尿蛋白与肌酐比值与子痫前期患者早期肾损伤的相关性

The correlation between the ratio of urine protein to creatinine and early renal injury in patients with preeclampsia

目的探讨尿蛋白与肌酐比值(urinary protein/creatinine ratio,UPCR)与子痫前期(preeclampsia,PE)患者早期肾损伤的相关性。方法选取2019年7月至2021年6月东莞市人民医院PE患者84例,其中轻度PE(MPE)38例为MPE组,重度PE(SPE)46例为SPE组,选取同期健康孕妇35例为对照组。比较3组临床资料及随机尿UPCR、晨尿UPCR水平,进行PE危险因素及PE患者早期肾损伤危险因素的Logistic分析,受试者工作特征(ROC)曲线分析随机尿UPCR、晨尿UPCR、24 h尿蛋白定量诊断PE患者早期肾损伤的价值。结果SPE组、MPE组体质量指数、收缩压、舒张压、C反应蛋白(CRP)、24 h尿蛋白定量、随机尿UPCR、晨尿UPCR高于对照组,血小板(PLT)、肾小球滤过率(e-GFR)低于对照组(P<0.05);SPE组收缩压、舒张压、CRP、24 h尿蛋白定量、随机尿UPCR、晨尿UPCR高于MPE组,PLT、e-GFR低于MPE组(P<0.05);Logistic回归分析显示,校正体质量指数、血压、CRP、PLT后,24 h尿蛋白定量、随机尿UPCR、晨尿UPCR升高及e-GFR降低均为PE发生的独立危险因素(P<0.05);Logistic回归分析显示,校正血压、CRP后,24 h尿蛋白定量、随机尿UPCR、晨尿UPCR升高均为PE患者早期肾损伤的独立危险因素(P<0.05);ROC曲线显示,随机尿UPCR、晨尿UPCR、24 h尿蛋白定量诊断AUC分别为0.828、0.840、0.840,其中随机尿UPCR、晨尿UPCR诊断AUC高于24 h尿蛋白定量。结论随机尿UPCR、晨尿UPCR可代替24 h尿蛋白定量评价PE病情进展及PE早期肾损伤,且诊断PE早期肾损伤的价值优于24 h尿蛋白定量。

Objective To explore the relationship between the ratio of urine protein to creatinine(UPCR)and early renal injury in patients with preeclampsia(PE).Methods A total of 84 patients with PE in Dongguan Peoples Hospital from July 2019 to June 2021 were selected,of which 38 patients with mild PE(MPE)were in the MPE group,and 46 patients with severe PE(SPE)were in the SPE group,35 healthy pregnant women during the same period were selected as the control group.Clinical data and random urine UPCR and morning urine UPCR levels were compared in 3 groups.The Logistic model was used to analyze the risk factors of PE and early renal injury in PE patients.Receiver operating characteristic(ROC)curve analysis was used to analyze the value of random urine UPCR,morning urine UPCR,and 24-hour urine protein quantitative diagnosis of early renal injury in patients with PE.Results Body mass index,systolic blood pressure,diastolic blood pressure,C-reactive protein(CRP),24 h urine protein quantification,random urine UPCR,morning urine UPCR in SPE group and MPE group were higher than those in the control group,platelet(PLT),glomerular filtration rate(e-GFR)were lower than those of the control group(P<0.05).Logistic regression analysis showed that after adjusting for body mass index,blood pressure,CRP,and PLT,24 h urine protein quantification,random urine UPCR,morning urine UPCR increase and e-CFR decrease were independent risk factors for PE(P<0.05).Logistic regression analysis showed that after adjusting blood pressure and CRP,24 h urine protein quantification,random urine UPCR,and morning urine UPCR increase were independent risk factors for early renal injury in PE patients(P<0.05).The ROC curve showed that the AUC of random urine UPCR,morning urine UPCR,and 24 h urine protein quantification were 0.828,0.840,0.840 respectively.Among them,the AUC of random urine UPCR and morning urine UPCR were higher than 24 h urine protein quantification.Conclusion Random urine UPCR and morning urine UPCR can replace 24 h urine protein quantification in evaluation of PE disease progression and early PE renal injury,and the value of diagnosing early PE renal injury is better than 24 h urine protein quantification.