血清胱抑素、β2-微球蛋白和尿微量白蛋白联合检测对妊娠期高血压疾病早期肾损伤的价值

Diagnostic value of combined detection of serum CysC,β2-MG and urinary mALB in detecting early renal injury in hypertensive disorder complicating pregnancy

目的探讨血清胱抑素C(CysC)、β2-微球蛋白(β2-MG)和尿微量白蛋白(mALB)联合检测对诊断妊娠期高血压疾病(HDCP)患者早期肾损伤的临床价值。方法选取2015年2月至2017年3月在宜宾市第一人民医院产科门诊和住院部诊断为HDCP的孕妇122例,根据2015年《妊娠期高血压疾病诊疗指南》中的诊断标准,将研究对象分为妊娠期高血压组(n=48例)、轻度子痫前期组(n=42例)和重度子痫前期组(n=32例)。选取同期在本院住院妊娠妇女30例为对照组。检测4组血清CysC、β2-M G和尿mALB水平;采用受试者工作特征(ROC)曲线评价指标的可靠性。结果血清CysC、β2-M G和尿mALB水平在重度子痫前期组、轻度子痫前期组、妊娠期高血压组和对照组4组间比较差异均有统计学意义(t=2.94~19.27,均P<0.05);血清CysC、β2-MG和尿mALB联合检测对HDCP患者早期肾损伤的ROC曲线下面积(AUC)为0.936,敏感度和特异度分别为94.95%、96.46%。结论血清CysC、β2-M G和尿mALB是HDCP患者早期肾功能受损的敏感指标,三者联合诊断对HDCP患者早期肾损伤具有重要临床意义。

Objective To explore clinical value of combined detection of serum cystatin C（ CysC）,β2-microglobulin（ β2-MG） and urinary microalbumin（ mALB） in diagnosing early renal injury in hypertensive disorder complicating pregnancy（ HDCP）. Methods A total of 122 pregnant women diagnosed with HDCP in outpatient and inpatient sections of obstetrics department of Yibin First People＇s Hospital from February 2015 to March 2017 were selected. Based on diagnostic criteria in Guidelines for Diagnosis and Treatment of Hypertensive Disorder Complicating Pregnancy in 2015,subjects were divided into gestational hypertension group（ n = 48）,mild preeclampsia group（ n = 42） and severe preeclampsia group（ n = 32）. Another 30 pregnant women hospitalized in the hospital in same period were selected as control group. Serum Cys C,β2-MG and urinary mALB levels were measured in four groups. Reliability of index was evaluated by receiver operating characteristic（ ROC） curve. Results Levels of serum Cys C,β2-MG and urinary mALB were significantly different among severe preeclampsia group,mild preeclampsia group,gestational hypertension group and control group（ t value ranged 2. 94-19. 27,all P 0. 05）. Area under ROC curve（ AUC） of combined detection of serum Cys C,β2-MG and urinary mALB in diagnosing early renal injury in HDCP patients was 0. 936,and sensitivity and specificity were 94. 95% and 96. 46%,respectively.Conclusion Serum Cys C,β2-MG and urinary mALB serve as sensitive indicators for diagnosing early renal injury of patients,and combined diagnosis with three indexes has important clinical significance for detection of early renal injury in patients with HDCP.