【作者】 李丽；

【导师】 陈敬国；

【作者基本信息】 南方医科大学 ， 儿科学（专业学位）， 2013， 硕士

【摘要】 [背景资料]羊水粪染(meconium-stained amniotic fluid, MSAF)是胎儿窘迫的临床表现之一,意味着胎儿宫内缺氧。当胎儿出现宫内缺氧时,为了保证重要生命器官的血液供应,除了心、脑外的其他器官血管收缩以保证心脑等重要生命器官的血液供应,肠系膜血管的收缩使肠道蠕动增加、频率增大,肛门括约肌松弛,将大量的胎粪排入羊水中,出现羊水粪染。Falciglia HS等[’]学者报道,在所有出生的活产儿中,出现羊水粪染的发生率约为7%-20.4%,其中约有2%-9%[2]发生新生儿胎粪吸入综合征(meconim aspiration syndrome, MAS),后者的死亡率可以达到5%-40%[2]。此外,羊水粪染亦有可能会引起新生儿缺氧缺血性脑病(Hypoxic-ischemic encephalopathy, HIE)、窒息,重者甚至死亡等,并且Ojha RK等[3]调查发现发生缺氧缺血性脑病的新生儿中约有50%在出生时有羊水粪染。所以通过判断羊水粪染在胎儿窘迫(fetal distress)诊断中的价值是十分必要的。林西[4]等调查报道,孕周小于37周的新生儿,羊水粪染率约为2.67%,足月儿约为17.37%,过期产儿约为85.28%。不过也有研究[5-6]认为,若新生儿出生时发现存在羊水粪染,但胎心率正常,则患儿可以有十分良好的预后。有学者研究认为[5,6],羊水粪染的程度和羊水粪染的时间早晚与胎儿围产期疾病有关,产程早期的羊水粪染,胎儿心率异常与新生儿窒息的发生率明显的增加,而产程后期的羊水粪染,胎儿心率异常和新生儿窒息的发生率较早期明显降低。目前,多数研究认为羊水粪染增加了胎儿围产期疾病的发生率和死亡率[7-8]。新生儿窒息(asphyxia of newborn)常常是胎儿窘迫的延续,而胎儿窘迫往往是新生儿窒息和围产期新生儿死亡的主要原因。新生儿窒息容易引起低氧血症和酸中毒,是出生后最常见的紧急情况,必须积极抢救以及正确处理,以降低新生儿疾病的发生率和死亡率,并预防远期后遗症的发生。新生儿窒息肾损害本质是缺氧缺血性肾损伤,肾损害发生率高的原因主要是胎儿对宫内缺氧的适应性反应的结果,这种反应通过肾素-血管紧张素-醛固酮系统的作用,使体内血流重新分布,维持心、脑、肾上腺等重要器官的血供,而肾、肠及皮肤血供显著减少。近年来,对缺氧缺血性肾损害的研究逐渐增多,成为一个研究新热点。众所周之,肾小管为肾单位的重要组成部分,约占肾实质体积的95%,远远超过肾小球的总容量,较肾小球具有高的易损性,其中缺氧缺血是引起肾小管损害最常见的三大原因之一。由于小儿肾单位的发育是一个渐进的过程,新生儿期尚未发育完善[9],在此生理基础上并发缺氧所致的一系列病理改变,可导致几乎100%新生儿肾小管功能受到损害。新生儿期的肾功能损害症状常常不典型,或者有合并症而较难辨认。近年来,随着围产医学的发展及肾功能检测手段的改进,新生儿肾功能损害发生率的报道较前明显增多。有研究表明,具有急性肾损害的新生儿有发展为慢性肾脏疾病及高血压的风险[10]。因此,新生儿肾功能损害做到早期诊断并积极治疗是必要的,对降低围产儿病死率和优生优育具有重要意义。目前,国外有文献报道新生儿窒息后器官损害发生率可高达82%,其中肾损害约为41.57%[11-12],而国内报道新生儿窒息器官损伤发生率为74.8%,肾损伤约为52.9%。新生儿窒息后肾脏损伤可以导致患儿出现少尿甚至无尿,以致引起水、电解质、酸碱平衡的紊乱,重者可引起急性肾功能衰竭从而危及生命。所以寻找一种能够反映早期肾功能损伤的敏感指标,指导临床合理的治疗以改善预后是目前国内外许多学者颇为关注的研究方向。目前已有多项肾早期损伤的检测指标,多数基于肾小球滤过率(glomerular filtration rate, GFR)及肾小管重吸收功能的改变。内生肌酐清除率(reatinine clearance, CCr)虽然是临床上公认的能比较准确地反映GFR变化的指标[13],但由于CCr需要留取24h尿液和抽两次血检测,不能因病情恶化进行反复多次测定。另外采用由性别、年龄、血浆Cr三个变量推算得出,也难计算准确,而且易受各种因素影响,结果准确度和灵敏度不理想。为此临床上迫切需要使用一些特异性强、灵敏度高的检测指标。长期以来,临床上一般以少尿、氮质血症和肌酐作为主要判断肾小球滤过率的诊断指标,基层医院新生儿肾功能诊断的最基本和常用的实验项目也是检测血清尿素氮(blood urea nitrogen, BUN)、肌酐(creatinine, Cr)。少尿症状在新生儿极易被忽视,而BUN、Cr仅属中度敏感。肌酐作为肾功能主要评判指标已有40余年,由于检测简便和费用低廉而颇受欢迎。有学者认为,虽然BUN作为肾功能评价指标,但它不能满足内源性肾小球滤过率标志物要求,且受机体疾病状况的影响较大,如充血性心力衰竭、营养不良、进食困难等；更为重要的是在肾小管有明显的被动重吸收功能[14]。诸多的研究表明Cr水平易受年龄、性别、体形、身高、肌肉量及膳食结构等因素影响。因此,用Cr评判肾功能亦并不可靠。据研究血尿素氮、肌酐作为判断新生儿肾小球滤过率评估及判断预后指标的最大缺点是敏感性较差,尤其是在急性肾功能障碍的早期,尿素氮、肌酐并不一定异常,同时新生儿肾脏代偿能力差,且早期肾功能损害的临床表现不典型,当BUN、Cr高于正常时已表明60%-70%的有效肾单位受到了破坏,病情已恶化,如重视不够,病情可能进一步发展。肾小球滤过率降低50%以上时,BUN、Cr才有明显反映,不能真实地反映肾小球滤过功能,所以不能作为肾脏早期功能受损的指标。以上表明,传统的肾功能检测方法不够灵敏,容易漏检病变早期或轻微的急性肾功能障碍的患儿。为此对评价新生儿早期肾功能损害,临床上迫切需要使用一些更安全、更方便、特异性强、灵敏度高的检查手段来早期发现肾损害。肾脏病理是诊断肾脏疾病的最可靠直接依据,目前肾活检已经成为肾内科的常规检查方法,但是作为创伤性检查,操作难度高,具有一定风险,肾活检无法作为一种常规、动态的检测手段在基层医院普及。Yamaguchi Y[16]等研究发现,新生儿窒息后肾损伤的过程中肾小管所受的损害可能要早于肾小球,尤其是近端肾小管上皮细胞对缺氧特别的敏感,因此选择一种能够早期诊断肾小管损害的理想指标,对缺氧缺血性肾脏损害进行早期诊断、早期治疗有着重要意义。近年来对肾脏病患者尿液中的微量蛋白的研究已越来越受到重视。目前,肾小管间质损伤的重要性已越来越受到中外学者的关注。尿系列微量蛋白的测定成为近年来检测肾小球、肾小管功能的主要手段,主要包括检测IgG、TRF、mAlb、NAG、α1-MG、β2-MG、RBP等,其中前三项主要反映肾小球功能,后四项主要反映肾小管受损情况。尿微量白蛋白(microalbumin,mALB)检测不仅能准确反映肾损伤情况,还具有操作简单、无损伤、易于自动化的优点[21]。