尿调节素在妊娠期高血压疾病合并急性肾损伤患者外周血中的表达及临床意义

Expression and clinical significance of uromodulin in peripheral blood of patients with hypertensive disorder complicating complicating pregnancy combined with acute kidney injury

目的观察尿调节素(uromodulin,UMOD)在妊娠期高血压疾病(hypertensive disorder complicating pregnancy,HDCP)合并急性肾损伤(acute kidney injury,AKI)患者外周血中的表达,并探讨其临床意义。方法选择武汉市第八医院妇产科2017年1月至2019年10月住院治疗的92例HDCP患者作为研究对象,根据入院7 d内是否出现AKI分为AKI组(35例)和非AKI组(57例),采用酶联免疫吸附法检测各组患者血清UMOD表达水平,同时检测各组患者入院时尿量、血清肌酐(serum creatinine,SCr)、尿素氮(blood urea nitrogen,BUN)、肾小球滤过率(glomerlar filtration rate,GFR)、胱抑素C(Cystatin C,CysC)、中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase associated lipocalin,NGAL)等指标。采用Logistic回归模型分析HDCP患者发生AKI的危险因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清UMOD早期预测AKI发生的临床价值。结果两组患者年龄、孕周、孕次、体质量指数等临床资料比较,差异无统计学意义(P>0.05),AKI组患者尿量、GFR及UMOD均低于非AKI组,SCr、BUN、CysC、NGAL均高于非AKI组(P<0.05);血清UMOD、SCr、BUN、CysC、NGAL均为影响HDCP患者入院7 d内发生AKI的独立因素(P<0.05);血清UMOD诊断HDCP患者入院72 h内发生AKI的AUC明显优于其他指标(P<0.05)。结论HDCP患者早期发生AKI时血清UMOD表达水平明显降低,在早期诊断HDCP合并AKI发生方面具有较高的临床价值。

Objective To observe the expression of uromodulin(UMOD)in peripheral blood of patients with hypertensive disorder complicating pregnancy(HDCP)complicated with acute kidney injury(AKI),and explore its clinical significance.Methods 92 HDCP patients hospitalized in the Obstetrics and Gynecology Department of the No.8 Hospital of Wuhan from January 2017 to October 2019 were selected and divided into AKI group(35 cases)and non-AKI group(57 cases)according to the presence of AKI within 7 days after admission.The level of UMOD was measured by ELISA,at the same time,urinary volume,SCr,BUN,GFR,CysC,NGAL were measured.The risk factors of AKI in HDCP patients were analyzed by Logistic regression model,and the clinical value of UMOD in predicting AKI was analyzed by ROC curve.Results There was no significant difference in age,gestational age,pregnant times and body mass index between the two groups(P>0.05).The urinary volume,GFR and UMOD in AKI group were significantly lower than those in non-AKI group,but the levels of SCr,BUN,CysC,NGAL were significantly higher than those in non-AKI group(P<0.05).Serum UMOD,SCr,BUN,CysC,and NGAL were independent factors that affect the occurrence of AKI within 7 days of admission of HDCP patients(P<0.05);AUC of serum UMOD diagnosis of HDCP patients with AKI within 72 hours of admission was significantly better than other indicators.Conclusion The serum UMOD expression level of HDCP patients is significantly reduced when AKI occurs early,and it has high clinical value in the early diagnosis of HDCP combined with AKI.