血清miR-650、miR-19b1和ACR在预测妊娠高血压综合征肾功能损害中的价值

Value of serum miR-650,miR-19b1 and ACR in predicting renal function damage in pregnancy-induced hypertension

目的观察血清miR-650、miR-19b1和尿微量蛋白/肌酐(ACR)在预测妊娠高血压综合征(以下简称妊高征)肾功能损害中的价值。方法选择2019年1月至2020年12月在该院诊治的妊高征患者130例为妊高征组。选择同期在该院产检的健康孕妇65例和健康体检女性45例,分别为健康妊娠组和健康对照组。根据患者肌酐清除率水平将妊高征组进一步分为肾功能异常组(96例)和肾功能正常组(34例)。采用实时荧光定量PCR检测血清miR-650和miR-19b1水平。观察各组血清miR-650、miR-19b1水平和ACR的变化,分析血清miR-650、miR-19b1水平,ACR与妊高征严重程度和肾功能损害的关系,以及以上指标预测妊高征患者发生肾功能损害的效能。结果妊高征组血清miR-650水平和ACR高于健康妊娠组和健康对照组(P<0.05),而健康妊娠组高于健康对照组(P<0.05),并且miR-650和ACR随着妊高征严重程度的升高而升高(P<0.05)。肾功能异常组的血清miR-650水平和ACR明显高于肾功能正常组(P<0.05)。妊高征组血清miR-19b1水平低于健康妊娠组和健康对照组(P<0.05),而健康妊娠组低于健康对照组(P<0.05),并且miR-19b1水平随着疾病严重程度升高而降低(P<0.05)。肾功能异常组的血清miR-19b1水平明显低于肾功能正常组(P<0.05)。妊高征患者血清miR-650(r=-0.684,P<0.05)和ACR(r=-0.752,P<0.05)与miR-19b1呈负相关,而血清miR-650水平与ACR呈正相关(r=0.717,P<0.05)。血清miR-650、miR-19b1和ACR在预测妊高征患者发生肾功能损害中具有较高的效能,3项指标联合检测的灵敏度为91.2%,特异度为81.2%,曲线下面积(AUC)为0.926,明显高于miR-650(Z=2.867,P<0.05)、miR-19b1(Z=2.369,P<0.05)和ACR(Z=2.419,P<0.05)。结论血清miR-650、miR-19b1和ACR在预测妊高征肾功能损害中具有较高的效能,联合检测有助于提高灵敏度和特异度。

Objective To observe the value of serum miR-650,miR-19b1 and urinary microprotein/creatinine ratio(ACR)for predicting renal function damage in pregnancy-induced hypertension.Methods A total of 130 patients with pregnancy-induced hypertension diagnosed and treated in this hospital from January 2019 to December 2020 were selected as the pregnancy-induced hypertension group.Contemporaneous 65 normal pregnant women with prenatal examination and 45 healthy females undergoing physical examination in this hospital were selected as the healthy pregnancy group and healthy control group,respectively.According to the level of creatinine clearance,the pregnancy-induced hypertension group was further divided into abnormal renal function group(96 cases)and normal renal function group(34 cases).The real-time quantitative PCR was used to detect the levels of serum miR-650 and miR-19b1.The changes of serum miR-650,miR-19b1 levels and ACR were observed in each group.The relationship between serum miR-650,miR-19b1 levels and ACR with the severity of pregnancy-induced hypertension and renal function damage was analyzed,and their diagnostic efficiency for predicting the renal impairment in the patients with pregnancy-induced hypertension was also analyzed.Results The serum level of miR-650 and ACR in the pregnancy-induced hypertension group were higher than those in the healthy pregnancy group and healthy control group(P<0.05),while the healthy pregnancy group was higher than the healthy control group(P<0.05),and the level of miR-650 and ACR were increased as the severity of the disease increase(P<0.05).The serum miR-650 level and ACR in the abnormal renal function group were significantly higher than those in the normal renal function group(P<0.05).The serum miR-19b1 level in the pregnancy-induced hypertension group was lower than that in the healthy pregnancy group and healthy control group(P<0.05),while the healthy pregnancy group was lower than the healthy control group(P<0.05),and the miR-19b1 level was decreased as the severity of the disease increase(P<0.05),the serum miR-19b1 level in the abnormal renal function group was significantly lower than that in the normal renal function group(P<0.05).The levels of serum miR-650(r=-0.684,P<0.05)and ACR(r=-0.752,P<0.05)in the patients with pregnancy-induced hypertension negatively correlated with miR-19b1,while the serum miR-650 level positively correlated with ACR(r=0.717,P<0.05).The serum miR-650,miR-19b1 and ACR had high diagnostic efficiency in predicting the renal injury occurrence in the patients with pregnancy-induced hypertension.The sensitivity of the 3-indicator combined detection was 91.2%,the specificity was 81.2%,and AUC was 0.926,which were significantly higher than those of miR-650(Z=2.867,P<0.05),miR-19b1(Z=2.369,P<0.05)and ACR(Z=2.419,P<0.05).Conclusion The serum miR-650,miR-19b1 and ACR have a high diagnostic efficiency for predicting renal dysfunction in pregnancy-induced hypertension.Their combined detection can help to improve the sensitivity and specificity.