妊娠期高血压疾病孕妇血清胱抑素C、同型半胱氨酸水平变化与早期肾损害的相关性分析

Analysis on correlations between changes of serum cystatin C,homocysteine levels and early renal damage in pregnant women with hypertensive disorder complicating pregnancy

目的探讨妊娠期高血压疾病(HDCP)孕妇血清胱抑素C(Cys-C)、同型半胱氨酸(Hcy)水平变化与早期肾损害的相关性,为及时对HDCP患者早期肾损害的诊断提供理论依据。方法选取2015年3月-2017年2月来院建立生育档案孕产妇174例,均确诊为HDCP,按照病情症状分组,轻度HDCP者113例为轻度HDCP组,中重度HDCP且伴有子痫症状者61例为子痫HDCP组;另选取同期健康孕产妇50例作为对照组,均行血清Cys-C、Hcy检测,评估Cys-C、Hcy水平与早期肾损害相关性。结果各组Cys-C、Hcy及肾小球滤过率(GFR)指标差异均有统计学意义(P<0.05),随HDCP患者病情的加重,自身Cys-C、Hcy指标增长越发明显,GFR水平减少越显著;Cys-C与GFR呈负相关性(r=-0.335,P=0.021),Hcy与GFR呈负相关性(r=-0.437,P=0.014);Cys-C、Hcy联合检测HDCP合并肾损伤的ROC面积评分为0.837(95%CI=0.756~0.895,P=0.015),诊断敏感度为90.3%,特异度为97.3%。结论 Cys-C、Hcy联合检测可有效预测妊娠期高血压患者早期肾损害状态,较常规尿酸、肌酐指标监测更具优势,属妊娠期HDCP防控监测重要指标。

Objective To explore the correlations between serum cystatin C(Cys-C）,homocysteine(Hcy） levels and early renal damage in pregnant women with hypertensive disorder complicating pregnancy(HDCP）,provide a theoretical basis for timely diagnosis of early renal damage in HDCP pregnant women. Methods From March 2015 to February 2017,174 pregnant women establishing medical records in Lanxi People’s Hospital were selected and diagnosed as HDCP definitely,then they were divided into mild HDCP group(113 cases with mild HDCP）and preeclampsia＋HDCP group(61 cases with moderate to severe HDCP and preeclampsia） according to the symptoms. Fifty healthy pregnant women during the same period were selected as control group. The levels of serum Cys-C and Hcy were detected,the correlations between serum Cys-C,Hcy levels and early renal damage were evaluated. Results There were statistically significant differences in the levels of serum Cys-C and Hcy,glomerular filtration rate(GFR） among the three groups(P〈0. 05）. The increases of Cys-C and Hcy,the decrease of GFR were significant with the aggravation of HDCP. Cys-C was negatively correlated with GFR(r =-0. 335,P = 0. 021）,Hcy was negatively correlated with GFR(r =-0. 437,P = 0. 014）. The area under ROC of Cys-C combined with Hcy in diagnosis of HDCP combined with renal damage was 0. 837(95% CI： 0. 756-0. 895,P = 0. 015）. The diagnostic sensitivity and specificity were 90. 3% and 97. 3%, respectively.Conclusion Combined detection of Cys-C and Hcy can effectively predict early renal damage in patients with HDCP,which is superior to routine indexes,such as uric acid,creatinine. Cys-C and Hcy are important indexes for prevention,control,and monitoring of HDCP.