尿蛋白与肌酐比值在妊娠期高血压疾病中应用价值  

APPLICATION VALUE OF URINE ALBUMIN-TO-CREATININE RATIO IN HYPERTENSIVE DISORDERS OF PREGNANCY

作　　者：陈响 詹瑛[1] 卢彩霞[1] 郑富民 刘世国[1] CHEN Xiang;ZHAN Ying;LU Caixia;ZHENG Fumin;LIU Shiguo(Department of Obstetrics,The Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学附属医院产科,山东青岛266555

出　　处：《青岛大学学报（医学版）》2023年第6期845-849,共5页Journal of Qingdao University(Medical Sciences)

基　　金：山东省自然科学基金资助项目(ZR2019MH127)。

摘　　要：目的分析妊娠期高血压疾病(HDP)孕妇微量尿蛋白/肌酐比值(ACR)与各临床指标的相关性,探讨其对HDP肾功能损害评估的临床意义。方法选取2018年5月—2019年10月在青岛大学附属医院产科规律产检的不同类型HDP孕妇共225例,其中妊娠期高血压55例,子痫前期89例,子痫4例,慢性高血压40例,慢性高血压并发子痫前期37例,随机选取同期在我院产检的正常单胎孕妇60例作为对照组。全部研究对象检查ACR、血常规、血凝常规、尿常规、肝肾功能、血脂等生化指标,尿蛋白异常者进行24 h尿蛋白定量检测。结果ACR与24 h尿蛋白定量呈高度线性相关(r=0.800,P<0.05);ACR与舒张压(DBP)、尿酸(UA)、尿素(UREA)、乳酸脱氢酶(LDH)呈显著正相关(r=0.484~0.574,P<0.05),与清蛋白(ALB)呈显著负相关(r=-0.579,P<0.05)。UA、ACR联合诊断HDP孕妇肾损伤的受试者工作特征曲线曲线下面积为0.996,截断值为0.881,特异度为0.951,灵敏度为0.929。结论ACR与DBP、UA、UREA、LDH升高和ALB降低相关;ACR与24 h尿蛋白定量呈高度线性相关,在HDP诊断方面有更准确便捷的评估价值;UA、ACR随HDP病情严重程度的增加而增高,二者联合检测对评估HDP孕妇肾损伤有临床应用价值。Objective To investigate the correlation between the urine albumin-to-creatinine ratio(ACR)and clinical parameters in patients with hypertensive disorders of pregnancy(HDP),and to explore the clinical significance of ACR in assessing impairment in renal function.Methods We included a total of 225 pregnant women with different types of HDP who received regular prenatal examinations at The Affiliated Hospital of Qingdao University from May 2018 to October 2019,including 55 with gestational hypertension,89 with preeclampsia,4 with eclampsia,40 with chronic hypertension,and 37 with chronic hypertension with superimposed preeclampsia.A total of 60 normal pregnant women with a single fetus examined at the same hospital during the same period were randomly selected as the control group.All the subjects had ACR,routine blood,routine coagulation,routine urine,liver and kidney function,and blood lipid tests.Patients with abnormal urine protein levels received 24 h urine protein mea-surement.Results ACR was highly linearly correlated with 24 h urine protein level(r=0.800,P<0.05),positively correlated with diastolic blood pressure,uric acid,UREA,and lactate dehydrogenase(r=0.484-0.574,P<0.05),and negatively correlated with albumin(r=-0.579,P<0.05).For ACR plus uric acid diagnosing renal impairment in pregnant women with HDP,the area under the receiver operating characteristic curve was 0.996,the cut-off value was 0.881,the specificity was 0.951,and the sensiti-vity was 0.929.Conclusion ACR is associated with increased diastolic blood pressure,uric acid,UREA,and lactate dehydrogenase levels and decreased albumin levels.The highly linear correlation between ACR and 24 h urine protein level indicates that ACR is an accurate and convenient indicator for the diagnosis of HDP.ACR and uric acid levels increase with the severity of HDP,and their combination has clinical value in evaluating renal injury in pregnant women with HDP.

关 键 词：高血压 妊娠性 白蛋白尿 肌酸酐 尿分析 诊断 

分 类 号：R714.25[医药卫生—妇产科学]