摘要
目的探讨肾损伤分子1(renal injury molecule-1,Kim-1)与β2微球蛋白(β2-Microglobulin,β2-MG)浓度在妊娠期高血压疾病(hypertensive disorder of pregnancy,HDP)并发早期肾损伤的诊断价值。方法回顾性分析2017年7月至2018年10月西安市中心医院收治的HDP并发肾损伤的56例孕妇和同期56名正常孕妇的临床资料,HDP并发肾损伤的孕妇为观察组,同期56名正常孕妇为对照组,比较两组孕妇孕30周、32周、34周、36周时血肌酐(serum creatinine,SCr)、Kim-1、β2-MG浓度的差异,并分析Kim-1、β2-MG联合诊断HDP早期肾损伤的价值。结果观察组孕30周、孕32周、孕34周、孕36周时SCr、Kim-1、β2-MG均呈升高趋势,差异有统计学意义(Kim-1:F组内=11.234、β2-MG:F组内=12.852、SCr:F组内=8.308,P均<0.001)。且观察组SCr[孕30周、孕32周、孕34周、孕36周:(75.35±10.32)、(75.41±10.35)、(77.02±10.50)、(87.78±10.64)μmol/L]、Kim-1[孕30周、孕32周、孕34周、孕36周:(5.68±1.50)、(7.56±1.52)、(8.25±1.62)、(9.65±1.76)ng/L]、β2-MG[孕30周、孕32周、孕34周、孕36周:(0.26±0.07)、(0.29±0.08)、(0.75±0.29)、(1.02±0.38)ng/L]均高于对照组SCr[孕30周、孕32周、孕34周、孕36周:(74.37±10.34)、(74.43±10.40)、(75.10±12.52)、(76.80±11.66)μmol/L]、Kim-1[孕30周、孕32周、孕34周、孕36周:(5.31±1.75)、(5.36±1.77)、(5.39±1.60)、(5.41±1.70)ng/L]、β2-MG[孕30周、孕32周、孕34周、孕36周:(0.25±0.07)、(0.26±0.09)、(0.28±0.08)、(0.27±0.08)mg/L],差异有统计学意义(SCr:F组间=10.254、Kim-1:F组间=16.352、β2-MG:F组间=18.221,P均<0.001)。两组在不同分组与不同时间之间存在交互作用(SCr:F交互=15.632、Kim-1:F交互=25.645、β2-MG:F交互=34.251,P均<0.001)。Kim-1联合β2-MG诊断HDP并发早期肾损伤的灵敏度96.43%(54/56)、特异度94.64%(53/56)、准确率95.54%(107/112),明显优于单独使用Kim-1[88.24%(45/51)、92.86%(52/56)、86.61%(97/112)]、β2-MG[81.13%(43/53)、78.57%(44/56)、77.68%(87/112)],差异有统计学意义(P均<0.05)。结论HDP早期肾损伤孕妇血清Kim-1、β2-MG浓度显著升高,可作为产前监控筛查早期肾损伤的可靠指标,联合检测能提高其诊断准确性。
Objective To investigate the diagnostic value of renal injury molecule-1(KIM-1)andβ2-microglobulin(β2-MG)concentration in hypertensive disorder of pregnancy(HDP)complicated with early renal injury.Methods From July 2017 to October 2018,the clinical data of 56 pregnant women with HDP complicated with renal injury and 56 normal pregnant women in the same period in Xi′an Central Hospital were analyzed retrospectively.The pregnant women with HDP complicated with renal injury were the observation group and the 56 normal pregnant women were the control group.The difference of serum creatine(SCr),KIM-1,β2-MG concentration between the two groups at 30,32,34 and 36 weeks of gestation was compared,and the value of KIM-1,β2-MG combined diagnosis of early renal injury in HDP was analyzed.Results At 30,32,34 and 36 weeks of gestation,Kim-1,β2-MG and SCr in the observation group increased significantly(Kim-1:Fintra-group=11.234,β2-MG:Fintra-group=12.852,SCr:Fintra-group=8.308;all P<0.001).In the observation group,SCr(30 weeks,32 weeks,34 weeks,36 weeks:(75.35±10.32),(75.41±10.35),(77.02±10.50),(87.78±10.64)μmol/L),Kim-1(30 weeks,32 weeks,34 weeks,36 weeks:(5.68±1.50),(7.56±1.52),(8.25±1.62),(9.65±1.76)ng/L),β2-MG(30 weeks,32 weeks,34 weeks,36 weeks:(0.26±0.07),(0.29±0.08),(0.75±0.29),(1.02±0.38)ng/L)were all higher than those of control group SCr(30 weeks,32 weeks,34 weeks,36 weeks:(74.37±10.34),(74.43±10.40),(75.10±12.52),(76.80±11.66)μmol/L),Kim-1(30 weeksL,32 weeks,34 weeks,36 weeks:(5.31±1.75),(5.36±1.77),(5.39±1.60),(5.41±1.70)ng/L),β2-MG(30 weeks,32 weeks,34 weeks,36 weeks:(0.25±0.07),(0.26±0.09),(0.28±0.08),(0.27±0.08)mg/L),the difference was statistically significant(SCr:Fintergroup=10.254,Kim-1:Fintergroup=16.352,β2-MG:Fintergroup=18.221;all P<0.001).There were interaction between the two groups at different time(SCr:Finteraction=15.632,Kim-1:Finteraction=25.645,β2-MG:Finteraction=34.251;all P<0.001).The sensitivity,specificity and accuracy of Kim-1 combined withβ2-MG were 96.43%(54/56),94.64%(53/56)and 95.54%(107/112),respectively.It was significantly better than Kim-1 alone(88.24%(45/51),92.86%(52/56),86.61%(97/112)),β2-MG alone(81.13%(43/53),78.57%(44/56),77.68%(87/112)),the difference was statistically significant(all P<0.05).Conclusion The serum levels of KIM-1 andβ2-MG in pregnant women with early renal injury of HDP are significantly increased,which can be used as a reliable indicator for prenatal monitoring and screening of early renal injury,and the combined detection can improve the accuracy of diagnosis.
作者
陈小琳
慕婷
雷洁
Chen Xiaolin;Mu Ting;Lei Jie(Department of Nephrology,Xi′an Central Hospital,Shaanxi Province,Xi′an 710002,China)
出处
《中国综合临床》
2020年第3期263-266,共4页
Clinical Medicine of China
关键词
肾损伤分子1
早期肾损伤
联合监测
妊娠期高血压
Β2微球蛋白
肾功能
Kidney injury molecule-1
Early renal injury
Combined monitoring
Pregnancy hypertension
β2-microglobulin
Renal function
