子痫前期和慢性肾病肾小球滤过率下降孕妇蛋白尿成分的差异性研究

Study on the difference on the proteinuria components between pregnant women with declined eGFR in preeclampsia and chronic kidney disease

目的 探讨子痫前期(PE)和慢性肾病(CKD)肾小球滤过率(eGFR)下降孕妇蛋白尿成分的差异。方法回顾性收集2016年7月至2022年12月328名孕妇的eGFR值和蛋白尿成分的资料进行分析。结果 当eGFR≥90mL/(min·1.73 m^(2))时,CKD组患者血清白蛋白(sAlb)高于PE组,但PE组患者24 h蛋白尿高于CKD组。而两组患者之间的尿微量白蛋白(uAlb)、尿转铁蛋白(uTRF)、尿α1-微球蛋白(uα1-MG)、尿β2-微球蛋白(uβ2-MG)和尿视黄醇结合蛋白(uRBP)比较,差异均无统计学意义。当eGFR<90 mL/(min·1.73 m^(2))时,CKD组患者的血清肌酐(sCr)显著高于PE组,而PE组的sAlb远低于CKD组。PE组患者的24 h蛋白尿仍高于CKD组。PE组患者的uAlb显著高于CKD组,而PE组的uβ2-MG和uRBP显著低于CKD组;以eGFR=90 mL/(min·1.73 m^(2))为标准,PE组内eGFR≥该标准的孕妇,其sAlb高于eGFR<该标准的PE孕妇,但sCr、BUN、24 h蛋白尿、uAlb、uTRF和uα1-MG均低于eGFR<该标准的PE孕妇。在CKD组内,eGFR≥该标准的CKD孕妇,其sAlb高于eGFR<该标准的CKD孕妇,但sCr、BUN、24 h蛋白尿、uAlb、uTRF、uα1-MG、uβ2-MG和uRBP均低于eGFR<该标准的CKD孕妇。结论 随着eGFR水平的下降,PE和CKD孕妇的蛋白尿成分存在显著差异。PE中eGFR的下降与低蛋白血症有关。而uα1-MG、uβ2-MG和uRBP水平的升高与CKD孕妇eGFR下降和sCr升高有关。

Objective To explore the difference on the proteinuria components between pregnant women with declined estimated glomerular filtration rate(eGFR) in preeclampsia(PE) and chronic kidney disease(CKD). Methods An retrospective study was conducted among 328 pregnant women from July 2016 to December 2022. Results of the eGFR and proteinuria components were collected. Results With eGFR≥90 mLL/(min·1.73 m^(2)), serum albumin(sAlb) in CKD was higher than that in PE, while 24 h proteinuria in PE was higher than that in CKD. There was no significant difference on urinary microalbumin(uAlb), transferrin(TRF), α1-microglobulin(α1-MG), β2-microglobulin(β2-MG), and retinol-binding protein(RBP) between PE and CKD. With eGFR<90 mL/(min·1.73 m^(2)), serum creatine(sCr) in CKD was higher than that in PE,while sAlb in PE was lower than that in CKD. 24 h proteinuria in PE was still higher than that in CKD. UAlb in the PE was higher than in CKD, while uβ2-MG and uRBP in PE was significantly lower than in the CKD group. The standard eGFR value of 90 mLL/(min·1.73 m2) was utilized. In the PE group, sAlb levels were higher, while sCr, BUN, 24 h proteinuria, uAlb,uTRF and uα1-MG levels were lower in those with an eGFR greater than or equal to this standard compared to those with an eGFR less than this standard. Among the CKD group, sAlb levels were higher in pregnant women with CKD and an eGFR greater than or equal to this standard compared to those with an eGFR less than this standard. However, sCr, BUN, 24 h proteinuria, uAlb, uTRF, uα1-MG, uβ2-MG, and uRBP levels were lower in CKD group with an eGFR greater than or equal to this standard. Conclusion There was a significant difference in proteinuria components between PE and CKD pregnant women with the declined eGFR levels. The decline of eGFR and appearance of glomerular urine protein in PE is related to hypoproteinemia, while an elevated level of uα1-MG, uβ2-MG and uRBP indicates the decline of eGFR with elevated sCr in CKD.