Jalali S Z, Enteshari M, Saadat F
Faculty of Medicine, Department of Paediatrics, Guilan University of Medical Sciences, Rasht, Iran.
Paediatric Diseases Research Centre, Guilan University of Medical Sciences, Rasht, Iran.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6624-6630. doi: 10.1080/14767058.2021.1918667. Epub 2021 May 4.
Asphyxia at birth is one of the major causes of morbidity and mortality in all neonates due to various organ dysfunctions, for example, kidneys. Recent advances in this area have suggested new urinary proteins for the assessment of renal damage, including beta-2 microglobulin (β2-MG). The aim of this study was to investigate the changes of urinary β2-MG in asphyxiated neonates and to evaluate the value of combined detection of multiple biomarkers in the early diagnosis of acute kidney injury (AKI) in asphyxiated neonates.
This case-control study was performed on 84 term neonates in two control and case groups who were hospitalized at the neonatal intensive care unit. Using the Sarnat scoring system, the asphyxiated neonates were neurologically divided. Renal function tests and urinary β2-MG (uβ2-MG) levels of participants who registered based on inclusion criteria were measured. The data analyzed using descriptive and inferential statistical tests. The diagnostic value of the biomarker was determined using receiver operating characteristic (ROC) curves.
This study showed that uβ2-MG was not a statistically significant difference in both asphyxiated neonates with AKI and non-AKI ( = .085). Whereas, uβ2-MG levels were statistically significant in neurological grading of asphyxiated infants to two groups ( = .013). A new predictor, uβ2-MG and blood urea nitrogen (BUN); named BB1, was substituted as the diagnostic value in neonates with asphyxia with an area under the receiver operating characteristic curve (AUC) (95% CI) of 0.88 (0.76-1.0). This AUC was significantly greater than the value for uβ2-MG associated with AKI ( = .003).
Our findings showed that mutual detection of uβ2-MG levels with BUN should be an early indicator for the diagnosis of renal injury with greater specificity and improved prognostic accuracy after neonatal asphyxia.
出生时窒息是所有新生儿发病和死亡的主要原因之一，可导致各种器官功能障碍，如肾脏。该领域的最新进展提出了用于评估肾损伤的新尿蛋白，包括β2微球蛋白（β2-MG）。本研究的目的是调查窒息新生儿尿β2-MG的变化，并评估多种生物标志物联合检测在窒息新生儿急性肾损伤（AKI）早期诊断中的价值。
本病例对照研究对在新生儿重症监护病房住院的84名足月儿进行了两个对照组和病例组的研究。使用萨纳特评分系统对窒息新生儿进行神经学分类。对符合纳入标准的参与者进行肾功能测试和尿β2-MG（uβ2-MG）水平测量。使用描述性和推断性统计检验对数据进行分析。使用受试者工作特征（ROC）曲线确定生物标志物的诊断价值。
本研究表明，在患有AKI和未患AKI的窒息新生儿中，uβ2-MG均无统计学显著差异（P = 0.085）。然而，在将窒息婴儿按神经学分级分为两组时，uβ2-MG水平有统计学显著差异（P = 0.013）。一种新的预测指标，uβ2-MG和血尿素氮（BUN）；命名为BB1，被用作窒息新生儿诊断价值的替代指标，其受试者工作特征曲线下面积（AUC）（95%CI）为0.88（0.76 - 1.0）。该AUC显著大于与AKI相关的uβ2-MG的值（P = 0.003）。
我们的研究结果表明，联合检测uβ2-MG水平和BUN应是诊断新生儿窒息后肾损伤的早期指标，具有更高的特异性和改善的预后准确性。
