妊娠中、晚期妇女肾功能指标的检测及其参考区间的建立

Establishment of reference intervals for renal function parameters in middle and late pregnancy

目的检测健康妊娠中、晚期妇女各项肾功能指标[尿素、肌酐(Cr)、尿酸(UA)、尿素/Cr比值、UA/Cr比值]水平并建立其参考区间。方法连续监测4 000名健康妊娠妇女(妊娠组)孕14~20周、孕24~28周及孕37~40周的尿素、Cr、UA水平,以同期4 000名健康育龄期妇女作为正常对照组。采用百分位数法[第2.5百分位数(P_(2.5))~第97.5百分位数(P97.5)]确定妊娠中、晚期妇女各项肾功能指标的参考区间。结果妊娠组不同孕周尿素、Cr水平均低于正常对照组(P<0.05)。孕14~20周及孕24~28周时UA水平低于正常对照组(P<0.05),而孕37~40周时UA水平则高于正常对照组(P<0.05)。妊娠组血清尿素/Cr比值在孕14~20周和孕24~28周有不同程度的降低,与正常对照组比较差异有统计学意义(P<0.05),而在孕37~40周则升高,与正常对照组比较差异无统计学意义(P>0.05)。妊娠组血清UA/Cr比值在14~20周时有所降低,而后随着孕周的进展又有较大幅度的升高,与正常对照组比较,差异均有统计学意义(P<0.05)。采用百分位数法确定正常妊娠妇女孕14~20周、孕24~28周、孕37~40周的参考区间:尿素分别为1.8~3.9、1.7~3.8、1.7~5.0 mmol/L,Cr分别为33~53、32~54、31~60μmol/L,UA分别为141~269、127~352、161~457μmol/L,尿素/Cr比值分别为43.66~92.71、39.97~97.37、36.44~124.04,UA/Cr比值分别为3.15~6.25、3.17~8.55、3.18~11.20。结论孕妇肾功能各项指标均随着妊娠的进展出现不同程度的生理性变化。初步建立了妊娠中、晚期妇女的肾功能参考区间。

Objective To investigate the renal function parameters[urea,creatinine(Cr),uric acid(UA),urea/Cr ratio and UA/Cr ratio]during healthy pregnancy,and to establish the reference intervals for renal function parameters in middle and late pregnancy.Methods The levels of urea,Cr and UA were determined in4000healthy pregnant women(pregnancy group)and4000healthy women of childbearing age(healthy control group).For pregnancy group,urea,Cr and UA levels were determined at14-20,24-28and37-40gestational weeks.The reference intervals in middle and late pregnancy were defined as the2.5th percentile(P2.5)-the97.5th percentile(P97.5).Results The levels of urea and Cr in pregnancy group were lower than those in healthy control group(P<0.05),and the levels of UA at14-20and24-28gestational weeks were lower than those in healthy control group(P<0.05).The levels of UA in37-40gestational weeks were higher than those in healthy control group(P<0.05).Compared with healthy control group,serum urea/Cr ratio in pregnancy group decreased to various degrees at14-20and24-28gestational weeks(P<0.05),and then increased at37-40gestational weeks(P>0.05).Serum UA/Cr ratio in pregnancy group decreased at14-20gestational weeks,and then increased with the progression of gestational weeks(P<0.05).The reference intervals of renal function parameters at14-20,24-28and37-40gestational weeks were1.8-3.9,1.7-3.8,1.7-5.0mmol/L for urea,33-53,32-54,31-60μmol/L for Cr,141-269,127-352,161-457μmol/L for UA,43.66-92.71,39.97-97.37,36.44-124.04for urea/Cr ratio,and3.15-6.25,3.17-8.55,3.18-11.20for UA/Cr ratio.Conclusions There are different degrees of physiological changes of renal function in pregnant women with the progression of pregnancy,so it should establish the reference intervals of renal function parameters in middle and late pregnancy.