血清Lp-PLA2、Hcy、mALB、NAG、CysC联合检测在妊娠期高血压疾病早期肾脏损伤中的诊断价值

Diagnostic value of combined detection of serum Lp-PLA2,Hcy,mALB,NAG and CysC in early renal injury of hypertensive disorder complicating pregnancy

目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)、血清胱抑素-C(CysC)、尿微量白蛋白(mALB)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)联合检测在妊娠期高血压疾病早期肾脏损伤中的诊断价值。方法前瞻性选取2019年3月至2020年9月我院收治的82例妊娠期高血压疾病的患者,根据孕妇病情程度分成妊娠期高血压组(n=27,血压≥140/90 mmHg,尿蛋白阴性)、轻度子痫前期组(n=26,血压≥140/90 mmHg,尿蛋白≥0.3 g/24h)和重度子痫前期组(n=29,血压≥160/100 mmHg,尿蛋白≥2.0 g/24h)。根据内生肌酐清除率(Ccr)水平将82例妊娠期高血压疾病患者分成肾功能异常组(Ccr<80 ml/min)42例和肾功能正常组(Ccr≥80 ml/min)40例。统计各项指标水平与患者病情、肾功能的关系,用ROC曲线分析其联合检测的诊断价值。结果重度子痫前期组血清Lp-PLA2、Hcy和CysC和尿mALB和NAG水平均比轻度子痫前期组和妊娠期高血压组高(P<0.05),轻度子痫前期组血清Lp-PLa2、Hcy和CysC和尿mALB和NAG水平比妊娠期高血压组高(P<0.05)。肾功能异常组血清Lp-PLA2、Hcy和CysC和尿mALB和NAG水平比肾功能正常组高(P<0.05)。ROC曲线分析显示,血清Lp-PLA2、Hcy、mALB、NAG、CysC联合检测在妊娠期高血压疾病早期肾脏损伤中的诊断价值AUC为0.928,灵敏度为92.86%(39/42),特异度为95.00%(38/40),准确度为93.90%(77/82)。结论血清Lp-PLA2、Hcy、CysC、尿mALB、NAG水平随着妊娠期高血压疾病的病情严重程度有明显相关,联合检测对妊娠期高血压疾病早期肾脏损伤的诊断有较高价值。

Objective To investigate the diagnostic value of combined detection of serum lipoprotein-associated phospholipase A2(Lp-PLA2),homocysteine(Hcy),serum cystatin C(CysC),urinary microalbumin(mALB)and N-acetyl-β-D-glucosaminidase(NAG)in early renal injury of hypertensive disorder complicating pregnancy.Methods A total of 82 patients with hypertensive disorder complicating pregnancy admitted to our hospital from March 2019 to September 2020 were selected prospectively,and they were divided into the hypertensive disorder complicating pregnancy group(n=27,blood pressure≥140/90 mmHg,urine protein was negative),the mild preeclampsia group(n=26,blood pressure≥140/90 mmHg,urine protein≥0.3 g/24 h)and the severe preeclampsia group(n=29,blood pressure≥160/100 mmHg,urine protein≥2.0 g/24 h)according to the degree of illness of pregnant women.According to the level of endogenous creatinine clearance(Ccr),82 patients with hypertensive disorder complicating pregnancy were divided into the abnormal renal function group(Ccr<80 ml/min,n=42)and the normal renal function group(Ccr≥80 ml/min,n=40).The correlation between each index level and the patient's illness and renal function was counted,and the diagnostic value of combined detection was analyzed by ROC curve.Results The levels of serum Lp-PLA2,Hcy and CysC,urine mALB and NAG in the severe preeclampsia group were all higher than those in the mild preeclampsia group and the hypertensive disorder complicating pregnancy group(P<0.05).The levels of serum Lp-PLA2,Hcy and CysC,urine mALB and NAG in the mild preeclampsia group were higher than thos e in the hypertens ive disorder complicating pregnancy group(P<0.05).The levels of serum Lp-PLA2,Hcy and CysC,urine mAlb and NAG in the abnormal renal function group were higher than those in the normal renal function group(P<0.05).ROC curve analysis showed that AUC of the diagnostic value of combined detection of serum Lp-PLA2,Hcy,mALB,NAG and CysC in early renal injury of hypertensive disorder complicating pregnancy was 0.928,the sensitivity was 92.86%(39/42),the specificity was 95.00%(38/40),and the accuracy was 93.90%(77/82).Conclusion The levels of serum Lp-PLA2,Hcy,CysC,urinary m ALB and NAG are s ignificantly correlated with the s everity of hypertens ive disorder complicating pregnancy.The combined detection is of high value in the diagnosis of early renal injury in hypertensive disorder complicating pregnancy.