随机尿白蛋白/肌酐比值与妊娠期高血压疾病的相关性研究

Correlation between random urine albumin/creatinine ratio and hypertensive disorder complicating pregnancy

目的探讨随机尿白蛋白/肌酐比值(urine albumin/creatinine ratio,ACR)与妊娠期高血压疾病(hypertensive disorder complicating pregnarcy,HDCP)的相关性。方法选择2015年3月至2017年6月深圳市龙岗区妇幼保健院收治的妊娠期高血压患者132例为研究对象,按照临床分类分为HDCP组、轻度子痫前期组、重度子痫前期组,选取同期正常妊娠孕妇100例为对照组。收集所有孕妇的血、尿样本,测定并比较两组孕妇的血常规指标、凝血功能、血脂水平、血生化指标、尿蛋白肌酐比值及24 h尿蛋白定量。Spearman相关分析ACR与各项血、尿指标的相关性,同时,采用ROC曲线分析ACR对于HDCP的诊断价值。结果各组孕妇的红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,HGB)、红细胞压积(hemotocrit,HCT)、血小板(platelet,PLT)、甘油三酯(triglyerude,TG)、总胆固醇(total cholesterol,TC)比较差异无统计学意义(P> 0.05),HDCP组、轻度子痫前期组、重度子痫前期组孕妇D-二聚体(D-Dimer,DD)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶时间(activation of partial thromboplastin time,APTT)、尿素氮(blood urea nitrogen,BUN)、肌酐(creatinie,Cr)、胱抑素C(cystatin C,Cys C)、空腹血糖(fasting blood-glucose,FBG)、糖化血红蛋白(glycated hemoglobin,GHB)、尿酸(uric acid,UA)、胰岛素(insulin,INS)、C肽(C-peptide)、低密度脂蛋白胆固醇(low density lipoprotein,LDL)、载脂蛋白AⅠ(apolipoprotein AⅠ,Apo AⅠ)、载脂蛋白B(apolipoprotein B,Apo B)、24h尿蛋白定量、ACR较对照组显著升高,纤维蛋白原(fibrinogen,Fib)、总蛋白(total protein,TP)、白蛋白(albumin,ALB)、高密度脂蛋白胆固醇(high density lipoprotein,HDL)较对照组显著降低,差异有统计学意义(P<0.05); ACR与BUN、Cr、Cys C、UA、DD、LDL、Apo AⅠ、Apo B、24 h尿蛋白定量呈正相关,与TP、ALB、HDL呈负相关; ACR诊断妊娠期高血压、轻度子痫前期、重度子痫前期的最佳值分别为1.44 mg/mmo L、10.48 mg/mmo L、39.84 mg/mmo L。结论凝血功能、血脂水平、血尿生化指标的变化与HDCP的发生有关,ACR与24 h尿蛋白定量显著相关,可作为HDCP诊断的有效指标。

Objective To investigate the relationship between random urinary albumin/creatinine ratio and hypertensive disorder complicating pregnancy(HDCP).Methods 132 cases of HDCP were selected from March 2015 to June 2017 in Shenzhen Longgang Women and Children Health Care Hospital.According to the clinical classification,they were divided into HDCP group,mild pre-eclampsia group and severe preeclampsia group.100 pregnant women with normal pregnancy were selected as the control group.Blood and urine samples of all pregnant women were collected.Blood routine parameters,coagulation function,blood lipid level,blood biochemical index,urine protein creatinine ratio and 24 h urine protein were measured and compared between the two groups.Spearman correlation analysis of the relationship between random urine albumin/creatinine ratio(ACR) and various blood and urine indicators,meanwhile,using ROC curve to analyze the diagnostic value of ACR for HDCP.Results Of the indexs of red blood cell(RBC),hemoglobin(HGB),hematocrit(HCT),platelet(PLT),triglyerude(TG),total cholesterol(TC),there were no significant difference between the two groups(P>0.05).D-Dimer(DD),prothrombin time(PT),activation of partial thromboplastin time(APPT),blood urea nitrogen(BUN),creatinie(Cr),cystatin C(Cys C),fasting blood-glucose(FBG),glycated hemoglobin(GHB),uric acid(UA),insulin(INS),C-peptide,low density lipoprotein(LDL),apolipoprotein AⅠ(Apo AⅠ),apolipoprotein B(Apo B),24 h urine protein quantitation and ACR of pregnancy hypertension group,mild preeclampsia group and severe preeclampsia group were significantly higher than the control group.Fibrinogen(Fib),total protein(TP),albumin(ALB),high density lipoprotein(HDL) were significantly lower than the control group,and the differences were statistically significant(P<0.05).ACR was positively correlated with BUN,Cr,Cys C,UA,DD,LDL,Apo A I,Apo B,and 24 h urine protein,and negatively correlated with TP,ALB,and HDL.The best values for ACR in the diagnosis of pregnancy-induced hypertension,mild pre-eclampsia,and severe pre-eclampsia were 1.44 mg/mmo L,10.48 mg/mmo L,and 39.84 mg/mmo L,respectively.Conclusion The changes of coagulation function,blood lipid level and hematuria biochemical index are related to the occurrence of HDCP.The ratio of random urine protein creatinine is significantly correlated with 24 h urine protein quantification,which can be used as an effective indicator for HDCP diagnosis.