子痫前期患者外周血中TLR-4、HMGB1的表达水平及其对肾损伤的诊断价值

Expression of TLR-4 and HMGB1 in Peripheral Blood of Patients with Preeclampsia and its Diagnostic Value for Rena Injury

【目的】探讨子痫前期患者外周血中Toll样受体-4(TLR-4)、高迁移率族蛋白1(HMGB1)的表达水平及其对肾损伤的诊断价值。【方法】选取2020年6月至2021年12月西安国际医学中心医院诊治的98例子痫前期患者(观察组),另选取同期来院孕检的92例健康孕妇(对照组)。比较两组孕妇外周血中TLR-4、HMGB1表达水平,根据子痫前期患者肾损伤发生情况分为并发组与未并发组,比较并发组与未并发组孕妇外周血中TLR-4、HMGB1表达水平和临床特征,采用Logistic回归分析子痫前期患者并发肾损伤的影响因素,采用受试者工作特征(ROC)曲线分析外周血中TLR-4、HMGB1表达对子痫前期患者并发肾损伤的诊断价值。【结果】观察组孕妇外周血中TLR-4、HMGB1表达水平均高于对照组(P<0.05);观察组孕妇肾损伤发生率为23.47%,并发组孕妇外周血中TLR-4、HMGB1表达水平均高于未并发组孕妇(P<0.05);并发组孕妇24 h尿蛋白含量、血肌酐水平与未并发组孕妇比较,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示:外周血中TLR-4、HMGB1水平及24 h尿蛋白含量均是影响子痫前期患者并发肾损伤的独立危险因素(P<0.05);ROC曲线分析显示:外周血中TLR-4、HMGB1表达水平诊断子痫前期患者并发肾损伤的最佳截断点分别为3.54 ng/mL、18.40 ng/mL,灵敏度分别为78.26%、82.61%,特异度分别为74.67%、70.67%,曲线下面积(AUC)分别为0.748、0.782,二者联合的特异度和AUC分别为93.33%和0.872。【结论】子痫前期孕妇外周血中TLR-4、HMGB1表达水平均异常升高,且二者均是子痫前期孕妇并发肾损伤的独立危险因素,临床检测子痫前期孕妇外周血TLR-4、HMGB1表达水平,均可作为诊断子痫前期孕妇并发肾损伤的敏感指标。

【Objective】To investigate the expression levels of Toll-like receptor-4(TLR-4)and high mobility group protein 1(HMGB1)in peripheral blood of patients with preeclampsia and their diagnostic value for renal injury.【Methods】A total of 98 patients with preeclampsia diagnosed and treated in Xi'an International Medical Center Hospital from June 2020 to December 2021(observation group)were selected,and 92 healthy pregnant women(control group)who came to the hospital for pregnancy examination at the same time were selected.The expression levels of TLR-4 and HMGB1 in the peripheral blood of the two groups of pregnant women were compared.According to the occurrence of renal injury in patients with preeclampsia,they were divided into the concurrent group and the non concurrent group.The expression level and clinical characteristics of TLR-4 and HMGB1 in peripheral blood of pregnant women in the concurrent group and the non concurrent group were compared.Logistic regression was used to analyze the influencing factors of renal injury in preeclampsia patients,and the diagnostic value of TLR-4 and HMGB1 expression in peripheral blood in preeclampsia patients with renal injury was analyzed using the ROC curve.【Results】The expression levels of TLR-4 and HMGB1 in peripheral blood of pregnant women in the observation group were higher than those in the control group(P<0.05);The incidence of renal injury in the observation group was 23.47%,and the expression levels of TLR-4 and HMGB1 in the peripheral blood of the pregnant women with complications were higher than those of the pregnant women without complications(P<0.05);The 24 hour urine protein content and serum creatinine level of the pregnant women in the concurrent group were significantly higher than those in the non concurrent group(P<0.05).Logistic regression analysis showed that TLR-4,HMGB1 levels in peripheral blood and 24h urine protein content were independent risk factors for renal injury in patients with preeclampsia(P<0.05);ROC curve analysis showed that the optimal cut-off points for TLR-4 and HMGB1 expression levels in peripheral blood to diagnose renal injury in patients with preeclampsia were 3.54 ng/mL and 18.40 ng/mL,respectively,with sensitivity of 78.26%,82.61%,specificity of 74.67%,70.67%,and area under the curve(AUC)of 0.748,0.782.The combined specificity and AUC of the two were 93.33%and 0.872,respectively.【Conclusion】The expression levels of TLR-4 and HMGB1 in peripheral blood of pre eclampsia pregnant women are abnormally elevated,and both of them are independent risk factors for renal injury in pre eclampsia pregnant women.The clinical detection of TLR-4 and HMGB1 expression levels in peripheral blood of pre eclampsia pregnant women can be used as sensitive indicators for diagnosing renal injury in pre eclampsia pregnant women.