血清Hcy、ET-1联合UACR检测对子痫前期患者早期肾损伤的诊断价值

Diagnostic value of serum Hcy,ET-1 combined with UACR detection for early renal injury in patients with preeclampsia

目的探讨血清同型半胱氨酸(Hcy)、内皮素-1(ET-1)联合尿微量清蛋白/肌酐比值(UACR)检测对子痫前期患者早期肾损伤的诊断价值。方法选择2017年3月至2019年3月该院产科有完整档案的孕妇265例为研究对象,分为健康对照组87例、妊娠高血压组92例、子痫前期组86例;测定3组Hcy、ET-1、UACR、肌酐(Scr)、磷(P)、钙(Ca)、尿素氮(BUN)、预估肾小球滤过率(eGFR)、超敏C反应蛋白(hs-CRP)水平,分析以上指标与早期肾损伤的关系。结果子痫前期组Hcy、ET-1、UACR、Scr、P、Ca、BUN、hs-CRP水平高于妊娠高血压组、健康对照组,妊娠高血压组以上指标水平高于健康对照组,差异均有统计学意义(P<0.05)。子痫前期组eGFR低于妊娠高血压组、健康对照组(P<0.05),妊娠高血压组eGFR低于健康对照组(P<0.05)。Hcy、ET-1、UACR与Scr、P、Ca、BUN、hs-CRP呈正相关(P<0.05),与eGFR呈负相关(P<0.05)。高水平的Hcy、ET-1、UACR为子痫前期患者发生早期肾损伤的危险因素(OR=2.43、2.20、5.02,P<0.05);ET-1、Hcy、UACR诊断子痫前期患者早期肾损伤的灵敏度、特异度相近(P>0.05),皆小于Hcy+ET-1+UACR(P<0.05)。结论子痫前期早期肾损伤患者Hcy、ET-1、UACR水平升高;高水平的Hcy、ET-1、UACR均为子痫前期患者发生早期肾损伤的危险因素;血清Hcy、ET-1联合UACR诊断子痫前期患者早期肾损伤具有较高的灵敏度、特异度,值得在临床上推广应用。

Objective To investigate the diagnostic value of serum homocysteine(Hcy),endothelin-1(ET-1)combined with urine microalbumin/creatinine ratio(UACR)for early renal injury in the patients with preeclampsia.Methods Two hundreds and sixty-five pregnant women with intact files in the obstetrics department of this hospital from March 2017 to March 2019 were selected as the study subjects and devided into the healthy control group(n=87),pregnancy-induced hypertension group(n=92)and preeclampsia group(n=86).Then the levels of Hcy,ET-1,UACR,Scr,P,Ca,BUN,eGFR and hs-CRP were measured and their relationship with early renal injury was analyzed.Results The levels of Hcy,ET-1,UACR,Scr,P,Ca,BUN and hs-CRP in the preeclampsia group were higher than those in the pregnancy-induced hypertension group and healthy control group,and the levels of above indicators in the pregnancy-induced hypertension group were higher than those in the healthy control group,and the differences were statistically significant(P<0.05).The eGFR in the preeclampsia group was lower than that in the pregnancy-induced hypertension group and the healthy control group(P<0.05),and the eGFR in the pregnancy-induced hypertension group was lower than that in the healthy control group(P<0.05).Hcy,ET-1 and UACR levels were positively correlated with the levels of Scr,P,Ca,BUN and hs-CRP(P<0.05),and negatively correlated with eGFR(P<0.05).The high levels of Hcy,ET-1,UACR were the risk factors for early renal injury in the patients with preeclampsia(OR=2.43,2.20,5.02,P<0.05).The sensitivity and specificity of ET-1,Hcy,and UACR for diagnosing early renal damage in preeclampsia patients were similar(P>0.05),which were all less than Hcy+ET-1+UACR(P<0.05).Conclusion The levels of Hcy,ET-1 and UACR in the preeclampsia patients with early renal injury are increased,the high levels of Hcy,ET-1 and UACR all are the risk factors of early renal injury occurrence in the patients with preeclampsia;moreover,the combined detection of serum Hcy,ET-1 and UACR for diagnosing early renal injury in preeclampsia patients has high sensitivity and specificity,which is worthy of clinical promotion and application.