CAJ | 학술논문

目的：评估血清胱抑素 C（Cys - C）水平对新生儿窒息患儿早期肾损伤的诊断价值。方法选取2012年2月—2014年8月定州市妇幼保健院儿科收治的轻度新生儿窒息患儿33例作为轻度窒息组、重度新生儿窒息患儿24例作为重度窒息组、健康足月新生儿30例作为对照组。比较3组新生儿血清 Cys - C、β2微球蛋白（β2- MG）水平、肾功能指标〔尿素氮（BUN）、肌酐（Scr）〕、肾血流动力学指标〔收缩期峰值血流速度（PSFV）、舒张末期血流速度（EDFV）、搏动指数（PI）、阻力指数（RI）〕，并分析血清 Cys - C 水平对新生儿窒息早期肾损伤的诊断价值。结果轻度窒息组新生儿血清 Cys - C、β2- MG、BUN、Scr 水平均高于对照组（P ﹤0.05）；重度窒息组新生儿血清 Cys- C、β2- MG、BUN、Scr 水平均高于轻度窒息组和对照组（P ﹤0.05）。轻度窒息组新生儿 PSFV、EDFV 低于对照组， PI、RI 高于对照组（P ﹤0.05）；重度窒息组新生儿 PSFV、EDFV 低于轻度窒息组和对照组，PI、RI 高于轻度窒息组和对照组（P ﹤0.05）。Cys - C 诊断新生儿窒息早期肾损伤的灵敏度为94.77%，特异度为76.67%，误诊率为23.33%，漏诊率为5.26%。Scr 诊断新生儿窒息早期肾损伤的灵敏度为91.23%，特异度为70.00%，误诊率为30.00%，漏诊率为8.77%。Cys - C 与 Scr 诊断新生儿窒息早期肾损伤的曲线下面积（ AUC）分别为0.932、0.921，差异无统计学意义（Z =0.448，P =0.719）。结论新生儿窒息患儿血清 Cys - C 水平较高，早期检测其血清 Cys - C水平可有效诊断肾损伤，与 Scr 相结合能够进一步提高诊断准确性。
목적：평고혈청광억소 C（Cys - C）수평대신생인질식환인조기신손상적진단개치。방법선취2012년2월—2014년8월정주시부유보건원인과수치적경도신생인질식환인33례작위경도질식조、중도신생인질식환인24례작위중도질식조、건강족월신생인30례작위대조조。비교3조신생인혈청 Cys - C、β2미구단백（β2- MG）수평、신공능지표〔뇨소담（BUN）、기항（Scr）〕、신혈류동역학지표〔수축기봉치혈류속도（PSFV）、서장말기혈류속도（EDFV）、박동지수（PI）、조력지수（RI）〕，병분석혈청 Cys - C 수평대신생인질식조기신손상적진단개치。결과경도질식조신생인혈청 Cys - C、β2- MG、BUN、Scr 수평균고우대조조（P ﹤0.05）；중도질식조신생인혈청 Cys- C、β2- MG、BUN、Scr 수평균고우경도질식조화대조조（P ﹤0.05）。경도질식조신생인 PSFV、EDFV 저우대조조， PI、RI 고우대조조（P ﹤0.05）；중도질식조신생인 PSFV、EDFV 저우경도질식조화대조조，PI、RI 고우경도질식조화대조조（P ﹤0.05）。Cys - C 진단신생인질식조기신손상적령민도위94.77%，특이도위76.67%，오진솔위23.33%，루진솔위5.26%。Scr 진단신생인질식조기신손상적령민도위91.23%，특이도위70.00%，오진솔위30.00%，루진솔위8.77%。Cys - C 여 Scr 진단신생인질식조기신손상적곡선하면적（ AUC）분별위0.932、0.921，차이무통계학의의（Z =0.448，P =0.719）。결론신생인질식환인혈청 Cys - C 수평교고，조기검측기혈청 Cys - C수평가유효진단신손상，여 Scr 상결합능구진일보제고진단준학성。
Objective To evaluate the diagnostic value of serum cystatin C level on early renal impairment in newborns with asphyxia. Methods From February 2012 to August 2014 in Maternal and Child Care Service Center of Dingzhou,a total of 30 newborns with mild asphexia were selected as A group,a total of 24 newborns with severe asphexia were selected as B group, a total of 30 healthy full - term newborns were selected as C group. Serum levels of cystatin C,β2 - MG,BUN and Scr,PSFV, EDFV,PI and RI were compared among the three groups,and the diagnostic value of serum cystatin C level on early renal impairment was analyzed. Results Serum levels of cystatin C,β2 - MG,BUN and Scr of A group were statistically significantly higher than those of C group,and above index of B group were statistically significantly higher than those of A group and C group(P ﹤ 0. 05). PSFV and EDFV of A group were statistically lower than those of C group,while PI and RI of A group were statistically significantly higher than those of C group(P ﹤ 0. 05);PSFV and EDFV of B group were statistically lower than those of A group and C group,while PI and RI of B group were statistically significantly higher than those of A group and C group (P ﹤ 0. 05). The sensitivity of serum cystatin C level in diagnosing early renal impairment in newborns with asphyxia was 94. 77% ,the specificity was 76. 67% ,the misdiagnosis rate was 23. 33% ,the rate of missed diagnosis was 5. 26% ;the sensitivity of serum Scr level in diagnosing early renal impairment in newborns with asphyxia was 91. 23% ,the specificity was 70. 00% ,the misdiagnosis rate was 30. 00% ,the rate of missed diagnosis was 8. 77% . The AUC of serum cystatin C level in diagnosing early renal impairment in newborns with asphyxia was 0. 932,that of serum Scr level was 0. 921,the difference was not statistically significantly different(Z = 0. 448,P = 0. 719). Conclusion Serum cystatin C level of newborns with asphyxia is significantly elevated,early detection of serum cystatin C level can effectively diagnose early renal impairment,and the combination of serum Scr level can improve the diagnostic accuracy.