血清尿素、胱抑素C和尿微量白蛋白联合检测在妊娠期高血压综合征早期肾损伤诊断中的应用价值

Application value of combined detection of serum urea,cystatin C and urine microalbumin in diagnosis of early kidney injury in pregnancy-induced hypertension syndrome

目的探讨血清尿素、胱抑素C(Cys C)和尿微量白蛋白(mALB)联合检测在妊娠期高血压综合征(妊高症)早期肾损伤临床诊断中的应用价值。方法选择2018年1月—2020年1月长沙市中心医院收治的118例妊高症孕妇作为妊高症组,根据疾病类型不同分为3个亚组,即子痫前期轻度组(38例),子痫前期重度组(40例)以及妊娠期高血压组(40例);将妊高症组孕妇根据肾功能有无异常分为2个亚组,即肾功能正常组(60例)和肾功能异常组(58例);另选择同期入院且孕前检查结果为正常的118名孕妇作为健康对照组。采用脲酶-谷氨酸脱氢酶法测定尿素,采用乳胶增强免疫比浊法测定Cys C,采用免疫比浊法测定尿mALB;比较各组孕妇的血清尿素、Cys C和尿mALB水平。结果妊高症组尿素、Cys C、mALB水平均明显高于健康对照组〔尿素(mmol/L):4.71±0.72比3.69±0.60,Cys C(mg/L):1.82±0.27比1.01±0.17,mALB(mg/L):76.62±11.39比15.59±2.03,均P<0.01〕;妊高症组中,子痫前期重度组的尿素、Cys C、mALB水平均明显高于轻度组及妊娠期高血压组〔尿素(mmol/L):5.39±0.79比4.36±0.52、4.00±0.56,Cys C(mg/L):1.99±0.35比1.79±0.26、1.30±0.20,mALB(mg/L):98.55±15.92比66.25±7.18、58.11±6.37,均P<0.01〕,肾功能异常组的尿素、Cys C、mALB水平均明显高于肾功能正常组〔尿素(mmol/L):5.29±0.87比4.10±0.55,Cys C(mg/L):2.09±0.33比1.55±0.20,mALB(mg/L):86.88±13.56比66.36±9.17,均P<0.01〕。结论血清尿素、Cys C和尿mALB联合检测在妊高症早期肾损伤临床诊断中的应用价值较高,可作为妊高症临床诊疗中的辅助性措施。

Objective To analyze the application value of combined detection of serum urea,cystatin(Cys C)and urine microalbumin(mALB)in the early diagnosis of kidney injury in pregnancy-induced hypertension syndrome(PIH).Methods The 118 cases of patients with PIH admitted to Changsha Central Hospital from January 2018 to January 2020 were selected as the PIH group.According to the different types of diseases,the patients in PIH group were divided into three subgroups such as mild preeclampsia group(38 cases),severe preeclampsia group(40 cases)and pregnancy hypertension group(40 cases);according to different renal functions,the patients in PIH group were divided into two subgroups such as normal renal function group(60 cases)and abnormal renal function group(58 cases).Other 118 cases of pregnant women who were admitted to the hospital during the same period with the results of pre-pregnancy examinations normal were selected as the healthy control group.Urea was determined by urease glutamate dehydrogenase method,Cys C was determined by latex enhanced immunoturbidimetry,and urine mALB was measured by immunoturbidimetry.The levels of urea,Cys C and mALB of pregnant women in each group were compared.Results The levels of urea,Cys C and mALB in the PIH group were significantly higher than those in the healthy control group[urea(mmol/L):4.71±0.72 vs.3.69±0.60,Cys C(mg/L):1.82±0.27 vs.1.01±0.17,mALB(mg/L):76.62±11.39 vs.15.59±2.03,all P<0.01].In the PIH group,the levels of urea,Cys C and mALB in severe preeclampsia group were significantly higher than those in mild preeclampsia group and pregnancy hypertension group[urea(mmol/L):5.39±0.79 vs.4.36±0.52,4.00±0.56,Cys C(mg/L):1.99±0.35 vs.1.79±0.26,1.30±0.20,mALB(mg/L):98.55±15.92 vs.66.25±7.18,58.11±6.37,all P<0.01];the levels of urea,Cys C and mALB in abnormal renal function group were significantly higher than those in normal renal function group[urea(mmol/L):5.29±0.87 vs.4.10±0.55,Cys C(mg/L):2.09±0.33 vs.1.55±0.20,mALB(mg/L):86.88±13.56 vs.66.36±9.17,all P<0.01].Conclusion The application of combined detection of serum urea,Cys C and urine mALB has high value in the clinical diagnosis of early renal injury in patients with PIH,and it can be used as an auxiliary measure in the clinical diagnosis and treatment of PIH.