尿mALB已被公认为是继发性肾病早期诊断的一种高敏感、高特异指标。αl-微球蛋白(alpha1-microglobulin,α1-MG)是一种分子量为26100的糖蛋白,它以游离状态或与高分子蛋白结合两种形式存在于血液中,游离状态的α1-MG可经肾小球滤过,且大部分被肾近曲小管重吸收,少量从尿中排出,当肾近曲小管受损时则其排量增加,所以α1-MG可敏感反映肾小管功能,β2-微球蛋白(beta2-microglobulin, β2-MG)广泛存在于血液,尿液和其他体液中,正常血清中浓度相当稳定约2mg/L,几乎全部从肾小球滤过,且99%被近曲小管重吸收并在细胞内被溶酶体系统分解。β2-MG是经典的肾小管标记蛋白,可直接反映肾小管的功能。吴红梅等[23]报道肾脏损害的患儿做尿常规及尿蛋白定量的检查,可出现正常的情况,而对尿微量蛋白增高的患儿作肾活检,发现肾脏损害明显。因此,不能以尿蛋白定性或尿蛋白定量作为肾损伤的早期指标,而尿微量蛋白指标比尿常规中的尿蛋白定性和血清指标肾功能检查更早出现,敏感性更高。因此检测尿微量蛋白,可尽早反映肾功能损伤,可指导临床治疗。此检查采样方便,无创伤,尤其适用于新生儿。通过尿微量蛋白动态变化检验能使我们早期更敏感地评价肾脏功能。目前大部分医院具有检测尿微量蛋白的条件,且标本收集方便,操作简单,化验结果可靠,并且可以避免因反复抽血引起的医源性贫血,可作为一种监测早期新生儿肾损害的常规有效方法,值得推广。综上所述,羊水粪染可引起新生儿多器官损害,但是否合并新生儿肾功能损害,目前相关报道尚较少。尿液中尿β2-微球蛋白、尿α1-微球蛋白及尿微量白蛋白等尿低分子量蛋白与羊水粪染肾损害可能有关,但与肾损害相关的研究目前主要集中在其与血清尿素氮、肌酐水平的关系,对指导临床医生处理羊水粪染引起的肾损害早期诊断价值有限。因此,本研究通过测定新生儿血气分析,血清尿素氮、肌酐、尿β2-微球蛋白、尿α1-微球蛋白及尿微量白蛋白含量,探讨新生儿尿β2-微球蛋白、尿α1-微球蛋白及尿微量白蛋白等尿低分子量蛋白在羊水粪染肾脏损害早期诊断中的意义。为临床医生及时、准确的处理因羊水粪染引起的肾损害提供实验依据。[目的]通过检测新生儿尿液中尿β2-微球蛋白(β2-MG)、尿a1-微球蛋白(α1-MG)及尿微量白蛋白(mALB)等尿低分子量蛋白水平,探讨尿β2-微球蛋白、尿α1-微球蛋白及尿微量白蛋白等尿低分子量蛋白联合检测在新生儿羊水粪染肾损害中的临床意义。[方法]1.分组方法采用病例对照研究的方法,选择2012年3月至2012年9月在中山市人民医院出生的120例足月新生儿,其中羊水粪染90例为研究组,按羊水粪染程度分成Ⅰ度、Ⅱ度、Ⅲ度；羊水清的正常新生儿30例为对照组,测定新生儿血气分析,血清尿素氮、肌酐、尿β2-微球蛋白、尿α1-微球蛋白及尿微量白蛋白含量。2.统计学方法采用SPSS17.0统计软件包建立数据库。两组间比较采用t检验,多组间比较采用方差分析,方差不齐时,采用Welch法,两两比较采用LSD法。以α=0.05作为检验水准,P<0.05差异有统计学意义。[结果]1、性别、年龄、体重等一般情况比较足月羊水粪染新生儿90例,其中男48例,女42例,出生时胎龄为37～42周(平均39.50±0.95周),体重2500～4000g(平均3571.11±438.30g),其中羊水Ⅰ度胎粪污染32例,Ⅱ度胎粪污染30例,Ⅲ度胎粪污染28例,未用过利尿剂及肾毒性药物。另选取本院产科出生的正常新生儿30例,其中男16例,女14例,出生时胎龄37～42周(平均39.42±1.26周),体重2500～4000g(平均3477.59±510.69g)作为对照组。羊水粪染患儿与正常新生儿性别、胎龄、出生体重比较无明显差异(P>0.05),具有可比性。2、羊水Ⅲ度粪染组血清尿素氮(BUN)、肌酐(Cr)、尿β2-微球蛋白(β2-MG)、尿α1-微球蛋白(α1-MG)及尿微量白蛋白(mALB)水平最高,羊水Ⅱ度粪染组次之,羊水Ⅰ度粪染组最低。羊水Ⅰ度、Ⅱ度、Ⅲ度粪染组脐带血血气分析PH值分别为7.25±0.34、7.22±0.32、7.16±0.23,脐带血PH值随着羊水粪染程度增高而降低,并且Ⅲ度粪染组平均值小于7.20,新生儿出现酸中毒情况。3、羊水Ⅰ、Ⅱ、Ⅲ度粪染组各指标分别与正常对照组比较,血清尿素氮和肌酐水平在羊水Ⅰ度、Ⅱ度、Ⅲ度粪染组与对照组比较,差异均无显著统计学意义(P>0.05)。尿β2-微球蛋白、尿α1-微球蛋白及尿微量白蛋白水平在Ⅰ度及Ⅱ度羊水粪染组与正常对照组比较,差异无显著统计学意义(P>0.05)。而尿β2-微球蛋白、尿α1-微球蛋白及尿微量白蛋白水平在羊水Ⅲ度粪染组与对照组比较,差异有显著统计学意义(P<0.05)。在羊水Ⅰ度、Ⅱ度粪染组中,脐带血PH值均在正常范围内,分别与对照组比较,差异均无显著统计学意义(P>0.05)。在羊水Ⅲ度粪染组中,脐带血PH值为7.25±0.34,与对照组比较,差异有显著统计学意义(P<0.05)。[结论]尿低分子量蛋白联合检测对羊水粪染引起的肾功能损害早期发现及评估其程度有一定的意义。更多还原

【Abstract】 [Background]Meconium-stained amniotic fluid (MSAF) is one of the clinical manifestations of fetal distress, mean fetal hypoxia. When fetal intrauterine hypoxia appears, in order to ensure the blood supply of the vital organs such as the heart and brain, and mesenteric vascular contraction increased intestinal peristalsis frequency increases, the anal sphincter relaxation, will make a lot of meconium into the amniotic fluid, MSAF appears. Falciglia HS reported [1]in the birth of all live births, the incidence of MSAF appears approximately7%-20.4%, of which about2%to9%[2]neonatal meconim aspiration syndrome (MAS), the mortality rate of the latter can be up to5%to40%[2]. In addition, MSAF may also cause neonatal hypoxic-ischemic encephalopathy (HIE), asphyxia, even death, and Ojha RK found that HIE about50%had MSAF at birth. So judging MSAF in fetal distress diagnostic value is very necessary. Linxi [4]reported that gestational age less than37weeks of neonatal MSAF rate was about2.67%, and full-term children about17.37%,expired births approximately85.28%. However, there are also studies [5,6]that the presence of MSAF at birth, the fetal heart rate is normal, the children may be associated with a very good prognosis. Academic studies [5,6]show that the degree and time of MSAF, and fetal perinatal disease early labor MSAF, fetal heart rate abnormalities and neonatal asphyxia incidence increased significantly, and the late labor MSAF, fetal heart rate abnormalities and neonatal asphyxia incidence decreased significantly. At present, the majority of studies suggest that the increased incidence of fetal perinatal diseases and MSAF[7-8].Neonatal asphyxia is often a continuation of fetal distress, fetal distress is often the major cause of death of neonatal asphyxia and perinatal newborn. Neonatal asphyxia easily lead to hypoxemia and acidosis, the most common emergencies after the birth,it must be actively rescued and the proper treatment, to reduce the incidence and mortality of the disease of the newborn, and the prevention of the occurrence of the long-term sequelae. The essence of the neonatal asphyxia kidney damage is hypoxic-ischemic renal injury, the reasons to the high incidence of kidney damage is the result of fetal intrauterine hypoxia adaptive response, such a response by the renin-angiotensin-aldosterone system the role of the in vivo blood flow redistribution to maintain the blood supply of the vital organs such as the heart, brain, adrenal, kidney, intestine, and a significant reduction in skin blood supply. In recent years, the study of hypoxic-ischemic kidney damage gradually increased, as a study of a new hot spot.All as we known, tubular as an important part of the nephron, about95%, more than the total capacity of the glomerulus, compared with glomerular has high vulnerability, which hypoxic-ischemic is the most common cause renal damage one of the three major reasons. Pediatric renal unit development is a gradual process[9], the neonatal period has yet to develop improved almost100%hypoxic newborns, can cause renal tubular function by a series of pathological changes in this physiological basis of concurrent hypoxia-induced damage.Neonatal period renal dysfunctions are often atypical symptoms or complications are more difficult to identify. In recent years, with the development of perinatal medicine and renal function tests means improved neonatal renal damage reported incidence increased significantly. Some studies have shown that newborns with acute kidney damage have the risk of the development of chronic kidney disease and hypertension[10].Therefore, neonatal renal dysfunction to achieve early diagnosis