妊娠期高血压患者外周血内皮素-1、D-二聚体水平以及尿蛋白/肌酐比值对急性肾损伤预测价值

Predictive value of endothelin-1,D-dimer and albuminuria/creatinine ratio in predicting acute kidney injury of patients with pregnancy-induced hypertension

目的探究妊娠期高血压(PIH)患者外周血内皮素-1(ET-1)、D-二聚体水平以及尿蛋白/肌酐比值(ACR)对急性肾损伤(AKI)的预测价值。方法回顾性分析2018年1月至2020年12月滁州市中西医结合医院妇产科收治的120例PIH患者作为研究对象,匹配同期正常分娩的健康产妇40名作为正常妊娠组,另选取40例同期进行体检的健康女性作为健康对照组。收集所有受试者的临床资料;检测各组受试者ET-1、D-二聚体及ACR的表达水平。采用Pearson相关性分析分析ET-1、D-二聚体及ACR的表达水平与肌酐清除率(CCR)的相关性;采用受试者工作特征(ROC)曲线判定ET-1、D-二聚体及ACR单独检测和联合检测的预测价值。结果PIH组患者的ET-1、D-二聚体和ACR水平均显著高于正常妊娠组和健康对照组受试者,正常妊娠组的ET-1、D-二聚体和ACR水平均显著高于健康对照组,差异均有统计学意义(P<0.05)。重度子痫前期组的ET-1、D-二聚体和ACR水平均显著高于轻度子痫前期组和单纯妊娠期高血压组,轻度子痫前期组的ET-1、D-二聚体和ACR水平均显著高于单纯妊娠期高血压组,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,PIH合并AKI患者的CCR表达水平与ET-1、D-二聚体和ACR水平均呈负相关(P<0.05)。单因素分析显示,收缩压、舒张压、CCR、ET-1、D-二聚体和ACR水平是影响PIH患者发生AKI的主要影响因素(P<0.05)。ET-1检测的临界值为66.35 ng/L,AUC为0.699(95%CI:0.615~0.758),敏感度为69.23%,特异度为69.17%;D-二聚体检测的临界值为124.51 ng/mL,AUC为0.705(95%CI:0.632~0.778),敏感度为75.00%,特异度为65.83%;ACR检测的临界值为75.12 mg/mmoL,AUC为0.739(95%CI:0.641~0.799),敏感度为73.08%,特异度为75.83%;ET-1+D-二聚体+ACR联合检测的AUC为0.895(95%CI:0.813~0.955),敏感度为86.54%,特异度为88.33%。结论ET-1、D-二聚体和ACR为PIH合并AKI患者的重要生物学标志物,ET-1+D-二聚体+ACR三项指标的联合检测的敏感度和特异度较高,对于PIH患者发生AKI具有较高的临床预测价值。

Objective To analysis the predictive value of endothelin-1(ET-1),D-dimer and albuminuria/creatinine ratio(ACR)in predicting acute kidney injury(AKI)of patients with pregnancy-induced hypertension(PIH).Methods A total of 120 patients with PIH admitted to Chuzhou City Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2020 were retrospectively collected as research objects,40 healthy pregnant women were collected as normal pregnant group,40 healthy women at the same period were collected as healthy control group.Clinical datas of all objects were collected;the expression levels of ET-1,D-dimer and ACR were detected.The correlation between ET-1,D-dimer,ACR and creatinine clearance rate(CCR)was analysed;the predictive value was evaluated by receiver operating characteristic(ROC)curve.Results The expression levels of ET-1,D-dimer and ACR of PIH group were higher than normal pregnant group and healthy control group,and the normal pregnant group was higher than healthy control group,the differences were statistically significant(P<0.05).The expression levels of ET-1,D-dimer and ACR of severe pre-eclampsia group were higher than mild pre-eclampsia group and simple gestational hypertension group,and the mild pre-eclampsia group was higher than simple gestational hypertension group,the differences were statistically significant(P<0.05).The Pearson analysis showed that the expression level of CCR was negatively correlated with ET-1,D-dimer and ACR(P<0.05).Univariate analysis showed that systolic pressure,diastolic pressure,CCR,ET-1,D-dimer and ACR were main factors of occurrence of AKI of PIH patients(P<0.05).The critical value of ET-1 was 66.35 ng/L,the AUC,sensitivity and specificity was 0.699(95%CI:0.615-0.758),69.23%and 69.17%;the critical value of D-dimer was 124.51 ng/mL,the AUC,sensitivity and specificity was 0.705(95%CI:0.632-0.778),75.00%and 65.83%;the critical value of ACR was 75.12 mg/mmoL,the AUC,sensitivity and specificity was 0.739(95%CI:0.641-0.799),73.08%and 75.83%;the AUC,sensitivity and specificity of combined detection of ET-1+D-dimer+ACR was 0.895(95%CI:0.813-0.955),86.54%and 88.33%.Conclusion The expression levels of ET-1,D-dimer and ACR were important biomarkers of patients with PIH combined with AKI,the combined detection of ET-1,D-dimer and ACR had higher sensitivity and specificity,which had superior clinical predictive value.