血清尿酸及NLRP3炎症小体对妊娠期高血压疾病孕妇并发急性肾损伤的预测价值

Predictive values of serum uric acid and NLRP3 inflammasome in pregnant women with hypertensive disorder complicating pregnancy with acute kidney injury

目的探讨妊娠期高血压疾病(HDCP)孕妇血清尿酸(SUA)和NOD样受体热蛋白结构域相关蛋白(NLRP)3炎症小体,对其急性肾损伤(AKI)的预测价值。方法选择2017年1月至2020年12月,在同济大学附属第一妇婴保健院收治的90例HDCP孕妇为观察组;再根据其是否并发AKI,进一步分为AKI亚组(n=35)和非AKI亚组(n=55)。选择同期与研究组孕妇在同一家医院建卡进行产前检查的90例健康孕妇,纳入对照组。采用多因素非条件logistic回归分析,对HDCP孕妇并发AKI的影响因素进行分析。绘制不同指标预测HDCP孕妇并发AKI的受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)。根据约登指数最大原则,确定这些指标预测HDCP并发AKI的最佳临界值。本研究遵循的程序符合病例收集医院伦理审查委员会制定的标准,并得到其批准(审批文号:KS2204)。与所有受试者签署临床研究知情同意书。结果①观察组和对照组孕妇年龄、孕龄、孕次比较,差异均无统计学意义(P>0.05)。②观察组孕妇SUA和NLRP3炎症小体水平,均明显高于对照组,而AKI亚组孕妇,明显高于非AKI亚组,并且差异均有统计学意义(P<0.05)。③影响HDCP孕妇并发AKI的单因素分析结果显示,胎盘早剥、产后出血量、血压是导致其并发AKI的影响因素(χ^(2)=5.442、9.091、6.461,P=0.019、0.011、0.039)。④多因素非条件logistic回归分析结果显示,SUA≥361.8μmol/L(OR=1.085,95%CI:1.062~1.320,P<0.001),NLRP3炎症小体≥5.6(OR=2.732,95%CI:1.074~3.665,P<0.001),胎盘早剥(OR=2.012,95%CI:1.300~5.984,P=0.003),产后出血量为1000~1500 mL与>1500 mL(OR=1.971、1.863,95%CI:1.011~4.540、1.016~4.950,P=0.020、0.019),血压为>160~180 mmHg(1 mmHg=0.133 kPa)与>180 mmHg(OR=2.000、1.903,95%CI:0.255~1.784、0.245~1.795,P=0.001、0.001),是导致HDCP孕妇并发AKI的独立危险因素。⑤SUA联合NLRP3炎症小体预测HDCP孕妇并发AKI的AUC为0.966(95%CI:0.962~0.970,P<0.05),根据约登指数最大原则,SUA联合NLRP3炎症小体预测HDCP孕妇并发AKI的最佳临界值分别为371.2μmol/L、5.8,此时其敏感度为97.5%,特异度为96.8%。结论SUA联合NLRP3炎症小体,对HDCP孕妇并发AKI具有良好预测价值,可为HDCP孕妇早期AKI的预防和诊疗提供参考。

Objective To explore the predictive value of pregnant women with hypertensive disorder complicating pregnancy(HDCP)for acute kidney injury(AKI)by serum uric acid(SUA)and NOD-like receptor heat protein domain-related protein(NLRP)3 inflammasome.Methods From January 2017 to December 2020,a total of 90 cases of HDCP pregnant women admitted to the Shanghai First Maternal and Infant Hospital,Tongji University were included into observation group,and according to whether they were concurrent with AKI,they were further divided into AKI subgroup(n=35)and non-AKI subgroup(n=55).Meanwhile another 90 healthy pregnant women underwent prenatal examination in the same hospital during the same period were selected into control group.Multivariate unconditional logistic regression analysis was used to analyze the influencing factors of AKI in HDCP pregnant women.The receiver operating characteristics(ROC)curves of different indexes to predict HDCP pregnant women complicated with AKI were drawn,and area under the curve(AUC)was calculated.According to the principle of maximum Youden index,the best critical value of different indexes for predicting HDCP complicated with AKI were determined.The procedure followed in this study met the standards formulated by the Ethics Review Committee of shanghai First Maternal and Infant Hospital,Tongji University and has been approved by it(Approval No.KS2204).Informed consent was obtained from each participate.Results①There were no significant differences between observation group and control group in age,gestational age and gravidity(P>0.05).②The levels of SUA and NLRP3 inflammasome in observation group were significantly higher than those in control group,and the levels of SUA and NLRP3 inflammasome in AKI subgroup were significantly higher than those in non-AKI subgroup,and the differences were statistically significant(P<0.05).③Univariate analysis of influencing factors of concurrent with AKI in HDCP pregnant women showed that placental abruption,volumes of postpartum hemorrhage and blood pressure might be the influencing factors of concurrent with AKI in HDCP pregnant women(χ^(2)=5.442,9.091,6.461;P=0.019,0.011,0.039).④Multivariate unconditional logistic regression analysis showed that SUA≥361.8μmol/L(OR=1.085,95%CI:1.062-1.320,P<0.001)and NLRP3 inflammasome≥5.6(OR=2.732,95%CI:1.074-3.665,P=0.003),postpartum hemorrhage were 1000-1500 mL and>1500 mL(OR=1.971,1.863,95%CI:1.011-4.540,1.016-4.950,P=0.020,0.019),and blood pressure were>160-180 mmHg(1 mmHg=0.133 kPa)and>180 mmHg(OR=2.000,1.903;95%CI:0.255-1.784,0.245-1.795;P=0.001,0.001)were independent risk factors caused concurrent of AKI in HDCP pregnant women.⑤The AUC of SUA combined with NLRP3 inflammasome in predicting AKI in HDCP pregnant women was 0.966(95%CI:0.962-0.970,P<0.05).According to the principle of maximum Youden index,the best critical value of combining SUA and NLRP3 inflammasome in predicting AKI in HDCP pregnant women were 371.2μmol/L,5.8,and its sensitivity was 97.5%and specificity was 96.8%.Conclusions The combined assessment of SUA and NLRP3 inflammasome has a good predictive performance for the concurrent of AKI in patients with HDCP,and may provide references for prevention,diagnosis and treatment of early AKI during pregnancy.