MPV、PDW和总胆红素对妊娠期糖尿病肾早期损伤的诊断价值

Diagnostic values of MPV,PDW and total bilirubin for early renal function damage in gestational diabetes mellitus

目的检测妊娠期糖尿病(gestational diabetes mellitus,GDM)患者外周血中平均血小板体积(mean platelet volume,MPV)、血小板分布宽度(platelet distribution width,PDW)值和血清总胆红素(total bilirubin,TBIL)等浓度水平的变化,并探讨其临床意义。方法选取GDM患者154例为研究对象,根据估算肾小球滤过率(estimated glomerular filtration rate,eGFR)将154例GDM患者分为肾功能正常组50例,肾功能早期受损组54例,肾功能受损组50例,另收集同期孕周50例健康孕妇为对照组。分别检测各组MPV、PDW及TBIL水平并加以分析。结果肾功能正常组、肾功能早期受损组、肾功能受损组MPV、PDW、TBIL、胱抑素C(Cystatin C,CysC)值高于对照组,肾功能正常组、肾功能早期受损组、肾功能受损组TBIL值低于对照组,肾功能早期受损组、肾功能受损组肌酐(creatinine,CREA)值高于对照组,肾功能受损组血尿素值高于对照组,差异有统计学意义(P<0.05)。肾功能早期受损组、肾功能受损组MPV、PDW、CysC值高于肾功能正常组,肾功能早期受损组、肾功能受损组TBIL值低于肾功能正常组,肾功能受损组血尿素、CREA值高于肾功能正常组,差异有统计学意义(P<0.05)。肾功能受损组MPV、PDW、CysC、血尿素、CREA值高于肾功能早期受损组,肾功能受损组TBIL值低于肾功能早期受损组,差异有统计学意义(P<0.05)。MPV、PDW值与CysC浓度水平呈正相关(r=0.478、0.393,P<0.05)。TBIL值与CysC浓度水平呈负相关(r=-0.393,P<0.05)。MPV、PDW、CysC是GDM发生肾功能损伤的危险因素,TBIL是保护因素。MPV、PDW、TBIL、CysC可用于诊断早期无明显肾功能损伤敏感度和特异度均较高,其中以CysC最高,诊断效能最好。结论MPV、PDW、TBIL可作为诊断GDM患者肾功能早期受损敏感、可靠的临床指标,应重视MPV、PDW及TBIL检测。

Objective To detect mean platelet volume(MPV),platelet distribution width(PDW)and serum total bilirubin(TBIL)in peripheral blood of patients with gestational diabetes mellitus(GDM),and explore its clinical significance.Methods A total of 154 GDM patients were selected as the study object.According to the estimated glomerular filtration rate(EGFR),154 GDM patients were divided into 50 cases of normal renal function group,54 cases of early renal function damage group,50 cases of renal function damage group,and 50 cases of healthy pregnant women in the same period of pregnancy as the control group.The levels of MPV,PDW and TBIL were detected and analyzed.Results The MPV,PDW,TBIL and Cystatin C(CysC)values of normal renal function group,early renal function damage group and renal function damage group were higher than those of the control group,the TBIL values of normal renal function group,early renal function damage group and renal function damage group were lower than those of the control group,the crea tinine(CREA)values of early renal function damage group and renal function damage group were higher than those of the control group,and the urea values of renal function damage group were higher than those of the control group,with statistical significance(P<0.05)The MPV,PDW and CysC values of the early damaged group and the damaged group were higher than those of the normal group,the TBIL values of the early damaged group and the damaged group were lower than those of the normal group,and the urea and crea values of the damaged group were higher than those of the normal group(P<0.05).The MPV,PDW,CysC,urea and crea values in the renal function damaged group were higher than those in the early renal function damaged group,and the TBIL values in the renal function damaged group were lower than those in the early renal function damaged group(P<0.05).MPV and PDW were positively correlated with CysC concentration(r=0.478,0.393,both P<0.05).There was a negative correlation between TBIL and CysC(r=-0.393,P<0.05).MPV,PDW and CysC were the risk factors of renal function damage in GDM,TBIL was the protective factor.The sensitivity and specificity of MPV,PDW,TBIL and CysC in the early diagnosis of no obvious renal function injury were higher,among which CysC was the highest and the best.Conclusion MPV,PDW and TBIL can be used as sensitive and reliable clinical indicators for the diagnosis of early renal function damage of GDM patients.