and aggressive treatment of kidney damage is necessary to reduce perinatal mortality and achieve important prenatal and postnatal care.At present, organ damage in neonatal asphyxia incidence may be as high as82%, approximately41.57%[11-12] of kidney damage while China reported the neonatal asphyxia organ injury incidence rate of74.8%, approximately52.9%of renal injury. Neonatal asphyxia can lead to kidney damage in children with oliguria or anuria, hence resulting in the water, electrolyte and acid-base balance disorders, severe cases can cause acute renal failure and life-threatening, so finding a way to reflect early renal sensitive indicator of damage, reasonable guide clinical treatment to improve the prognosis of many scholars at home and abroad are quite concerned research direction. There are a number of renal early damage detection indicators, mostly based on the change of GFR and renal tubular reabsorption. Creatinine clearance rate (CCr) is clinically recognized more accurately reflect the GFR change[13], but due to the the CCr need specimens from24h urine and pumping blood twice detection operation is complicated and can not be due to disease progression, conducted repeatedly determination. Addition extrapolated by the three variables of gender, age, plasma Cr difficult to calculate accurately, and vulnerable to a variety of factors, the results unsatisfactory accuracy and sensitivity. So it need high sensitivity detection indicators in this clinical specificity.For a long time, clinical general oliguria, azotemia and creatinine as diagnostic indicators, as the major judgment glomerular filtration rate (GFR) and the primary hospital diagnosis of neonatal renal most basic and commonly used experimental project is detection serum BUN, Cr. Oliguria symptoms in a newborn can easily be ignored, but BUN, Cr merely moderately sensitive. Some scholars believe that, although BUN as the evaluation of renal function, but it can not meet the requirements of the endogenous marker of glomerular filtration rate, and the influence of body disease status, such as congestive heart failure, malnutrition, eating difficulties etc.; the more important it is the tubular passive reabsorption. Cr as renal evaluation indicators for over40years, its detection is simple and low-cost. However, studies have shown that Cr levels by age, gender, body shape, height, muscle mass and dietary structure factors. Therefore, Cr is not reliable. According to the study of BUN, Cr as GFR judged by neonatal assessment and prognostic indicators biggest drawback is poor sensitivity, especially in the early stage of acute renal dysfunction, BUN and Cr are not necessarily abnormal, compensatory ability of neonatal kidney, and atypical clinical manifestations of early renal damage, show that60%to70%effective renal units are destroyed when BUN, Scr higher than normal, the condition has worsened, such as inadequate attention, the