Perlman J M, Risser R
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75235-9063, USA.
J Pediatr. 1998 Mar;132(3 Pt 1):436-9. doi: 10.1016/s0022-3476(98)70016-2.
The purine metabolite hypoxanthine accumulates with hypoxia ischemia and with reperfusion is converted to uric acid (UA). We hypothesized that elevated UA concentration is a marker of previous hypoxia ischemia and would identify infants at greatest risk for having subsequent intraventricular hemorrhage (IVH)/periventricular leukomalacia (PVL). We determined the relationship between UA concentrations in the first postnatal day and the development of severe IVH, PVL, or both in 58 infants of birth weight 865 +/- 177 gm and gestational age 27 +/- 2 weeks. Severe IVH developed in 10 (17%) infants and PVL in 3 (5.1%) infants. UA concentrations on day 1 (obtained at 16 +/- 4 hours) were 7.9 +/- 2.8 mg/dl and increased to 9.5 +/- 2.58 mg/dl on day 2. UA concentrations on day 1 were higher in infants with severe IVH/PVL versus those in infants with neither condition: 10.2 vs 7.3 mg/dl (p = 0.005). Infants with hyperkalemia on the second postnatal day had higher UA concentrations on the first day versus infants with normal potassium levels: 11.7 +/- 2 mg/dl versus 6.8 +/- 1.8 mg/dl (p < 0.0005). Infants with severe IVH/PVL had higher potassium levels on day 2 versus infants with neither condition: 11.9 vs 6.9 mg/dl (p < 0.048). By univariate analysis UA concentrations were significantly related to gestational age (p = 0.005) and birth weight (p = 0.03). Only UA concentration (p = 0.004) and gestational age (p = 0.02) were related to IVH/PVL. By multivariate analysis UA remained significantly related to IVH/PVL even when adjusted for other clinical variables, with an odds ratio estimate of 1.63 (95% confidence interval 1.16 to 2.31). In conclusion, higher UA concentrations on the first postnatal day were associated with the subsequent development of severe IVH/PVL and with subsequent hyperkalemia. Elevated UA concentrations in the first postnatal day may help to identify a subset of premature infants at greatest risk for having subsequent hemorrhagic ischemic injury.
嘌呤代谢产物次黄嘌呤在缺氧缺血时会蓄积，并在再灌注时转化为尿酸（UA）。我们推测，升高的UA浓度是既往缺氧缺血的一个标志物，且能够识别出发生随后的脑室内出血（IVH）/脑室周围白质软化（PVL）风险最高的婴儿。我们确定了出生体重865±177克、胎龄27±2周的58例婴儿出生后第1天的UA浓度与严重IVH、PVL或两者发生之间的关系。10例（17%）婴儿发生了严重IVH，3例（5.1%）婴儿发生了PVL。第1天（在16±4小时时获得）的UA浓度为7.9±2.8毫克/分升，第2天升至9.5±2.58毫克/分升。发生严重IVH/PVL的婴儿第1天的UA浓度高于未发生这两种情况的婴儿：分别为10.2与7.3毫克/分升（p = 0.005）。出生后第2天有高钾血症的婴儿第1天的UA浓度高于血钾水平正常的婴儿：分别为11.7±2毫克/分升与6.8±1.8毫克/分升（p < 0.0005）。发生严重IVH/PVL的婴儿第2天的血钾水平高于未发生这两种情况的婴儿：分别为11.9与6.9毫克/分升（p < 0.048）。通过单因素分析，UA浓度与胎龄显著相关（p = 0.005）和出生体重显著相关（p = 0.03）。仅UA浓度（p = 0.004）和胎龄（p = 0.02）与IVH/PVL相关。通过多因素分析，即使在对其他临床变量进行校正后，UA仍与IVH/PVL显著相关，比值比估计值为1.63（95%置信区间为1.16至2.31）。总之，出生后第1天较高的UA浓度与随后严重IVH/PVL的发生以及随后的高钾血症相关。出生后第1天升高的UA浓度可能有助于识别出发生随后出血性缺血性损伤风险最高的一部分早产儿。
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