尿MALB、β2MG、TRF、RBP联合检测对GDM早期肾损伤的诊断意义

发布时间：2018-04-02 11:10

本文选题：GDM　切入点：肾脏早期损伤　出处：《吉林大学》2017年硕士论文

【摘要】：目的:妊娠期糖尿病(GDM)为妊娠期妇女特发疾病,其发病流行曲线呈现上升趋势。GDM可导致母儿近、远期多种并发症发生,对母儿均有严重危害,尽早干预可以明显改善母儿预后,故早期诊断、早期预防、早期治疗意义重大。本文通过对尿MALB、β2MG、TRF与RBP四种肾脏早期损伤标志物的联合检测,分析其对妊娠期糖尿病早期肾损伤的诊断意义及应用前景。方法:1)收集吉大二院2016年1月~2016年12月,产科收住院的临床诊断为GDM的孕妇的尿蛋白7项检测结果50例以及临床诊断为正常妊娠无合并症的孕妇的尿蛋白7项检测结果50例。诊断标准以谢幸、苟文丽主编的第8版《妇产科学》为准,收集的标本分为GDM组50例,正常对照组50例。所有研究对象均无GDM以外的其他妊娠合并症,除外胎膜早破,活动性阴道流血,除外多囊卵巢综合征,慢性高血压、糖尿病、肝病、肾疾病及免疫性疾病病史,且均无肾脏损伤类药物服用史,两组孕妇在年龄、身高、孕周等一般资料比较差异无统计学意义(P0.05)。2)两组均于入院24小时内留取尿蛋白7项标本,检测尿液中MALB、β2MG、TRF以及RBP表达水平,并做受试者特征曲线下面积(AUCROC)评价指标的可靠性。3)采用Windows SPSS 21中文版分析软件。临床资料以X±S表示,两组间均数比较采用两独立样本t检验,多组组间均数两两比较采用方差分析。实验结果的数据采用SPSS 21.0作图,P0.05表示差异有统计学意义。结果:(1)GDM组与正常妊娠组相比,UMALB含量显著高于正常妊娠组(P0.05,差异具有统计学意义)。(2)GDM组与正常妊娠组相比,Uβ2MG含量显著高于正常妊娠组(P0.05,差异具有统计学意义)。(3)GDM组与正常妊娠组相比,UTRF含量显著高于正常妊娠组(P0.05,差异具有统计学意义)。(4)GDM组与正常妊娠组相比,URBP含量显著高于正常妊娠组(P0.05,差异具有统计学意义)。(5)对UMALB、Uβ2MG、UTRF、URBP四个指标做ROC曲线结果显示,UMALB曲线下面积:0.708;Uβ2MG曲线下面积:0.820;URBP曲线下面积:0.829;UTRF曲线下面积:0.741。说明该四项指标GDM早期肾脏损伤的诊断价值,URBPUβ2MGUMALBUTRF。(6)UMALB、Uβ2MG、UTRF、URBP四个标志物对于GDM早期肾损伤的预测,两两联合检测的灵敏度和特异度较单一指标检测有优势,三个指标联合检测其灵敏度和特异度较两两联合检测有优势。四项指标较三项指标检测无明显优势。结论:1.GDM孕妇尿中MALB、β2MG、TRF、RBP的含量均显著升高,早于尿蛋白(+)出现,说明四个指标的浓度对GDM患者早期肾脏损伤有预测价值。2.ROC曲线结果表明URBP和Uβ2MG对预测GDM早期肾脏损伤的价值较高,得出的最佳截断值对临床工作有一定的指导意义。3.四个标志物对于GDM早期肾损伤的预测,两两联合检测的灵敏度和特异度较单一指标检测有优势,三个指标联合检测其灵敏度和特异度较两两联合检测有优势。说明联合检测对于肾早期损伤更有诊断价值及临床应用前景。
[Abstract]:Therefore, early diagnosis, early prevention and early treatment are of great significance.The diagnostic significance and application prospect of urinary MALB, 尾 2MGG TRF and RBP markers for early renal injury in gestational diabetes mellitus (GDM) were analyzed.The diagnostic criteria were Xie Xing and Gou Wenli's eighth edition of Gynecology. The collected specimens were divided into GDM group (n = 50) and normal control group (n = 50).All subjects had no pregnancy complications other than GDM, except premature rupture of membranes, active vaginal bleeding, polycystic ovary syndrome, chronic hypertension, diabetes, liver disease, kidney disease and immune disease.The reliability of the evaluation index of the area under the characteristic curve of subjects was made. 3) the Chinese version of Windows SPSS 21 was used to analyze the reliability.The clinical data were expressed as X 卤S, the mean of the two groups was compared with two independent samples t test, and the analysis of variance was used in the comparison of the two groups.The results of the experiment were statistically significant using SPSS 21. 0 to map the data.Results the content of UMALB in GDM group was significantly higher than that in normal pregnancy group (P 0.05), and the difference was statistically significant (P 0.05). The content of U 尾 2MG in GDM group was significantly higher than that in normal pregnancy group (P 0.05).The results show that under the UMALB curve, the area under the U 尾 2MG curve is 0: 0. 708 U 尾. The area under the U 尾 2MG curve is 0: 0. 820 and the area under the URBP curve is 0. 829 and the area under the UTRF curve is 0: 0. 741.The diagnostic value of these four markers for early renal injury of GDM is that URBPU 尾 2MGUMALBUTRF.6 UMALBU U 尾 2MGGUUTRFRFUBP has advantages in predicting early renal injury in GDM. The sensitivity and specificity of two combined detection methods are superior to that of single index.The sensitivity and specificity of the combined detection of the three indexes were superior to that of pairwise combined detection.The best truncation value has certain guiding significance for clinical work. 3.The sensitivity and specificity of the combined detection were superior to that of the single index in predicting early renal injury of GDM, and the sensitivity and specificity of the combined detection of the three markers were superior to that of the combined detection.It shows that combined detection is more valuable for early renal injury diagnosis and clinical application prospects.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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