condition may develop further. More than50%reduction in GFR[15], Cr and BUN have obviously reflect, no reflection of the GFR, can not be used as indicators of early renal dysfunction. Not sensitive enough to show that the traditional method of detection of renal easily missed lesions early or mild acute renal dysfunction in children. So clinical need safer, more convenient, more specificity, and high sensitivity to find the early renal damage.Renal pathology is directly based on the most reliable diagnosis of kidney disease, renal biopsy has become a routine examination of the Department of Nephrology, but as traumatic, difficult operation, with a certain risk, renal biopsy can not be used as routine, dynamic testing means popularity at the grassroots level hospitals. Yamaguchi Y[16]found that renal tubular damage suffered in the process of renal injury after neonatal asphyxia may be earlier than the glomerulus, the proximal tubular epithelial cells particularly sensitive to hypoxia, choose a way to early ideal indicators for the diagnosis of renal tubular damage, early diagnosis, early treatment is of great significance for hypoxic-ischemic kidney damage.Estimates of trace amount of protein in the urine of patients with kidney disease in recent years have been more and more attention [17,18]. The importance of tubulointerstitial injury has been more and more attention of Chinese and foreign scholars. Determination of trace protein in the urine Series to become the primary means of detection of glomerular and tubular function in recent years[19,20],mainly including IgG, TRF, Alb, NAG, α1-MG, β2-MG, RBP, etc., in which the first three are mainly reflect kidney the ball, after four reflect renal tubular damage. Detected in trace amounts in urine microalbumin (mALB) not only can accurately reflect the situation of renal injury, also was a simple operation, no damage, easy to automate[21]. The urine mALB was recognized secondary nephropathy early diagnosis of highly sensitive and highly specific indicators[22]. α1-MG is a glycoprotein with a molecular weight of26,100, its free state or in combination with the high molecular proteins exist in the blood, the free state of α1-MG by glomerular filtration, and most of the kidney proximal convoluted tubule reabsorption, and a small amount from the urine, increased its displacement when impaired renal proximal tubule, so α1-MG sensitive reflects tubular function, β2-MG is widely present in the blood, urine and other body fluids.The normal blood level was very stable2mg/L, almost all from the glomerular filtration, and99%of the proximal convoluted tubule reabsorption and intracellular lysosomal system decomposition. β2-MG as classic tubular marker protein, can be a direct reflection of renal tubular function. Wu Hongmer[23] reported kidney damage in children check urine and urinary protein, it may appear normal, and the urine trace protein increased