不同程度蛋白尿的子痫前期孕妇尿蛋白成分的差异及尿蛋白定量与肾小球滤过率的相关性分析  

Difference of urinary protein components and the correlation between urinary protein quantification and glomerular filtration rate in pregnant women with pre-eclampsia

作　　者：庄旭[1] 陈云燕[1] 汪川[1] 张宁[1] 张羽[1] 林建华[1] Zhuang Xu;Chen Yunyan;Wang Chuan;Zhang Ning;Zhang Yu;Lin Jianhua(Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,上海200127

出　　处：《中华妇产科杂志》2023年第8期582-588,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：上海交通大学“交大之星”计划医工交叉研究基金(YG2021QN24)。

摘　　要：目的探讨不同程度蛋白尿的子痫前期(PE)孕妇尿蛋白成分的差异及24 h尿蛋白定量与估算肾小球滤过率(eGFR)的相关性。方法收集2018年7月至2022年6月于上海交通大学医学院附属仁济医院分娩的PE孕妇共101例的临床资料进行回顾性分析,根据24 h尿蛋白定量分为3组,其中轻度蛋白尿组(24 h尿蛋白定量≤2.0 g)40例,中度蛋白尿组(24 h尿蛋白定量为>2.0~5.0 g)21例,重度蛋白尿组(24 h尿蛋白定量>5.0 g)40例。比较3组PE孕妇一般临床资料、尿蛋白指标(包括24 h尿蛋白定量及尿蛋白成分)及肾功能指标的差异。结合年龄、血清肌酐(sCr)、血清尿素氮(BUN)、血清白蛋白(sAlb)等指标计算eGFR,分析24 h尿蛋白定量与eGFR及其计算指标年龄、sCr、BUN、sAlb之间的相关性。结果(1)一般临床资料:轻度蛋白尿组PE孕妇的中位发病孕周(31周)和分娩孕周[(36.4±3.6)周]均晚于中度蛋白尿组[中位发病孕周:22周,分娩孕周:(32.2±4.2)周]和重度蛋白尿组[中位发病孕周:25周,分娩孕周:(29.6±3.4)周],收缩压、舒张压、丙氨酸转氨酶、天冬氨酸转氨酶水平以及胎儿生长受限发生率均低于中度蛋白尿组及重度蛋白尿组,中位新生儿出生体重(3150 g)高于中度蛋白尿组(1305 g)及重度蛋白尿组(1042 g),分别比较,差异均有统计学意义(P均<0.05)。(2)尿蛋白指标:轻度蛋白尿组、中度蛋白尿组、重度蛋白尿组PE孕妇的24 h尿蛋白定量、尿微量白蛋白(mAlb)和尿转铁蛋白(TRF)水平均依次升高,分别两两比较,差异均有统计学意义(P均<0.05)。重度蛋白尿组PE孕妇的中位尿α1微球蛋白水平(50 mg/L)显著高于轻度蛋白尿组(17 mg/L)和中度蛋白尿组(22 mg/L;P均<0.05),但轻度蛋白尿组与中度蛋白尿组比较,差异无统计学意义(P>0.05)。3组PE孕妇的中位尿β2微球蛋白水平比较,差异无统计学意义(P=0.632)。(3)肾功能指标:轻度蛋白尿组、中度蛋白尿组、重度蛋白尿组PE�Objective To investigate the difference of urinary protein components in pregnant women with pre-eclampsia(PE)with different degrees of proteinuria and the correlation between 24-hour urinary protein quantification and estimated glomerular filtration rate(eGFR).Methods Clinical data of 101 PE pregnant women who were delivered in Renji Hospital,Shanghai Jiao Tong University School of Medicine from July 2018 to June 2022 were retrospectively analyzed.According to 24-hour urinary protein quantification,they were divided into 3 groups,including 40 cases of mild proteinuria group(24-hour urinary protein quantification≤2.0 g),21 cases of moderate proteinuria group(2.0 g<24-hour urinary protein quantification≤5.0 g),40 cases of severe proteinuria group(24-hour urinary protein quantification>5.0 g).The general clinical data,urinary protein index and renal function index of PE pregnant women in 3 groups were compared.The eGFR was calculated based on age,serum creatinine(sCr),blood urea nitrogen(BUN)and serum albumin(sAlb).Correlation analysis was conducted between 24-hour urinary protein quantification and each index of eGFR.Results(1)General clinical data:the median PE onset week(31 weeks)and delivery gestational week[(36.4±3.6)weeks]of PE pregnant women in the mild proteinuria group were later than those in the moderate proteinuria group[median PE onset:22 weeks,delivery:(32.2±4.2)weeks]and severe proteinuria group[median PE onset:25 weeks,delivery:(29.6±3.4)weeks];systolic blood pressure,diastolic blood pressure,alanine aminotransferase,aspartate aminotransferase levels and the incidence of fetal growth restriction were lower than those in the moderate and severe proteinuria groups;median newborn birth weight(3150 g)was higher than those in the moderate proteinuria group(1305 g)and the severe proteinuria group(1042 g),respectively.The differences were statistically significant(all P<0.05).(2)Urinary protein index:the 24-hour urinary protein quantification,urinary microalbumin(mAlb)and urinary transferrin(TRF)lev

关 键 词：先兆子痫 蛋白尿 肾小球滤过率 

分 类 号：R714.244[医药卫生—妇产科学]