标题：妊娠高血压综合征并发肾损伤患者血清生化指标水平变化及其早期诊断价值

      作者：王纯静，李金艳，何文丽，武晶    延安大学咸阳医院妇产科，陕西 咸阳 712000

      卷次： 2019年30卷18期

      【摘要】 目的 探究妊娠高血压综合征(PIH)并发肾损伤(AKI)患者血清生化指标水平变化及其早期诊断价值。方法 选取 2016年 12月至 2018年 12月延安大学咸阳医院收治的 86例PIH患者作为观察组，其中轻度组 39例，中度组27例，重度组20例；按照是否肾损害分为AKI组(41例)和非AKI组(45例)。另选取同期孕晚期健康孕妇86例作为对照组。比较各组孕妇血清胱抑素C (CysC)、内皮素-1 (ET-1)、N端脑利钠肽前体(NT-proBNP)及中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的水平，并采用ROC曲线分析其对早期肾损伤的诊断价值。结果 观察组患者的血清CysC、ET-1、NT-proBNP及NGAL水平分别为(1.79±0.30) mg/L、(57.20±11.47) ng/L、(121.49±45.04) ng/L、(36.31±8.39) μg/mL，明显高于对照组的(1.14±0.22) mg/L、(45.74±9.95) ng/L、(70.93±16.78) ng/L、(21.18±5.46) μg/mL，差异均有统计学意义(P<0.05)；观察组中轻度、中度、重度组患者的血清CysC [(1.25±0.33) mg/L、(1.91±0.33) mg/L、(2.17±0.31) mg/L]、ET-1 [(48.66±5.51) ng/L、(54.18±11.21) ng/L、(60.46±9.29) ng/L]、NT-proBNP [(89.70±25.47) ng/L、(105.17±34.11) ng/L、(137.05±63.28) ng/L]、NGAL [(25.48±9.53) μg/mL、(35.75±14.45) μg/mL、(47.55±16.03) μg/mL]水平比较差异均有统计学意义(P<0.05)，且重度组高于中度组，中度组高于轻度组，差异均有统计学意义(P<0.05)；AKI组患者的CysC、ET-1、NT-proBNP、NGAL水平分别为(1.97±0.36) mg/L、(63.04±17.93) ng/L、(150.10±67.18) ng/L、(41.29±6.77) μg/mL，明显高于非AKI组的(1.58±0.25) mg/L、(51.84±14.79) ng/L、(92.09±51.38) ng/L、(34.99±4.97) μg/mL，差异均有统计学意义(P<0.05)；ROC曲线分析结果显示，CysC、ET-1、NT-proBNP、NGAL预测 PIH早期肾损伤的AUC分别为 0.916、0.852、0.912、0.890；其中，CysC对 PIH早期肾损伤的诊断价值最高，AUC为0.916，Cut-off值为1.79 mg/L，敏感性为 90.02%，特异性为 80.00%，Youden指数为 0.702。结论 PIH并发AKI患者血清CysC、ET-1、NT-proBNP、NGAL水平随着PIH病情的严重程度而升高，对早期肾损伤的诊断具有指导意义，临床诊断时可联合检测，互为参考印证。
      【关键词】 妊娠高血压综合征；肾损伤；血清胱抑素C；内皮素-1；N端脑利钠肽前体；中性粒细胞明胶酶相关脂质运载蛋白
      【中图分类号】 R714.24+6 【文献标识码】 A 【文章编号】 1003—6350（2019）18—2383—04

Changes of serum biochemical markers and their early diagnostic value in patients with pregnancy-inducedhypertension complicated with renal injury.
WANG Chun-jing, LI Jin-yan, HE Wen-li, WU Jing. Department ofObstetrics and Gynecology, Xianyang Hospital of Yan'an University, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To explore the changes of serum biochemical indicators and their early diagnosis valuein patients with pregnancy-induced hypertension (PIH) complicated with acute kidney injury (AKI). Methods FromDecember 2016 to December 2018, 86 patients with PIH admitted to the Xianyang Hospital of Yan'an University wereselected as the observation group, including 39 patients in the mild group, 27 patients in the moderate group, and 20 pa-tients in the severe group. They were divided into AKI group (41 cases) and non-AKI group (45 cases) according towhether the kidney was damaged. During the same period, another 86 healthy pregnant woman in the third trimesterwere selected as the control group. The levels of serum cystatin C (CysC), endothelin-1 (ET-1), N-terminal pro-brain na-triuretic peptide (NT-proBNP) and neutrophil gelatinase-associated lipocalin (NGAL) in pregnant women were com-pared in each group, and the diagnostic value of early renal injury was analyzed by ROC curve. Results The serum lev-els of CysC, ET-1, NT-proBNP and NGAL were significantly higher in the observation group than in the control group,and all differences were statistically significant (P<0.05) (1.79±0.30) mg/L vs (1.14±0.22) mg/L, (57.20±11.47) ng/L vs(45.74±9.95) ng/L, (121.49±45.04) ng/L vs (70.93±16.78) ng/L, (36.31±8.39) μg/mL vs (21.18 ± 5.46) μg/mL. In themild, moderate, and severe group of the observation group, the serum levels of CysC were (1.25±0.33) mg/L, (1.91±0.33) mg/L, and (2.17±0.31) mg/L), respectively; ET-1 levels were (48.66±5.51) ng/L, (54.18±11.21) ng/L, and (60.46±9.29) ng/L, respectively; NT-proBNP levels were (89.70±25.47) ng/L, (105.17±34.11) ng/L, and (137.05±63.28) ng/L, re-spectively; NGAL levels were respectively (25.48±9.53) μg/mL, (35.75±14.45) μg/mL, and (47.55±16.03) μg/mL; alldifferences were statistically significant (P<0.05). Among them, the serum levels were higher in the severe group than in