the children for the renal biopsy, kidney damage significantly. Therefore, you can not qualitative or urinary protein excretion of urinary protein as early indicators of kidney injury, and urinary microalbumin indicators than urine routine urine protein qualitative and serum renal function tests occur earlier and higher sensitivity. Urine trace protein, can be as soon as possible to reflect the renal injury, can guide clinical treatment. This check sampling is convenient, non-invasive, and is particularly suitable for newborns. Through the dynamic changes of the urine trace protein test can make us more sensitive to early evaluation of kidney function. Most hospitals have conditions to detect trace protein in urine, and specimen collection is convenient, simple operation, reliable test results and avoid iatrogenic anemia caused due to repeated blood, can be used as a monitoring and early neonatal kidney damage conventional effective method worthy of promotion.In summary, we can see MASF can cause neonatal multiple organ damage, but whether the merger neonatal renal dysfunction, fewer reports. UrineP2-microglobulin (β2-MG), urinaryα1-microglobulin (ai-MG) and urinary microalbumin urine (mALB) and other low molecular weight protein with meconium staining of renal damage may be relevant, But the research associated with kidney damage mainly in its relationship with the level of serum BUN, Cr, a guide clinicians meconium staining caused kidney damage early diagnosis is of limited value. Therefore, this study by measuring neonatal blood gas analysis, BUN, Cr, β2-MG, α1-MG and mALB, explore neonatal low molecular weight protein in meconium staining kidney damage to the significance of early diagnosis. To provide experimental evidence for clinicians timely and accurate processing meconium staining caused kidney damage.[Objective]Detecting neonatal urine in the urinary beta2-microglobulin (β2-MG), urinaryα1-micro-globulin (α1-MG) and urinary albumin (mALB) the urine low molecular weight protein levels, to investigate explore the clinical significance of combined detection of urinary low molecular weight protein in neonatal meconium staining of renal damage.[Method]1. Grouping methodA case-control study of the method, select120cases of full-term newborns born in Zhongshan City People’s Hospital from March2012to September2012, including90cases of meconium-stained amniotic fluid for the study group, divided according to the degree of meconium staining degree Ⅰ degree Ⅱ, Ⅲ degree; clear amniotic fluid of normal newborns and30cases in the control group, and determination of neonatal blood gas analysis, blood urea nitrogen (BUN), creatinine (Cr), urinary β2-microglobulin (β2-MG), urinary α1-microglobulin (α1-MG) and urinary albumin (mALB) content.2. Statistical methodsEstablish a database using the SPSS17.0statistical package. Between the two groups using t test, analysis of variance was used to