Urinary Allantoin Is Elevated in Severe Intraventricular Hemorrhage in the Preterm Newborn.
Urinary Allantoin Is Elevated in Severe Intraventricular Hemorrhage in the Preterm Newborn.
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DOI：
10.1007/s12975-015-0405-y
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发表时间：
2016-04
影响因子：
6.9
通讯作者：
Boskovic DS
中科院分区：
文献类型：
--
作者：
Esiaba I;Angeles DM;Holden MS;Tan JB;Asmerom Y;Gollin G;Boskovic DS
生发基质脑室内出血（IVH）是早产儿最常见的颅内出血类型。它是神经认知发育不良、脑瘫和死亡的先兆。病理生理学尚不明确，但对脆弱的生发基质血管的损害可能是由于炎症期间产生的自由基和缺血再灌注的结果。因此，评估这些婴儿的氧化应激状态是很重要的。尿尿囊素浓度测定在早产儿作为氧化应激与IVH相关的标志物。收集44例早产儿24 ~ 72小时（HOL） 4个时间点尿液，采用气相色谱-质谱法测定尿囊素含量。回顾性回顾记录，IVH的发生率和严重程度分为：无IVH （n=24）、轻度（1-2级）IVH （n=13）和重度（3-4级）IVH （n=7）。重度IVH新生儿尿囊素水平较未IVH组显著升高（分别为0.098±0.013µmol和0.043±0.007µmol, p= 0.002）。尿囊素浓度在72 h时仍然升高（分别为0.079±0.014µmol和0.033±0.008µmol, p= 0.021）。无IVH组和轻度IVH组尿囊素水平无显著差异。IVH平均在出生后第11天左右通过头部成像诊断出来。在随后诊断为严重IVH的新生儿中，尿囊素水平在出生后3天内显著升高，提示氧化应激可能是IVH发病的关键因素。需要进一步的研究来评估尿囊素在早期识别有严重IVH风险的早产儿和监测对预防或治疗IVH干预措施的反应方面的作用。
Germinal matrix intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage observed in preterm neonates. It is a precursor of poor neurocognitive development, cerebral palsy and death. The pathophysiology is not well defined, but damage to the fragile germinal matrix vasculature may be due to free radicals generated during inflammation and as a consequence of ischemia followed by reperfusion. Assessment of the oxidative stress status in these infants is therefore important. Urinary allantoin concentration was measured in preterm neonates as a marker of oxidative stress associated with IVH. Urine was collected from 44 preterm neonates at four time points between 24 and 72 hours of life (HOL) and the allantoin content was determined by gas chromatography mass spectrometry (GCMS). Records were retrospectively reviewed and the incidence and severity of IVH was categorized as follows: no IVH (n=24), mild (grade 1-2) IVH (n=13) and severe (grade 3-4) IVH (n=7). Neonates with severe IVH showed significantly elevated allantoin levels vs subjects with no IVH from 36 HOL (0.098±0.013µmol and 0.043±0.007µmol, respectively, p=.002). The allantoin concentration remained elevated even at 72 HOL (0.079±0.014µmol and 0.033±0.008µmol, respectively, p=.021). There were no significant differences in allantoin levels in the no IVH and mild IVH groups. IVH was diagnosed by head imaging on average at about 11th post-natal day. Urinary allantoin levels were significantly elevated during the first 3 days of life in the neonates subsequently diagnosed with severe IVH, suggesting that oxidative stress might be a crucial factor in IVH pathogenesis. Further studies are needed to assess the usefulness of urinary allantoin in early identification of preterm infants at risk for or with severe IVH, and monitoring of the response to interventions designed to prevent or treat it.