胱抑素C、尿白蛋白-肌酐比值与妊娠期高血压疾病肾损伤的相关性研究

Correlation between cystatin C,urinary albumin-creatinine ratio and renalinjury in hypertensive disorders of pregnancy

目的分析妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)患者血清胱抑素C(cystatin C,Cys-C)水平和随机尿白蛋白-肌酐比值(albumin-creatinine ratio,ACR)在评估HDP肾损伤、病情严重程度及围产儿结局中的应用价值。方法选取2019年7月至2021年6月在深圳市中西医结合医院住院的HDP患者58例(子痫前期患者28例,重度子痫前期患者30例),同期住院的正常孕产妇32例作为对照组,测定孕妇血清Cys-C水平和24 h尿蛋白定量;检测随机尿白蛋白和肌酐,计算ACR;分析血清Cys-C、ACR、24 h尿蛋白水平与HDP疾病严重性的相关性,比较HDP各组孕产妇不良妊娠结局的发生率。结果子痫前期组、重度子痫前期组血清Cys-C水平和随机尿ACR均高于对照组,而重度子痫前期组均高于子痫前期组(P均<0.05);不良妊娠结局包括胎盘早剥、产后出血、胎儿窘迫、早产、胎儿生长受限以及新生儿窒息发生率比较,子痫前期组、重度子痫前期组明显高于对照组(P<0.05),重度子痫前期组高于子痫前期组(P<0.05);血清Cys-C水平、随机尿ACR与HDP病情的严重程度及妊娠不良结局呈正相关(P<0.05)。结论血清Cys-C水平、随机尿ACR的升高可以提示HDP肾脏损害情况,可以在一定程度上更快捷、方便地评估和判断HDP病情严重程度和不良妊娠结局。

Objective To analyze the serum cystatin C(Cys-C)level and random urinary albumin-creatinine ratio(ACR)in patients with hypertensive disorders of pregnancy(HDP)in the evaluation of HDP renal injury,severe disease extent and application value in perinatal outcomes.Methods A total of 58 HDP patients(28 patients with preeclampsia and 30 patients with severe preeclampsia)who were hospitalized in Shenzhen Hospital of Integrated Traditional and Western Medicine from July 2019 to June 2021 were selected,and 32 normal pregnant women who were hospitalized during the same period were selected as control group,the serum Cys-C level and 24-hour urine protein quantification of pregnant women were detected;the random urine albumin and creatinine were detected,and ACR was calculated;the correlation between serum Cys-C,ACR,24-hour urine protein levels and the severity of HDP disease was analyzed;The incidence of maternal adverse pregnancy outcomes in each group of HDP was compared.Results Serum Cys-C level and random urine ACR in the preeclampsia group and severe preeclampsia group were higher than those in the control group,and the severe preeclampsia group was higher than the preeclampsia group(all P<0.05);Adverse pregnancy outcomes including placental abruption,postpartum hemorrhage,fetal distress,premature birth,fetal growth restriction(FGR)and neonatal asphyxia,the preeclampsia group and severe preeclampsia group were significantly higher than the control group(P<0.05),the severe preeclampsia group was higher than the preeclampsia group(P<0.05);serum Cys-C level and random urinary ACR were positively correlated with the severity of HDP and poor pregnancy outcomes(P<0.05).Conclusion The increase of serum Cys-C level and random urinary ACR can indicate the kidney damage of HDP,and to a certain extent,it can more quickly and conveniently evaluate and judge the severity of HDP and adverse pregnancy outcomes.