血清β2-微球蛋白、RBP4及尿NGAL联合检测在诊断妊娠期高血压早期肾损害价值

Diagnostic value of serumβ2-microglobulin,RBP4 and urinary NGAL for early renal impairment of patients with hypertensive disorder complicating pregnancy

目的:探讨血清β2-微球蛋白(β2-MG)、视黄醇结合蛋白4(RBP4)及尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合检测在妊娠期高血压疾病(HDCP)患者早期肾损害中的诊断价值。方法:选择HDCP患者63例为观察组,正常孕妇42例为对照组,以尿蛋白排泄率(UAER)为依据,将观察组分为正常蛋白尿组(16例,UAER<20μg/min),微量白蛋白尿组(23例,20μg/min<UAER<200μg/min),大量蛋白尿组(24例,UAER>200μg/min),分别检测各组血清β2-MG、RBP4、尿NGAL水平,分析组间差异,受试者工作特征曲线(ROC)分析诊断HDCP早期肾损害的效能。结果:各组血清β2-MG、RBP4、尿NGAL水平为大量蛋白尿组>微量蛋白尿组>正常蛋白尿组(P<0.05),正常蛋白尿组与对照组无差异(P>0.05)。联合检测在正常蛋白尿组、微量蛋白尿组、大量蛋白尿组的阳性检出率(31.3%、95.7%、100%)高于单独检测,诊断HDCP早期肾损伤的灵敏度、特异度、阳性预测值、阴性预测值、准确度、阳性似然比(89.4%、92.8%、90.3%、93.0%、93.8%、9.0)高于单独检测,阴性似然比(1.02)低于单独检测。ROC分析β2-MG、RBP4、NGAL、联合检测诊断HDCP早期肾损伤的曲线下面积(AUC)分别为0.637(95%CI:0.027~1.384)、0.731(95%CI:0.635~9.034)、0.799(95%CI:0.027~13.057、0.895(95%CI:0.034~6.314)。结论:联合检测血清β2-MG、RBP4、尿NGAL可提高对HDCP早期肾损伤的诊断准确率,为临床诊治提供可靠依据。

Objective：To investigate the diagnostic value of detection of serum β2-microglobulin（β2-MG）combined with detection of retinol-binding protein 4（RBP4）and urine neutrophil gelatinase-associated lipocalin（NGAL）for early renal impairment of patients with hypertensive disorder complicating pregnancy（HDCP）.Methods：63 patients with HDCP were selected in observation group,and another 42 normal pregnant women were selected in control group.Based on the urinary protein excretion rate（UAER）,the patients in observation group were also divided into normal proteinuria group（16 cases,UAER〈20 ug/min）,and microalbumin（23 patients,20 ug/min〈UAER〈200 ug/min）,and massive proteinuria group（24 patients,UAER〉200 ug/min）.The levels of serum β2-MG,RBP4,and urinary NGAL of patients were measured in each group.Differences among these groups was analyzed,and receiver operating characteristic curve（ROC）analysis of β2-MG detection combined with detection of RBP4 and NGAL was used to evaluated the value for early diagnosing renal damage of patients with HDCP.Results：The serum levels of β2-MG,RBP4 and urinary NGAL of patients in massive proteinuria group were significant higher than those of patients in microal buminuria group,those of patients in microal buminuria group were significant higher than those of patients in normal proteinuria group,and those of patients in normal proteinuria group were significant higher than those of patients in healthy control group（all P〈0.05）.The positive rates by combined detection in normal proteinuria group,in microproteinuria group,and in macroalbuminuria group were 31.3%,95.7%,and 100%,respectively,which were significant higher than those by individual detection.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and positive likelihood ratio by combined detection for diagnosing early renal injury of patients with HDCP were 89.4%,92.8%,90.3%,93.0%,93.8%,and 9.0,respectively,which were significant higher than those detected by individual detection,but the negative likelihood ratio of combined detection（1.02）was significant lower than that by individual detection.The area under the curve（AUC）ofβ2-MG,RBP4,NGAL,and combined detection by ROC analysis for diagnosing early renal injury of patients with HDCP was 0.64（95% CI：0.03-1.38）,0.73（95% CI：0.64-9.03）,0.80（95% CI：0.03-13.06,and 0.90（95% CI：0.03-6.31）.Conclusion：The serum β2-MG detection combines with detection of RBP4 and urinary NGAL can improve the accuracy of diagnosis early renal injury of patients with HDCP,which can provide a reliable evidence for clinical diagnosis and treatment.