胱抑素-C、中性粒细胞明胶酶相关载脂蛋白、肾损伤分子-1联合检测在妊娠高血压综合征肾病患者中的临床价值  

Clinical value of combined detection of cystatin-C,neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 in patients with pregnancy-induced hypertension and nephropathy

作　　者：杨锦平 张现明 郑定容 YANG Jin-ping;ZHANG Xian-ming;ZHENG Ding-rong(Department of Blood Transfusion,Bao′an Central Hospital of Shenzhen City,Guangdong Province,Shenzhen518102,Chin)

机构地区：[1]深圳市宝安区中心医院输血科,广东深圳518102

出　　处：《中国当代医药》2021年第23期17-20,F0003,共5页China Modern Medicine

摘　　要：目的探究胱抑素-C(Cys-C)、中性粒细胞明胶酶相关载脂蛋白(NGAL)、肾损伤分子-1(KIM-1)联合检测在妊娠高血压综合征肾病患者中的临床价值。方法随机选取深圳市宝安区中心医院2018年2月—2020年8月收治的180例妊娠高血压综合征患者作为研究对象,根据尿白蛋白/肌酐比值(uACR),将患者分为单纯妊娠高血压综合征组(A组,uACR<30 mg/g,90例)、妊娠高血压综合征早期合并急性肾损伤组(B组,30 mg/g≤uACR<300 mg/g,50例)、临床妊娠高血压综合征肾病组(C组,ACR≥300 mg/g,40例),同期选取100名正常妊娠者作为对照组。比较各组的血清NGAL、KIM-1和Cys-C浓度动态变化情况,分析血清NGAL、KIM-1、Cys-C水平与uACR的相关性,采用受试者工作特征(ROC)曲线分析各项指标诊断妊娠高血压综合征患者早期肾损伤的效能。结果A组、B组和C组的血清NGAL、KIM-1和Cys-C浓度水平均高于对照组,并且C组>B组>A组,差异有统计学意义(P<0.05)。经Spearman相关性分析,B组及C组的患者血清NGAL、KIM-1、Cys-C水平与uACR均呈正相关(r=0.651、0.673、0.563,P<0.05)。ROC曲线分析显示,NGAL、KIM-1、Cys-C及三者联合检验诊断妊娠高血压综合征患者早期肾损伤的AUC分别为0.754(95%CI:0.685~0.908)、0.804(95%CI:0.689~0.913)、0.763(95%CI:0.683~0.907)和0.923(95%CI:0.858~0.998);NGAL、KIM-1、Cys-C最佳临界值分别为44.5 ng/mL、37.8 ng/L和1.3 mg/L,NGAL、KIM-1、Cys-C及三者联合的敏感性分别为74.57%、81.25%、73.01%和95.61%,NGAL、KIM-1、Cys-C及三者联合的特异性分别为76.03%、72.34%、82.24%和98.64%。结论血清NGAL、KIM-1和Cys-C水平与妊娠高血压综合征患者肾功能受损程度存在显著正相关,NGAL、KIM-1和Cys-C联合检测对预测妊娠高血压综合征急性肾损伤效能具有较好的临床诊断价值。Objective To explore the clinical value of combined detection of cystatin-C(Cys-C),neutrophil gelatinase-associated lipocalin(NGAL)and kidney injury molecule-1(KIM-1)in patients with pregnancy-induced hypertension and nephropathy.Methods A total of 180 patients with pregnancy-induced hypertension who were admitted to Bao′an Central Hospital of Shenzhen City from February 2018 to August 2020 were randomly selected as the research subjects,based on the urine albumin/creatinine ratio(uACR),the patients were divided into simple pregnancy-induced hypertension group(group A,uACR<30 mg/g,90 cases),early pregnancy-induced hypertension syndrome combined with acute kidney injury group(group B,30 mg/g≤uACR<300 mg/g,50 cases),clinical pregnancy-induced hypertension nephropathy group(group C,ACR≥300 mg/g,40 cases),and 100 normal pregnant women were selected as the control group during the same period.The dynamic changes of serum NGAL,KIM-1 and Cys-C concentrations in each group were compared,the correlation between serum NGAL,KIM-1,Cys-C levels and uACR was analyzed,and the receiver operating characteristic(ROC)curve was used to analyze each various indicators to determine the efficacy of early renal injury in patients with pregnancy-induced hypertension.Results The serum NGAL,KIM-1 and Cys-C levels of the group A,the group B and the group C were higher than those of the control group,and the group C>the group B>the group A,the differences were statistically significant(P<0.05).According to Spearman correlation analysis,serum NGAL,KIM-1,Cys-C levels of patients in group B and C were positively correlated with uACR(r=0.651,0.673,0.563,P<0.05).ROC curve analysis showed that the AUCs of NGAL,KIM-1,Cys-C and the combined test of the three to diagnose early renal injury in patients with pregnancy-induced hypertension were 0.754(95%CI:0.685-0.908),0.804(95%CI:0.689-0.913),0.763(95%CI:0.683-0.907)and 0.923(95%CI:0.858-0.998);the best cut-off values for NGAL,KIM-1,and Cys-C were 44.5 ng/mL,37.8 ng/L and 1.3 mg/L,respectively,th

关 键 词：妊娠高血压综合征 急性肾损伤 胱抑素-C 肾损伤分子-1 中性粒细胞明胶酶相关载脂蛋白 

分 类 号：R714.246[医药卫生—妇产科学]