血清sTREM-1、suPAR和sCD14水平对妊娠期肾病综合征妊娠结局不良的预测效能

Efficacy of serum sTREM-1,suPAR and sCD14 levels in predicting poor pregnancy outcome in nephrotic syndrome during pregnancy

目的观察血清可溶性髓系细胞触发受体-1(sTREM-1)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)和可溶性CD14(sCD14)水平对妊娠期肾病综合征(NSP)患者妊娠结局不良的预测效能。方法选择2020年1月至2022年12月在该院诊断为NSP的患者98例作为NSP组,根据NSP患者24 h尿蛋白定量将其分为轻度蛋白尿组(32例)、中度蛋白尿组(22例)和重度蛋白尿组(44例)。另选择同期在本院定期产检的健康孕妇45例作为正常妊娠组。观察各组血清sTREM-1、suPAR和sCD14水平。采用二元Logistic回归分析影响妊娠结局不良的因素;采用受试者工作特征(ROC)曲线分析血清sTREM-1、suPAR和sCD14水平对妊娠结局不良的诊断效能。结果NSP组血清sTREM-1、suPAR和sCD14水平均明显高于正常妊娠组(P<0.05);重度蛋白尿组血清sTREM-1、suPAR和sCD14水平均明显高于中度蛋白尿组和轻度蛋白尿组,而中度蛋白尿组血清sTREM-1、suPAR和sCD14水平均明显高于轻度蛋白尿组,差异均有统计学意义(P<0.05)。根据妊娠结局的不同,将NSP患者分为妊娠结局不良组(25例)和妊娠结局良好组(73例)。妊娠结局不良组尿蛋白、同型半胱氨酸、sTREM-1、suPAR和sCD14水平均明显高于妊娠结局良好组(P<0.05)。二元Logistic回归分析结果发现血清sTREM-1、suPAR和sCD14水平升高是发生妊娠结局不良的危险因素(P<0.05)。血清sTREM-1、suPAR和sCD14水平联合检测NSP患者发生妊娠结局不良的灵敏度为88.0%,特异度为95.9%,曲线下面积(AUC)为0.924,明显高于sTREM-1(z=2.039,P=0.041)、suPAR(z=2.143,P=0.032)和sCD14(z=2.417,P=0.016)单独检测,但血清sTREM-1、suPAR和sCD14单独检测的AUC比较,差异无统计学意义(P>0.05)。结论血清sTREM-1、suPAR和sCD14可以作为评估NSP严重程度的检测指标,且三项联合检测有助于提高NSP患者发生妊娠结局不良的诊断效能。

Objective To investigate the efficacy of serum levels of soluble triggering receptor expressed on myeloid cells-1(sTREM-1),soluble urokinase-type plasminogen activator receptor(suPAR)and soluble CD14(sCD14)in predicting adverse pregnancy outcomes in nephrotic syndrome during pregnancy(NSP).Methods A total of 98 patients diagnosed with NSP in the hospital from January 2020 to December 2022 were selected as NSP group,who were subdivided into mild proteinuria group with 32 cases,moderate proteinuria group with 22 cases and severe proteinuria group with 44 cases according to 24-h urine protein quantification.Meanwhile 45 healthy pregnant women who had regular obstetrical checkups in the hospital were selected as normal pregnancy group.The serum sTREM-1,suPAR and sCD14 levels were observed in each group.The binary Logistic regression was used to analyze factors affecting poor pregnancy outcome;the receiver eperating characteristic(ROC)curve was applied to analyze the diagnostic efficacy of serum sTREM-1,suPAR and sCD14 levels for poor pregnancy outcome.Results The serum sTREM-1,suPAR and sCD14 levels in NSP group were significantly higher than those in normal pregnancy group(P<0.05);serum sTREM-1,suPAR and sCD14 levels in the severe proteinuria group were significantly higher than those in the moderate proteinuria group and the mild proteinuria group,while serum sTREM-1,suPAR and sCD14 levels in the moderate proteinuria group were significantly higher than those in the mild proteinuria group,and the differences were all statistically significant(P<0.05).The NSP patients were divided into poor pregnancy outcome group with 25 cases and good pregnancy outcome group with 73 cases according to the results of pregnancy outcomes,and the levels of PRO,Hcy,sTREM-1,suPAR and sCD14 in the poor pregnancy outcome group were significantly higher than those in the good pregnancy outcome group(P<0.05).The binary Logistic regression analysis results showed that increased serum levels of sTREM-1,suPAR and sCD14 were risk factors for poor pregnancy outcome(P<0.05).The sensitivity of the combined serum sTREM-1,suPAR and sCD14 levels for detecting the occurrence of poor pregnancy outcome in NSP patients was 88.0%,the specificity was 95.9%,and the AUC was 0.924,which was significantly higher than that of sTREM-1(z=2.039,P=0.041),suPAR(z=2.143,P=0.032)and sCD14(z=2.417,P=0.016)alone,but the difference was not statistically significant when comparing the AUC of serum sTREM-1,suPAR and sCD14 alone(P>0.05).Conclusion Serum sTREM-1,suPAR and sCD14 can be used as indicators for assessing the severity of NSP,and the combined detection of the above indicators is helpful to improve the diagnostic efficacy of adverse pregnancy outcomes in patients with NSP.