血管紧张素转换酶在妊娠高血压综合征早期诊断中的价值

Serum angiotensin-converting enzyme in the early diagnosis of pregnancy-induced hypertension

目的探讨血管紧张素转换酶(ACE)在妊娠高血压综合征(简称妊高征)早期诊断中的价值。方法检测55例妊高征孕妇及45名正常孕妇(对照组)孕中期和孕后期的肾功能指标[肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、胱抑素C(Cys C)、视黄醇结合蛋白(RBP)、β_2-微球蛋白(β_2-MG)]、血糖(Glu)及ACE水平。采用受试者工作特征(ROC)曲线评估各项指标诊断妊高征的价值。结果妊高征组孕中期Cr、BUN、UA、Cys C、RBP均明显高于同期对照组(P<0.05),孕晚期Cr、UA、Glu、β_2-MG、RBP、ACE水平明显高于同期对照组(P<0.05)。妊高征组孕晚期BUN、β_2-MG、RBP、ACE水平明显高于孕中期(P<0.05),其他指标2个组之间差异均无统计学意义(P>0.05)。ROC曲线分析显示,肾功能各项指标诊断妊高征的曲线下面积(AUC)孕中期最大的是Cr,但其AUC也仅为0.716;孕晚期AUC最大的是ACE(0.924),其次为β_2-MG(0.897)。从孕中期到孕晚期,AUC升高最明显的是ACE。以临床诊断为标准,β_2-MG诊断妊高征的敏感性从孕中期的63.6%升高至孕晚期的67.3%,特异性从55.6%升高至88.9%;ACE的敏感性从70.9%升高至83.6%,特异性从95.6%升高至97.8%。β_2-MG与ACE无相关性(r=0.278,P>0.05)。结论ACE是早期诊断妊高征的敏感指标,具有一定的临床价值。

Objective To evaluate the role of serum angiotensin-converting enzyme（ACE） in the early diagnosis of pregnancy-induced hypertension. Methods A total of 55 pregnant women with pregnancy-induced hypertension and 45 healthy pregnant women（control group） were enrolled. Renal function indices [creatinine（Cr）,blood urea nitrogen（BUN）,uric acid（UA）,cystatin C（Cys C）,retinol-binding protein（RBP） and beta2-microglobulin（β2-MG） levels],glucose（Glu）and ACE level were determined at the middle- and later-periods of pregnancy. Receiver operating characteristic（ROC） curve was used to evaluate the roles of renal function indices and ACE level for the diagnosis of pregnancy-induced hypertension. Results The levels of Cr,BUN,UA,Cys C and RBP in pregnancy-induced hypertension group at the middle-period of pregnancy were higher than those in control group（P〈0.05）. The levels of Cr,UA,Glu,β2-MG,RBP and ACE at the later-period of pregnancy were higher than those in control group（P〈0.05）. The levels of BUN,β2-MG,RBP and ACE in pregnancy-induced hypertension group at the later-period of pregnancy were higher than those at the middle-period of pregnancy（P〈0.05）,and the other indices had no statistical significance（P〉0.05）. ROC curve showed that the area under curve（AUC） of Cr（0.716） was the biggest at the middle-period of pregnancy. At the later-period of pregnancy,the AUC of ACE（0.924） was the biggest,followed by the AUC of β2-MG（0.897）. From the middle-period of pregnancy to later-period of pregnancy,ACE had the most obvious increasing of AUC. The sensitivities of β2-MG for the diagnosis of pregnancy-induced hypertension were increased from 63.6% at the middle-period of pregnancy to 67.3% at the later-period of pregnancy,and the specificities were increased from 55.6% to 88.9%. The sensitivities of ACE were increased from 70.9% to 83.6%,and the specificities were increased from 95.6% to 97.8 %. There was no correlation between β2-MG and ACE（r=0.278,P〉0.05）. Conclusions ACE is a sensitive index for the early diagnosis of pregnancy-induced hypertension.