血清Hcy联合hs-CRP在妊娠期糖尿病肾病中的诊断价值

Diagnostic value of serum homocysteine combined with hs-CRP in gestational diabetic nephropathy

目的探讨血清同型半胱氨酸(Hcy)联合超敏C反应蛋白(hs-CRP)在诊断妊娠期糖尿病(GDM)肾病的应用价值。方法选择丽水市妇幼保健院2016年1月至2017年10月期间收治的80例GDM患者为研究对象,并根据尿白蛋白排除率(UAER)将其分为单纯GDM组(52例)和GDM肾病组(28例),选择同期50例健康孕妇纳入对照组。比较不同组别研究对象血清Hcy、hs-CRP以及肌酐(Scr)、尿素氮(BUN)、UAER水平,并分析Hcy、hs-CRP对GDM早期肾病的诊断价值。结果三组间Scr、BUN比较均无显著性差异(F值分别为1.023、0.908,均P>0.05),UAER、Hcy、hs-CRP比较均有显著性差异(F值分别为19.056、9.807、11.435,均P<0.05),进一步每两组比较发现GDM肾病组UAER、Hcy、hs-CRP均显著高于对照组和单纯GDM组(t_(GDM肾病组与对照组值)分别为4.076、6.675、9.553,t_(GDM肾病组与单纯GDM组值)分别为2.908、3.007、5.214,均P<0.05)。单纯GDM组Hcy、hs-CRP均显著高于对照组(t值分别为3.125、4.080,均P<0.05),但两组UAER比较无显著性差异(t=1.786,P>0.05)。GDM肾病组血清Hcy、hs-CRP阳性率均显著高于单纯GDM组(χ~2值分别为6.572、4.185,均P<0.05),两组患者血清Scr和BUN阳性率比较均无显著性差异(χ~2值分别为0.208、0.398,均P>0.05)。对GDM肾病组Hcy、hs-CRP、Hcy联合hs-CRP诊断价值分析后发现,Hcy联合hs-CRP阳性率均显著高于Hcy、hs-CRP(χ~2值分别为11.789、13.462,均P<0.05)。Pearson相关分析显示,GDM患者血清Hcy、hs-CRP水平与UAER均呈显著正相关(r值分别为0.593、0.552,均P<0.05)。结论对于妊娠期糖尿病患者定期检测血清Hcy、hs-CRP,可以早期识别及诊断肾损伤。

Objective To explore the value of serum homocysteine（Hcy）combined with high sensitivity C reactive protein（hs-CRP）in the diagnosis of gestational diabetic nephropathy.Methods Eighty cases of patients with GDM in Lishui Maternal and Child Health Care Hospital from January 2016 to October 2017 were selected and divided into simple GDM group（52 cases）and GDM nephropathy group（28 cases）according to UAER.Fifty healthy pregnant women in the same period were selected as control group.The serum levels of Hcy,hs-CRP and Scr,BUN and UAER were compared among subjects of different groups.The diagnostic value of Hcy and hs-CRP on early renal disease in GDM cases was analyzed.Results There was no significant difference in Scr and BUN among three groups（Fvalue was 1.023 and 1.023,respectively,both P〈0.05）.The differences were significant in UAER,Hcy and hs-CRP among three groups（Fvalue was 19.056,9.807 and 11.435,respectively,all P〈0.05）.UAER,Hcy and hs-CRP were significantly higher in GDM nephropathy group compared with control group and simple GDM group（t_（GDM nephropathy group compared with control group）value was 4.076,6.675 and 9.553,t_（GDM nephropathy group compared with simple GDM group）value was 2.908,3.007 and 5.214,respectively,all P〈0.05）.Both Hcy and hs-CRP in simple GDM group were significantly higher than those in the control group（t value was 3.125 and 4.080,respectively,both P〈0.05）,but there was no significant difference in UAER between two groups（t=1.786,P〈0.05）.The positive rate of Hcy and hs-CRP in GDM nephropathy group were significantly higher than that of simple GDM group（χ^2 value was 6.572 and 4.185,respectively,both P〈0.05）,but there was no significant difference in positive rate of Scr and BUN between two groups（χ^2 value was 0.208 and 0.398,respectively,both P〈0.05）.After analyzing the diagnostic value of Hcy,hs-CRP,Hcy combined hs-CRP in GDM nephropathy group,the positive rate of Hcy combined hs-CRP was significantly higher than that of Hcy and hs-CRP（χ^2 value was 11.789 and 13.462,respectively,both P〈0.05）.Peason correlation analysis showed that the serum Hcy and hs-CRP levels of GDM patients were significantly positively correlated with UAER（r value was 0.593 and 0.552,respectively,both P〈0.05）.Conclusion Regular detection of serum Hcy and hs-CRP in patients with gestational diabetes can identify and diagnose renal injury in early stage.