compare the groups, unequal variances, the Welch method, pairwise comparisons using LSD method. When variances are unequal. a=0.05as the inspection level, P<0.05show it is statically significant. [Results]1.Sex, age, body weight, etc. Usually ComparisonTerm meconium stained newborns90cases, including48males and42females,37to42weeks gestational age at birth (average39.50±0.95weeks), weighing2500～4000g (average3571.11±438.30g), which amniotic fluid I degree of meconium-stained32cases, Ⅱ degree meconium-stained30cases,28cases of Ⅲ degree of meconium contamination, unused diuretics nephrotoxic drugs. Select the other30cases the hospital obstetric born normal newborn, including16males and14females, born37to42weeks of gestational age (average39.42±1.26weeks), weight of2500～4000g (average3477.59±510.69g) control group. Stained amniotic fluid in children with normal neonatal gender, gestational age, birth weight was no significant difference (P>0.05), comparable.2.Meconium-stained amniotic fluid Ⅲ degree of serum urea nitrogen (BUN), creatinine (Cr), urinaryβ2-microglobulin (β2-MG), urinaryα1-microglobulin (α1-MG) and urinary microalbumin (mALB highest) level, meconium-stained amniotic fluid II degree group, followed by meconium-stained amniotic fluid grade I group the lowest. Amniotic fluid Ⅰ, Ⅱ degree Ⅲ degree of meconium-stained cord blood blood gas analysis of PH values were7.25±0.34,7.22±0.32,7.16±0.23, cord blood PH value decreased with increasing degree of meconium staining and III degree of fecal the transfected group average is less than7.20, neonatal acidosis.3.Amniotic fluid Ⅰ, Ⅱ, Ⅲ degree of meconium-stained group indicators were compared with normal control group, serum urea nitrogen and creatinine levels in amniotic fluid Ⅰ, Ⅱ degree Ⅲ degree of meconium-stained group compared with control group, there was no significant difference in statistics significance (P>0.05). Urine β2-microglobulin, urinary α1-microglobulin and urinary microalbumin levels of Ⅰ and Ⅱ degree of meconium staining group and the normal control group, the difference was not statistically significant (P>0.05). Urinaryβ2-microglobulin, urinaryα1-micro-globulin and urinary microalbumin level in meconium-stained amniotic fluid Ⅲ degree and control groups compare, the difference was statistically significant (P<0.05). Amniotic fluid Ⅰ,Ⅱ degree of meconium-stained group, umbilical cord blood pH values were within the normal range, respectively, compared with the control group, the differences were not statistically significant (P>0.05). Meconium-stained amniotic fluid III degree group, umbilical cord blood pH value of7.25±0.34, compared with the control group, the difference was statistically significant (P<0.05).[Conclusions]The combined detection of Low molecular weight protein urine meconium staining of renal damage caused by early discovery and evaluation of amniotic fluid is of certain significance to the extent.更多还原