Pro-NT、HE-4和ACR对妊娠期糖尿病早期肾损害的诊断价值  

Diagnostic value of Pro-NT,HE-4 and ACR in early renal damage in patients with gestational diabetes mellitus

作　　者：刘琴 彭珊珊[2] LIU Qin;PENG Shanshan(Department of Obstetrics and Gynecology,Shanghai United Family Pudong Hospital,Shanghai 200129,China;不详)

机构地区：[1]上海和睦家新城医院妇产科,上海市200129 [2]广东省深圳市宝安区妇幼保健院妇产科,518000

出　　处：《河北医药》2021年第6期842-845,850,共5页Hebei Medical Journal

摘　　要：目的观察血清前神经降压肽(Pro-NT),人附睾蛋白-4(HE-4)和随机尿微量白蛋白与尿肌酐比值(ACR)在妊娠期糖尿病(GDM)早期肾损害的诊断价值。方法选择2017年1月至2018年12月就诊的GDM患者130例为GDM组,选择同期就诊的糖尿病耐量异常患者和妊娠体检者分别糖耐量异常组和正常妊娠组,每组45例。观察3组血清Pro-NT、HE-4、ACR和β2-MG水平的变化,GDM组血清Pro-NT、HE-4、ACR和β2-MG水平与糖尿病严重程度,肾脏损害和肾病严重程度的关系,及其在早期诊断早期GDM肾病的诊断效能。结果GDM组血清Pro-NT、HE-4、ACR和β2-MG水平明显高于糖尿病异常组和正常妊娠组(P<0.01),而糖耐量异常组明显高于正常妊娠组(P<0.01)。血清Pro-NT、HE-4、ACR和β2-MG水平与GDM糖尿病严重程度,肾脏损害和肾病严重程度增加而升高(P<0.01)。血清Pro-NT(Z=2.791,P<0.01),HE-4(Z=2.181,P<0.05)和ACR(Z=2.136,P<0.05)在诊断早期GDM肾病的灵敏度和特异性方面明显优于β2-MG,而Pro-NT、HE-4和ACR之间的诊断效能差异无统计学意义(P>0.05)。联合检测(Pro-NT+HE-4+ACR)的灵敏度为97.9%,特异性为97.8%,AUC为明显优于单个指标Pro-NT(Z=2.256,P<0.05),HE-4(Z=3.085,P<0.01)和ACR(Z=3.311,P<0.01)。结论血清Pro-NT、HE-4和ACR水平与GDM疾病的发生发展密切联系,在早期诊断GDM肾损害具有较高的诊断效能。Objective To investigate the diagnostic value of pre-serum neuropeptide(Pro-NT),human epididymis protein-4(HE-4)and random albumin to creatinine ratio(ACR)in early renal damage in patients with gestational diabetes mellitus(GDM).Methods A total of 130 patients with GDM who were admitted and treated in our hospital from January 2017 to December 2018 were enrolled as GDM group,and the other 45 patients with diabetes tolerance abnormality were enrolled as glucose tolerance abnormality group,moreover,the 45 helthy pregnant women were enrolled as control group.The serum levels of Pro-NT,HE-4,ACR andβ2-MG were observed and compared among the three groups.In addition the correlation between the serum levels of Pro-NT,HE-4,ACR andβ2-MG and severity of diabetes,kidney damage,and severity of kidney disease was analyzed,and its diagnostic efficacy in early diagnosis of early GDM nephropathy was investigated.Results The serum levels of Pro-NT,HE-4,ACR andβ2-MG in GDM group were significantly higher than those in glucose tolerance abnormality group and control group(P<0.01),moreover,which in glucose tolerance abnormality group were significantly higher than those in control group(P<0.01).The serum levels of Pro-NT,HE-4,ACR andβ2-MG were increased with the severity of GDM,kidney damage and severity of kidney disease(P<0.01).The sensitivity and specificity of serum levels of Pro-NT,HE-4 and ACR in diagnosis of early GDM nephropathy were superior to those ofβ2-MG,however,there was no significant difference in the diagnostic efficacyamong Pro-NT,HE-4 and ACR(P>0.05).The sensitivity of combined detection(Pro-NT+HE-4+ACR)was 97.9%and the specificity was 97.8%.The AUC of combined detection was significantly better than that by simple Pro-NT,HE-4 or ACR(P<0.01).Conclusion The serum levels of Pro-NT,HE-4 and ACR are closely related to the occurrence and development of GDM,which have higher diagnostic efficiency in early diagnosis of renal damage due to GDM.

关 键 词：前神经降压肽 人附睾蛋白-4 妊娠糖尿病 肾损害 诊断效能 

分 类 号：R587.1[医药卫生—内分泌]