Patel Kinjal Prahaladbhai, Makadia Mayur Goradhanbhai, Patel Vishwal Indravardan, Nilayangode Haridas Neelakandan, Nimbalkar Somashekhar Marutirao
Resident, Department of Biochemistry, Pramukhswami Medical College , Karamsad, Gujarat, India .
Professor, Department of Biochemistry, Pramukhswami Medical College , Karamsad, Gujarat, India .
J Clin Diagn Res. 2017 Jan;11(1):SC08-SC10. doi: 10.7860/JCDR/2017/22697.9267. Epub 2017 Jan 1.
Perinatal hypoxia is one of the leading causes of perinatal mortality in developing countries. Both apgar score and arterial blood pH predict the neonatal mortality in asphyxia. Apgar score alone does not predict neurologic outcome and as it is influenced by various factors. This study was conducted to evaluate the utility and sensitivity of urinary uric acid to creatinine ratio (UA/Cr ratio) in asphyxia diagnosis, compared to invasive Arterial Blood Gas (ABG) analysis.
To assess the urinary uric acid/creatinine ratio as an additional marker for perinatal asphyxia compared with ABG analysis in apgar score monitoring.
The present case control study was conducted at a teaching hospital in Central Gujarat. Data of 40 healthy newborns and 40 asphyxiated newborns were collected. In absence of regional estimates, a sample of size 39 was required to attain a power of 80% at 5% alpha (type I error) considering a moderate effect size of 0.65. (UA/Cr) ratio was measured from the spot urine sample collected during 24-72 hours of birth. Statistical analysis was performed by Independent t-test, Pearson's correlation coefficient (r) and Receiver Operating Characteristic (ROC) plots.
The mean (UA/Cr ratio) (2.75±0.18 vs 1.78±0.23) is significantly higher in asphyxiated group than in the control group (p<0.0001). Urinary UA/Cr ratio had negative correlation with blood pH (r= -0.27, p=0.18), which was not significant (p>0.05). Urinary UA/Cr ratio with criterion of >2.3 had 100% sensitivity, 100% specificity with AUC of 1 (p<0.0001) had a better predictive value.
Apgar score is usually reduced in neonates with congenital anomalies and premature neonates. Hence, it is preferable that the clinical diagnosis of asphyxia by apgar scores be supported by other investigations so that early decision can be taken about the level of care the baby needs. pH, lactates and base deficits change with establishment of respiration following resuscitation. However, pH, lactate, base deficit estimations are invasive and need rapid estimations. Non-invasive urinary UA/Cr ratio may be an answer to these issues as it easy, economical and equally efficient.
围产期缺氧是发展中国家围产期死亡的主要原因之一。阿氏评分和动脉血pH值均可预测窒息新生儿的死亡率。单独的阿氏评分不能预测神经学结局，且它受多种因素影响。本研究旨在评估与有创动脉血气（ABG）分析相比，尿尿酸与肌酐比值（UA/Cr比值）在窒息诊断中的效用和敏感性。
在阿氏评分监测中，评估尿尿酸/肌酐比值作为围产期窒息的一项额外标志物，并与ABG分析进行比较。
本病例对照研究在古吉拉特邦中部的一家教学医院开展。收集了40例健康新生儿和40例窒息新生儿的数据。在缺乏区域估计值的情况下，考虑到中等效应量为0.65，需要39个样本量才能在5%的α水平（I型错误）下达到80%的检验效能。在出生后24至72小时内收集的即时尿样中测量（UA/Cr）比值。采用独立t检验、Pearson相关系数（r）和受试者工作特征（ROC）曲线进行统计分析。
窒息组的平均（UA/Cr比值）（2.75±0.18 vs 1.78±0.23）显著高于对照组（p<0.0001）。尿UA/Cr比值与血pH值呈负相关（r = -0.27，p = 0.18），差异无统计学意义（p>0.05）。以>2.3为标准的尿UA/Cr比值具有100%的敏感性、100%的特异性，曲线下面积（AUC）为1（p<0.0001），具有更好的预测价值。
先天性异常新生儿和早产儿的阿氏评分通常较低。因此，最好通过其他检查来支持根据阿氏评分对窒息进行的临床诊断，以便能尽早决定婴儿所需的护理级别。复苏后随着呼吸的建立，pH值、乳酸和碱缺失会发生变化。然而，pH值、乳酸、碱缺失的测定具有侵入性，且需要快速测定。非侵入性的尿UA/Cr比值可能是解决这些问题的答案，因为它简便、经济且同样有效。
