尿RBP、mALB、NAG和血清Cys C联合检测对妊高征早期肾损伤的意义

发布时间：2018-05-28 00:11

本文选题：妊娠期高血压疾病 + 重度子痫前期　；参考：《吉林大学》2016年硕士论文

【摘要】：目的:妊娠期高血压疾病孕妇往往存在不同程度的肾脏损害,本文利用血清胱抑素C和尿RBP、m ALB、NAG在肾小球、肾小管的特异性表达,通过联合测定这些指标的变化评价其对妊娠期高血压疾病早期肾损伤的临床诊断价值及应用前景。方法:1)选取2015年6月~2015年12月在吉大二院产科门诊和住院部临床诊断为妊娠期高血压疾病的孕妇46例,根据谢幸主编的《妇产科学》第八版中的诊断标准,将研究对象分为重度子痫前期组31例,慢性高血压并发子痫前期组15例,正常对照组20例,均为同期住院妊娠妇女。所有研究对象均无妊娠期高血压疾病以外的其他妊娠合并症,无高血压史、糖尿病史、肾病等慢性病史,亦未应用影响肾功能的任何药物。2)两组均于入院24小时内、产后42天留取血、尿标本,检测血清胱抑素C、尿酸、肌酐(Scr)和尿液中RBP、m ALB、NAG表达水平,采用受试者正作特征曲线下面积(AUCR0c)评价指标的可靠性。3)采用Windows SPSS 21分析软件。临床资料以X士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Graph Pad Prism 5.0作图,PO.05表示差异有显著性。结果:(1)妊娠期高血压疾病组与正常妊娠组相比,身高、体重无明显差异(P0.05),Scr和UA水平、产前及产后2h血压显著高于正常妊娠组(P0.01,差异具有统计学意义),但终止妊娠周数、新生儿体重显著低于正常妊娠组(P0.01,差异具有统计学意义)。(2)慢性高血压并发子痫前期组与重度子痫前期组比较,产前血压、早产率、新生儿体重无明显差异(P0.05),产后2h血压明显高于重度子痫前期组(P0.05,差异具有统计学意义)。(3)与正常妊娠组相比,重度子痫前期组和慢性高血压并发子痫前期组中s Cys C、u RBP、u MALB、u NAG水平明显升高(P0.01,差异具有统计学意义)。(4)对s Cys C、u RBP、u MALB、u NAG四个指标做ROC曲线结果显示,s Cystain C曲线下面积:0.743;u RBP曲线下面积:0.909;u MALB曲线下面积:0.982;u NAG曲线下面积:0.720。说明u MALB对妊娠期高血压疾病早期肾脏损伤的诊断价值最高,其次为u RBP、s Cystain C,u NAG的诊断价值最低。(5)s Cys C、u RBP、u MALB、u NAG四个标志物对于妊娠期高血压疾病早期肾损伤的预测,两两联合的敏感性及特异性大于单个指标,三个指标联合其敏感性及特异性大于两两联合。(6)产后42天复查,妊娠期高血压疾病组s Cys C、u RBP、u MALB、u NAG水平明显低于妊娠期高血压疾病组产前水平(P0.01,差异具有统计学意义)。结论:1.妊娠期高血压疾病组孕妇血尿标本中均有s Cys C、u RBP、u MALB、u NA的表达,产后42天表达水平降低。与正常对照组比较,妊娠期高血压疾病组血液中s Cys C、u RBP、u MALB、u NAG水平均显著升高。说明四个指标的浓度对妊娠期高血压疾病早期肾脏损伤有预测价值。2.慢性高血压并发子痫前期组与重度子痫前期比较,s Cys C、u RBP、u MALB、u NAG表达无显著性差异,说明其早期肾损伤程度可能无显著差别,但此结论有待进一步行肾活检来验证。3.ROC曲线结果表明u MALB和u RBP对预测妊娠期高血压疾病早期肾脏损伤的价值较高,根据其敏感度和特异性得出的最佳截断值对临床工作有一定的指导意义。4.四个标志物对于妊娠期高血压疾病早期肾损伤的预测,两两联合的敏感性及特异性大于单个指标,三个指标联合其敏感性及特异性大于两两联合,说明联合检测对于肾早期损伤更有诊断价值及应用前景,有助于临床上判断肾损伤部位,针对性用药,更好的、更科学的监管妊娠期高血压疾病患者,力求母婴结局的完美。
[Abstract]:Objective: pregnant women with hypertension often have different degrees of renal damage. In this paper, the specific expression of serum cystatin C and urinary RBP, m ALB, NAG in the glomeruli and renal tubules is used to evaluate the clinical diagnostic value and application prospect of the early renal injury of pregnancy induced hypertension by combined determination of these indexes. 1) 46 cases of pregnant women who were diagnosed as pregnancy induced hypertension in the Department of Obstetrics outpatient department and inpatient department of jjda in June 2015 ~2015 were divided into 31 cases of severe preeclampsia group, 15 cases of chronic high blood pressure and preeclampsia, and 20 normal control group, according to the diagnostic criteria of the eighth edition of Obstetrics and gynecology. All the subjects were hospitalized for pregnancy in the same period. All the subjects had no pregnancy complications other than hypertensive disorder complicating pregnancy, no history of hypertension, diabetes history, kidney disease and any other chronic medical history, and no drugs affecting the renal function of any drug.2) two groups were hospitalized for 24 hours, 42 days after postpartum blood, urine specimens, serum cystatin C, uric acid, The expression level of creatinine (Scr) and urine RBP, m ALB, NAG, the reliability.3 of the area (AUCR0c) evaluation index under the positive characteristic curve of the subjects was adopted. The Windows SPSS 21 analysis software was used. The