Baumert Małgorzata, Surmiak Piotr, Więcek Andrzej, Walencka Zofia
Department of Neonatology, School of Medicine in Katowice, Medical University of Silesia, Medyków 14 Street, 40-752, Katowice, Poland.
Department of Nephrology, Endocrinology and Metabolic Diseases, School of Medicine in Katowice, Medical University of Silesia, Francuska 20/24 Street, 40-027, Katowice, Poland.
Clin Exp Nephrol. 2017 Aug;21(4):658-664. doi: 10.1007/s10157-016-1320-6. Epub 2016 Sep 2.
Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that serum neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI, but there are the lacks of data about its use in term neonates with perinatal asphyxia.
A prospective cohort study was conducted on 43 term neonates. Umbilical cord blood and 24 h after birth serum NGAL, copeptin, creatinine, and molality were measured in all asphyxiated and controls neonates.
During the study period, 8 of asphyxiated nenates (18.6 %) suffered from AKI, while 35 newborns have no signs of AKI and 30 healthy infants. We did not observe any differences in creatinine and copeptin levels, as well as serum osmolality in all three investigated groups (AKI, no-AKI, and controls) in cord blood, and 24 h after birth. Serum NGAL levels in umbilical cord blood were significantly higher in the AKI group (174.3 ng/mL) compared with no-AKI (88.5 ng/mL, p = 0.01) and control groups (28.5 ng/mL, p < 0.001), and 24 h after birth (respectively, AKI 152.5 ng/mL vs no-AKI 74.9 ng/mL, p = 0.02 vs controls 39.1 ng/mL, p < 0.001). NGAL concentration showed a strong negative correlation to umbilical artery pH (Rho = -0.42, p = 0.04), base excess (Rho = -0.31, p = 0.03), and Apgar score in 1st min (Rho = -0.41, p = 0.02) and 5th min of life (Rho = -0.20, p = 0.001). ROC curve analysis demonstrated a good predictive value for NGAL levels (>140.7 ng/mL) which allows to diagnose AKI in asphyxiated patients with 88.9 % sensitivity (95 % CI 75-95 %) and 95.0 % specificity (95 % CI 76-99 %).
NGAL seems to be a promising marker, even in subclinical AKI in neonates, due to its high specificity, but copeptin did not meet expectations.
急性肾损伤（AKI）是围产期窒息最常见的并发症。近期研究表明，血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是AKI的早期标志物，但缺乏其在足月围产期窒息新生儿中应用的数据。
对43例足月新生儿进行前瞻性队列研究。测定所有窒息新生儿和对照新生儿的脐带血以及出生后24小时血清中的NGAL、 copeptin、肌酐和渗透压。
在研究期间，8例窒息新生儿（18.6%）发生了AKI，35例新生儿无AKI体征，30例为健康婴儿。我们未观察到三组研究对象（AKI组、非AKI组和对照组）在脐带血以及出生后24小时的肌酐、copeptin水平和血清渗透压有任何差异。AKI组脐带血中的血清NGAL水平（174.3 ng/mL）显著高于非AKI组（88.5 ng/mL，p = 0.01）和对照组（28.5 ng/mL，p < 0.001），出生后24小时亦是如此（AKI组分别为152.5 ng/mL，非AKI组为74.9 ng/mL，p = 0.02；对照组为39.1 ng/mL，p < 0.001）。NGAL浓度与脐动脉pH值（Rho = -0.
