NGAL和Cys-C在妊娠高血压疾病肾损伤诊断中的临床价值
发布时间：2018-09-11 13:33
【摘要】：目的：妊娠期高血压疾病患者均存在不同程度的肾脏损害,本研究利用中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和血清胱抑素C (Cys-C)在妊娠期高血压疾病肾脏损伤早期肾小球和肾小管特异表达,通过联合测定妊娠高血压(PIH)患者血NGAL、Cys-C和肌酐(Cr),评价NGAL和Cys-C在预测妊娠高血压疾病肾脏损伤的诊断价值。 方法：1、病历选择：选取2013年2月～2013年8月在天津医科大学第二医院产科收住的诊断为妊娠高压综合征(PIH组)的孕妇80例,诊断标准按照《妇产科学》第七版,分为四个亚组,妊娠期高血压亚组、轻度子痫前期亚组、重度子痫前期亚组、子痫亚组。正常对照组40例,均为同期住院妊娠结局正常的孕妇。两组均除外慢性高血压史、糖尿病史、肝肾疾病及免疫性疾病史。2、两组均于入院24h内及产后72h取血,检测血清NGAL、血清Cys-C和血Cr表达水平,分析其与疾病及其严重程度的关系。3、分别以配对t检验、单因素方差分析做统计学处理,采用Spearman rho分析法做相关性分析。 结果：1、受试者入院24h内和产后72h结果比较：NGAL入院24h内的浓度较产后72h的检测结果明显增高,差异有显著性(P0.05),Cys-C入院24h内的浓度较产后72h的检测结果明显增高,差异有显著性(P0.05),Cr入院24h内的浓度较产后72h的检测结果明显增高,差异有显著性(P0.05)。 2、PIH组入院24h内NGAL的检测结果较正常对照组均明显增高,差异有统计学意义(P0.05),PIH组入院24h内Cys-C的检测结果较正常对照组均明显增高,差异有统计学意义(P＜0.05), PIH组产后72h NGAL的检测结果和正常对照组比较,两组间差异无统计学意义(均P0.05), PIH组产后72h Cys-C的检测结果和正常对照组比较,两组间差异无统计学意义(均P0.05)。 3、PIH组各亚组间比较发现,随着疾病进展,妊娠高血压亚组、轻度子痫前期亚组、重度子痫前期亚组、子痫亚组,单因子组间两两比较,血中NGAL表达水平均增高,各组间差异均有统计学意义(均p0.05)；Cys-C各组间比较只有妊娠高血压亚组和子痫亚组比较有显著性差异(p0.05),其余各亚组均无统计学差异(p0.05)。 4、受试者入院24h内NGAL和Cr相关性分析显示NGAL和Cr呈正相关,相关系数为0.905 受试者入院24h内Cys-C和Cr相关性分析显示NGAL和Cr呈正相关,相关系数为0.663 5、对NGAL、Cys-C和Cr三个指标做ROC曲线结果显示,Cr曲线下面积0.706,Cys-C曲线下面积0.812,NGAL曲线下面积0.835,说明NGAL对妊娠期高血压疾病肾脏损伤的诊断价值最高,其次为Cys-C, Cr的诊断价值最低 结论：1、妊娠期高血压疾病患者血液中均有NGAL和Cys-C的表达,产后表达降低。与正常对照组比较妊娠期高血压疾病组血液中NGAL和Cys-C水平均显著升高。说明NGAL和Cys-C含量与妊娠期高血压疾病肾脏损伤高度相关。 2、不同严重程度妊娠期高血压疾病患者血液NGAL的表达具有差异,NGAL的含量随着患者血Cr的升高而增加,进一步分析证实NGAL含量与疾病的严重程度高度相关；Cys-C表达的差异性不强,这可能和本实验选取的样本过少有关,有待近一步做大样本实验分析。 3、同一患者血液中NGAL与Cr含量具有正相关性,说明NGAL含量与疾病的严重程度高度相关;Cys-C含量与Cr含量也具有正相关性,血NGAL与疾病严重程度的相关系数为0.905(p=0.000),Cys-C与疾病严重程度的相关系数为0.663(p=0.000)。血液NGAL的相关性大于Cys-C,血液NGAL比Cys-C更能有效的反应疾病的严重程度。 4、ROC曲线结果表明NGAL和Cys-C对预测妊娠期高血压疾病肾脏损伤的价值高于血Cr, NGAL对妊娠期高血压疾病肾脏损伤的诊断价值最高。 综上所述,血液NGAL和Cys-C可以作为预测妊娠期高血压疾病肾脏损伤及其严重程度的一个重要的指标。
[Abstract]:Objective: To investigate the expression of neutrophil gelatinase-associated lipoprotein (NGAL) and serum cystatin C (Cys-C) in glomeruli and tubules of patients with pregnancy-induced hypertension (PIH) at the early stage of renal injury. GAL, Cys-C and creatinine (Cr) were used to evaluate the diagnostic value of NGAL and Cys-C in predicting renal injury in hypertensive disorder complicating pregnancy.
