尿微量白蛋白与肌酐比值在妊娠期糖尿病肾病早期诊断及病情监测中的意义

Significance of Urine Albumin to Creatinine Ratio in Early Diagnosis and Disease Monitoring of Gestational Diabetes Mellitus with Nephropathy

目的探讨尿微量白蛋白与肌酐比值(micro-albumin creatinine ratio,ACR)在妊娠期糖尿病(gestational diabetes mellitus,GDM)肾病早期诊断及病情监测中的意义。方法选取GDM 100例作为GDM组,正常孕妇80例作为正常孕妇组;根据血糖检测结果及治疗方案不同,GDM组分为GDM饮食组77例和GDM胰岛素组23例。GDM患者与正常孕妇均于孕中及晚期检测尿ACR、微量白蛋白(m ALB)、β2-微球蛋白(β2-MG)及血肌酐(Cr)、糖化血红蛋白水平,并对检测结果进行统计分析。结果孕中期及孕晚期GDM组尿ACR、mALB、β_2-MG及血糖化血红蛋白均高于正常孕妇组;GDM组孕晚期尿ACR、mALB、β_2-MG及血糖化血红蛋白均高于孕中期,差异有统计学意义(P <0. 05)。孕中期GDM饮食组尿ACR、mALB及血糖化血红蛋白均低于GDM胰岛素组,孕晚期GDM饮食组尿ACR、mALB、β_2-MG及血糖化血红蛋白均低于GDM胰岛素组;GDM饮食组孕晚期尿ACR及mALB均高于孕中期,GDM胰岛素组孕晚期尿ACR、mALB、β_2-MG及血糖化血红蛋白均高于孕中期,差异有统计学意义(P <0. 05)。GDM饮食组尿ACR阳性率明显高于尿mALB和β_2-MG阳性率,差异有统计学意义(P <0. 05)。Pearson相关分析显示,孕晚期GDM组尿ACR分别与尿mALB、β_2-MG及血糖化血红蛋白呈正相关。结论 ACR升高与GDM肾病早期肾损害密切相关,ACR对GDM肾病早期诊断和病情评估有重要意义。

Objective To explore the significance of urine albumin to creatinine ratio （ACR） in early diagnosis and disease monitoring of gestational diabetes mellitus （GDM） with nephropathy. Methods One hundred patients with GDM were selected as GDM group, and 80 healthy pregnant women as normal pregnancy group. According to different results of blood glucose test and treatment options, the GDM group was divided into diet control group （ n =77） and insulin treatment group （ n =23）. For GDM patients and normal pregnant women, the levels of ACR, microalbumin （mALB）, β 2-microglobulin （β 2-MG）, serum creatinine （Cr） and glycosylated hemoglobin were measured in the mid and late pregnancy, and the results were statistically analyzed. Results The levels of urine ACR, mALB, β 2-MG and glycated hemogobin （GHB） in GDM group were all higher than those in normal pregnancy group in the mid and late pregnancy; In GDM group, the levels of urine ACR, mALB, β 2-MG and GHB in the late pregnancy were all higher than those in the mid pregnancy, and the differences were statistically significant （ P 〈0.05）. In the mid pregnancy, the levels of urine ACR, mALB and GHB in the diet control group were all lower than those in the insulin treatment group. In the late pregnancy, the levels of urine ACR, mALB and GHB in the diet control group were all lower than those in the insulin treatment group; in the diet control group, the levels of urine ACR and mALB in the late pregnancy were all higher than those in the mid pregnancy, while in the insulin treatment group, the levels of urine ACR, mALB, β 2-MG and GHB in the late pregnancy were all higher than those in the mid pregnancy, and the differences were statistically significant （ P 〈0.05）. The positive rate of urine ACR in the diet control group was significantly higher than that of urine mALB andβ 2-MG, and the differences were statistically significant （ P 〈0.05）. The Pearson correlation analysis revealed that urine ACR was positively associated with mALB, β 2-MG and GHB respectively in GDM group during the late pregnancy （ P 〈0.05）. Conclusion An increase in the level of ACR is closely related to the early renal damage of GDM patients with nephropathy. ACR has an important significance in early diagnosis and evaluation of the severity of GDM patients with nephropathy.