clinical data was expressed in X S, and the average number of the two groups was compared with two independent sample t tests. The results of the multiple groups were compared with the analysis of variance. Experimental results were used. The data were made with Graph Pad Prism 5, and PO.05 showed significant difference. Results: (1) there was no significant difference in height and weight (P0.05), Scr and UA, and significantly higher in pre natal and postpartum blood pressure than in the normal pregnancy group (P0.01, the difference was statistically significant) compared with the normal pregnancy group (P0.05). The weight of the children was significantly lower than that of the normal pregnancy group (P0.01, the difference was statistically significant). (2) the preeclampsia group and the severe preeclampsia group had no significant difference in preeclampsia and preeclampsia (P0.05), and the postpartum 2H blood pressure was significantly higher than that of the severe preeclampsia group (P0.05, the difference was statistically significant). (3) and normal The s Cys C, u RBP, u MALB and u NAG levels in the severe preeclampsia group and the preeclampsia group were significantly higher (P0.01, the difference was statistically significant). (4) the area under the curve of s Cys was 0.743; the area under the curve of 0.909; Area below line: 0.982; area under u NAG curve: 0.720. indicates that u MALB has the highest diagnostic value for early renal injury in pregnancy induced hypertension, followed by u RBP, s Cystain C, and u NAG. The sensitivity and specificity of three indexes were greater than that of 22. (6) 42 days after postpartum reexamination, s Cys C, u RBP, u MALB, u NAG levels were significantly lower than the prenatal level of hypertensive disorder complicating pregnancy (P0.01, difference was statistically significant). Conclusion: 1. pregnancy induced hypertension group The expression of s Cys C, u RBP, u MALB, u NA and the 42 day postpartum expression level decreased in pregnant women's hematuria. Compared with the normal control group, the level of s Cys C in the blood of pregnancy induced hypertension group was significantly higher than that of the normal control group. There was no significant difference in s Cys C, u RBP, u MALB, u NAG expression in preeclampsia group and severe preeclampsia, indicating that there may be no significant difference in the degree of early renal injury. The value is higher, and the best truncation value based on its sensitivity and specificity has certain guiding significance for clinical work..4. four markers are used to predict early renal injury in pregnancy induced hypertension. The sensitivity and specificity of the 22 combination are greater than that of a single index, and the sensitivity and specificity of the three indicators are greater than that of 22. It shows that joint detection is of more diagnostic value and application prospect for early renal injury. It is helpful to judge the site of renal injury in clinic, and to improve and scientifically supervise the patients with pregnancy induced hypertension, and strive to perfect the outcome of mother and baby.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.246

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