Methods: 1. Medical Record Selection: Eighty pregnant women with pregnancy-induced hypertension (PIH) admitted to the Obstetrics Department of the Second Hospital of Tianjin Medical University from February 2013 to August 2013 were divided into four subgroups according to the diagnostic criteria of < Obstetrics and Gynecology > 7th edition: pregnancy-induced hypertension subgroup, mild preeclampsia subgroup, severe preeclampsia subgroup, and eclampsia subgroup. Epilepsy subgroup. 40 normal pregnant women with normal pregnancy outcome were enrolled in the same period. The two groups were excluded from the history of chronic hypertension, diabetes, liver and kidney disease and immune disease. 2. Blood samples were taken within 24 hours after admission and 72 hours after delivery. The levels of serum NGAL, Cys-C and Cr were detected, and their relationship with the severity of the disease was analyzed. Paired t test and one-way ANOVA were used for statistical analysis and Spearman Rho was used for correlation analysis.
Results: 1. Comparing the results within 24 hours after admission and 72 hours after delivery, the concentration of NGAL in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cys-C in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cr in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The difference was significant (P0.05).
2. The results of NGAL detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P 0.05). The results of Cys-C detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P < 0.05). The results of NGAL detection in PIH group were significantly higher than those in normal control group 72 hours after delivery (P < 0.05). Significance (all P 0.05). There was no significant difference between PIH group and normal control group (all P 0.05).
3. Comparing with each subgroup of PIH group, the expression of NGAL in blood increased with the progress of disease, pregnancy induced hypertension subgroup, mild pre-eclampsia subgroup, severe pre-eclampsia subgroup, eclampsia subgroup and single factor group, and the difference was statistically significant (all p0.05). There was a significant difference in the epileptic subgroup (P0.05), but there was no significant difference between the other subgroups (P0.05).
4, NGAL and Cr correlation analysis showed that NGAL and Cr were positively correlated with 24h, and the correlation coefficient was 0.905.
Correlation analysis between Cys-C and Cr in 24h showed that NGAL and Cr were positively correlated, with a correlation coefficient of 0.663.
5. The ROC curves of NGAL, Cys-C and C r showed that the area under C R curve was 0.706, the area under Cys-C curve was 0.812, and the area under NGAL curve was 0.835, indicating that NGAL had the highest diagnostic value for renal injury in pregnancy-induced hypertension, followed by Cys-C and C r had the lowest diagnostic value.
Conclusion: 1. Both NGAL and C ys-C are expressed in the blood of patients with gestational hypertension, and the expression of NGAL and C ys-C is decreased postpartum.
2. The expression of NGAL was different in patients with different severity of gestational hypertension. The content of NGAL increased with the increase of serum Cr. Further analysis confirmed that the content of NGAL was highly correlated with the severity of the disease. Large sample analysis.
3. There was a positive correlation between serum NGAL and CR levels in the same patient, indicating that NGAL levels were highly correlated with the severity of the disease; Cys-C levels were positively correlated with CR levels; the correlation coefficient between serum NGAL and the severity of the disease was 0.905 (p = 0.000), and that between Cys-C and the severity of the disease was 0.663 (p = 0.000). In Cys-C, blood NGAL is more effective than Cys-C in reflecting the severity of the disease.
4. ROC curves showed that NGAL and C ys-C had higher value in predicting renal injury in pregnancy-induced hypertension than that in blood Cr. NGAL had the highest value in diagnosing renal injury in pregnancy-induced hypertension.
