatment in HIE group were significantly higher than those in control group (t = 28.15, t = 16.12, P <0.01) and control group The incidence of abnormal HMAP in HIE group was significantly higher than that of β2 - MG group (χ2 = 10.62, P <0.01). The incidence of HMAP in HIE group was significantly higher than that in mild group (t = 2.35, There was a linear positive correlation between HMAP and β2-MG in HIE group (r = 0.56, P <0.01). Conclusions Most newborn infants with HIE have renal dysfunction. Urinary HMAP reflects the degree of renal damage more sensitively than β2-MG in HIE. Early renal damage can be found in neonates with HIE.