肾损伤分子-1、β2-微球蛋白、内皮素-1和肌酐在妊娠期高血压疾病并发急性肾损伤的临床研究

Clinical research of kidney injury molecules-1,β 2-microglobulin,endothelin-1 and creatinine in gestational hypertension complicated with acute kidney injury

目的:探讨血清肌酐(SCr)、内皮素-1(ET-1)、肾损伤分子-1(KIM-1)和β2-微球蛋白(β2-MG)的水平在妊娠期高血压疾病并发早期肾损伤的临床意义。方法:将妊娠期高血压疾病并发肾损伤的孕产妇40例设为肾病组,同期正常孕产妇40例设为对照组,分别在孕龄30周、32周、34周、36周检测孕妇血SCr、ET-1、尿KIM-1和β2-MG的水平。结果:1肾病组与对照组比较,患者的年龄、孕次和流产史均无统计学差异(P>0.05),尿量、尿素氮(BUN)、SCr及尿蛋白定量均存在统计学差异(P<0.001);2肾病组和对照组整体比较,SCr、ET-1、KIM-1和β2-MG的组间、时间点间的交互作用均有统计学差异(P<0.05);3孕36周SCr、孕32周KIM-1及孕34周ET-1和β2-MG水平肾病组与对照组组间存在统计学差异(P<0.05);4对照组组内不同孕周间SCr、ET-1、KIM-1和β2-MG水平无统计学差异(P>0.05);肾病组组内与孕30周时比,KIM-1水平在孕32周显著升高(P<0.05),在孕34周、36周进一步升高(P<0.01);ET-1和β2-MG水平在孕34周显著升高(P<0.05),而SCr在孕36周显著升高(P<0.05)。结论:妊娠期高血压疾病孕妇产前监控中,联合检测SCr、ET-1、KIM-1和β2-MG能及时发现肾损伤的存在;妊娠期高血压疾病并发肾损伤时KIM-1、ET-1和β2-MG的改变早于SCr的改变。

Objective： To explore the clinical significance of the serum creatinine （SCr）, kidney injury molecules- 1 （KIM- 1 ）, β2 -microglobulin （β2-MG）, endothelin- 1 （ET- 1） gestational hypertension disease compalicated with early renal damage. Methods： Normal maternal cases （n=40） were collected as control group, at the same time gestational hypertension disease complicated with renal injury were collected as maternal group （n=40）. SCr, ET-1, KIM-1 and β2-MG levels at gestational age 30 weeks, 32 weeks, 34 weeks and 36 weeks were detected. Results： ① There was no significant difference in history of pregnancy and abortion between nephropathy group and control group （P〉0.05）; while urine output, blood urea nitrogen （BUN）, SCr and urinary protein quantitative existed significant differences between the two groups （P〈0.001）. ② SCr, ET-1, KIM-1 and β2-MG between nephropathy group and control group, were statistically significant at each time point （P〈0.05）. ③ Compared with control group, the change of SCr appeared a significant difference at gestational age 36 week in nephropathy group. KIM-1 had a significant difference at gestational age 32 weeks （P〈0.05）. ET-1 and β2-MG concentrations at gestational age 34 weeks nephropathy group was significantly higher than that in control group （P〈0.05）. 4） Contrast in the respective group, SCr, KIM- 1, ET- 1 and β2-MG of control group had no significant difference at different gestational age （P〉0.05）. In different gestational ages of the nephropathy group KIM-1 level was significantly increased than gestational age 32 weeks （P〈0.05）, especially at 34 and 36 weeks gestation, this change was more significant （P〈0.01）. ET-1 and β2-MG in 34 weeks gestation was significantly increased （P〈0.05）, while SCr increased significantly at 36 weeks gestation （P〈0.05）. Conclusion： In maternal prenatal monitoring of gestational hypertension disease, jointly detecting SCr, ET-1, KIM-1 and β2-MG can timely find the existence of kidney damage. In gestational hypertension complicated with kidney injury, KIM-1, β2-MG and ET-1 are much earlier changing than SCr.