To sum up, blood NGAL and C ys-C can be used as an important index to predict renal injury and its severity in pregnancy-induced hypertension.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.246
本文编号：2236831
[Abstract]:Objective: To investigate the expression of neutrophil gelatinase-associated lipoprotein (NGAL) and serum cystatin C (Cys-C) in glomeruli and tubules of patients with pregnancy-induced hypertension (PIH) at the early stage of renal injury. GAL, Cys-C and creatinine (Cr) were used to evaluate the diagnostic value of NGAL and Cys-C in predicting renal injury in hypertensive disorder complicating pregnancy.
Methods: 1. Medical Record Selection: Eighty pregnant women with pregnancy-induced hypertension (PIH) admitted to the Obstetrics Department of the Second Hospital of Tianjin Medical University from February 2013 to August 2013 were divided into four subgroups according to the diagnostic criteria of < Obstetrics and Gynecology > 7th edition: pregnancy-induced hypertension subgroup, mild preeclampsia subgroup, severe preeclampsia subgroup, and eclampsia subgroup. Epilepsy subgroup. 40 normal pregnant women with normal pregnancy outcome were enrolled in the same period. The two groups were excluded from the history of chronic hypertension, diabetes, liver and kidney disease and immune disease. 2. Blood samples were taken within 24 hours after admission and 72 hours after delivery. The levels of serum NGAL, Cys-C and Cr were detected, and their relationship with the severity of the disease was analyzed. Paired t test and one-way ANOVA were used for statistical analysis and Spearman Rho was used for correlation analysis.
Results: 1. Comparing the results within 24 hours after admission and 72 hours after delivery, the concentration of NGAL in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cys-C in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cr in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The difference was significant (P0.05).
2. The results of NGAL detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P 0.05). The results of Cys-C detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P < 0.05). The results of NGAL detection in PIH group were significantly higher than those in normal control group 72 hours after delivery (P < 0.05). Significance (all P 0.05). There was no significant difference between PIH group and normal control group (all P 0.05).
3. Comparing with each subgroup of PIH group, the expression of NGAL in blood increased with the progress of disease, pregnancy induced hypertension subgroup, mild pre-eclampsia subgroup, severe pre-eclampsia subgroup, eclampsia subgroup and single factor group, and the difference was statistically significant (all p0.05). There was a significant difference in the epileptic subgroup (P0.05), but there was no significant difference between the other subgroups (P0.05).
4, NGAL and Cr correlation analysis showed that NGAL and Cr were positively correlated with 24h, and the correlation coefficient was 0.905.
Correlation analysis between Cys-C and Cr in 24h showed that NGAL and Cr were positively correlated, with a correlation coefficient of 0.663.
5. The ROC curves of NGAL, Cys-C and C r showed that the area under C R curve was 0.706, the area under Cys-C curve was 0.812, and the area under NGAL curve was 0.835, indicating that NGAL had the highest diagnostic value for renal injury in pregnancy-induced hypertension, followed by Cys-C and C r had the lowest diagnostic value.
Conclusion: 1. Both NGAL and C ys-C are expressed in the blood of patients with gestational hypertension, and the expression of NGAL and C ys-C is decreased postpartum.
2. The expression of NGAL was different in patients with different severity of gestational hypertension. The content of NGAL increased with the increase of serum Cr. Further analysis confirmed that the content of NGAL was highly correlated with the severity of the disease. Large sample analysis.
3. There was a positive correlation between serum NGAL and CR levels in the same patient, indicating that NGAL levels were highly correlated with the severity of the disease; Cys-C levels were positively correlated with CR levels; the correlation coefficient between serum NGAL and the severity of the disease was 0.905 (p = 0.000), and that between Cys-C and the severity of the disease was 0.663 (p = 0.000). In Cys-C, blood NGAL is more effective than Cys-C in reflecting the severity of the disease.
4. ROC curves showed that NGAL and C ys-C had higher value in predicting renal injury in pregnancy-induced hypertension than that in blood Cr. NGAL had the highest value in diagnosing renal injury in pregnancy-induced hypertension.
To sum up, blood NGAL and C ys-C can be used as an important index to predict renal injury and its severity in pregnancy-induced hypertension.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.246
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