尿L-FABP、NGAL联合ACR检测诊断妊娠期糖尿病早期肾功能损伤价值

Value of the urinary liver type fatty acid binding protein and neutrophil gelatina SE associated lipocalin levels combined with the value of urinary albumin creatinine ratio of the women with gestational diabetes mellitus for diagnosing their early renal impairment

目的:探究孕妇尿肝型脂肪酸结合蛋白质(L-FABP)、中性粒细胞明胶酶相关载脂蛋白(NGAL)及尿清蛋白与尿肌酐比值(ACR)用于妊娠期糖尿病(GDM)早期肾功能损伤的临床诊断价值。方法:选取本院产科2018年1月—2019年12月收治的妊娠期糖尿病患者120例,根据是否发生早期肾功能损伤分为肾损伤组(n=36)和无肾损伤组(n=84),常规产前检查健康孕妇100例为对照组。收集晨中段尿检测尿液L-FABP、NGAL及ACR并分析3指标对妊娠期糖尿病早期肾功能损伤诊断价值。结果:尿L-FABP、NGAL、ACR水平对照组、无肾损伤组、肾损伤组逐渐升高(P<0.05)。Pearson相关性分析显示,L-FABP、NGAL、ACR与尿微量白蛋白呈正相关(r=0.612、0.624、0.702,均P<0.05)。受试者工作特征曲线分析,L-FABP AUC为0.855,最佳截断值>53.12 ng/ml,灵敏度为74.8%,特异度为87.2%;NGAL AUC为0.812,最佳截断值>3.74μg/ml,灵敏度为70.2%,特异度为90.4%;ACRAUC为0.834,最佳截断值≥35.71,灵敏度为90.2%,特异度为85.4%。L-FABP、NGAL、ACR联合检测的灵敏度为96.7%,特异度为99.4%,AUC为0.979。结论:GDM早期肾功能损伤患者尿L-FABP、NGAL、ACR异常升高,3指标联合检测诊断GDM早期肾功能损伤效能较高,有助于早期诊断、及时干预,降低肾功能损伤。

Objective:To investigate the value of the urinary liver type fatty acid binding protein(L-FABP)and neutrophil gelatina SE associated lipocalin(NGAL)levels combined with and the value of urinary albumin creatinine ratio(ACR)of the women with gestational diabetes mellitus(GDM)for diagnosing their early renal impairment.Methods:A total of 120 pregnant women with GDM were selected and were divided into group A(36 women with kidney injury)and group B(84 women without renal injury)according to the occurrence of early renal impairment of the pregnant women from January 2018 to December 2019.In addition,100 healthy pregnant women who underwent standardized pregnancy test were selected in group C during the same period.The middle samples of the morning urine from the women in the three groups were collected for detecting the levels of urine L-FABP,NGAL and CAR.The values of the levels of urine L-FABP,NGAL and CAR of the women for diagnosing their early renal impairment was analyzed.Results:The levels of urinary L-FABP,NGAL,and ACR of the women in group C,group B,and group A had increased gradually(P<0.05).Pearson correlation analysis showed that the levels of L-FABP,NGAL,ACR of the women were positively correlated with their urinary microalbumin level(r=0.612,0.624,0.702,all P<0.05).Receiver operating characteristic curve analysis showed that the AUC,the optimal cut-off value,the sensitivity,and the specificity of l-FABP level of the pregnant women with GDM for diagnosing their early renal impairment were 0.855,>53.12 ng/mL,74.8%,and 87.2%,respectively.The AUC,the optimal cut-off value,the sensitivity,and the specificity of NGAL level of the pregnant women with GDM for diagnosing their early renal impairment were 0.812,>3.74μg/ml,70.2%,and 90.4%,respectively.The AUC,the optimal cut-off value,the sensitivity,and the specificity of ACR level of the pregnant women with GDM for diagnosing their early renal impairment were 0.834,≥35.71 mg/g,90.2%,and85.4%,respectively.The sensitivity,the specificity,and AUC of the combination of L-FABP,NGAL,and ACR levels of the pregnant women with GDM for diagnosing their early renal impairment were 96.7%,99.4%,and 0.979,respectively.Conclusion:The levels of urinary L-FABP,NGAL,and ACR of the pregnant women with GDM and early renal impairment are abnormal increase.The combined detections of urinary L-FABP,NGAL,and ACR for diagnosing early renal impairment has higher efficiency,which is helpful to early diagnose,timely intervention,and reduce the renal injury.