[1]张莉莉,关丫丫,张林波.血清同型半胱氨酸、中性粒细胞明胶酶相关脂质运载蛋白联合尿微量白蛋白对妊娠期高血压疾病患者早期肾损伤的诊断价值[J].新乡医学院学报,2022,39(2):177-181.[doi:10.7683/xxyxyxb.2022.02.016]
　ZHANG Lili,GUAN Yaya,ZHANG Linbo.Diagnostic value of serum homocysteine,neutrophil gelatinase-associated lipid carrier protein and urinary microalbumin for early renal injury of patients with hypertensive disease of pregnancy[J].Journal of Xinxiang Medical University,2022,39(2):177-181.[doi:10.7683/xxyxyxb.2022.02.016]
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血清同型半胱氨酸、中性粒细胞明胶酶相关脂质运载蛋白联合尿微量白蛋白对妊娠期高血压疾病患者早期肾损伤的诊断价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年2
页码:
177-181
栏目:
临床研究
出版日期:
2022-02-05

文章信息/Info

Title:
Diagnostic value of serum homocysteine,neutrophil gelatinase-associated lipid carrier protein and urinary microalbumin for early renal injury of patients with hypertensive disease of pregnancy
作者:
张莉莉; 关丫丫; 张林波
（新乡医学院第三附属医院检验科，河南　新乡　453003）
Author(s):
ZHANG Lili; GUAN Yaya; ZHANG Linbo
（Department of Clinical Laboratory,the Third Affiliated Hospital of Xinxiang Medical University，Xinxiang 453003，Henan Province，China）
关键词:
妊娠期高血压疾病; 早期肾损伤; 同型半胱氨酸; 中性粒细胞明胶酶相关脂质运载蛋白; 尿微量白蛋白
Keywords:
hypertensive disease of pregnancy; early renal injury; homocysteine; neutrophil gelatinase-associated lipid carrier protein; urinary microalbumin
分类号:
R714.24+6
DOI:
10.7683/xxyxyxb.2022.02.016
文献标志码:
A
摘要:
目的　探讨血清同型半胱氨酸（HCY）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和尿微量白蛋白（U-mAlb）对妊娠期高血压疾病（HDP）患者早期肾损伤的诊断价值。方法　选择2018年11月至2020年7月新乡医学院第三附属医院收治的HDP患者182例为HDP组，根据高血压程度将HDP患者分为妊娠期高血压组（n=61）、子痫前期轻度组（n=59）、子痫前期重度组（n=62），根据肌酐清除率将HDP患者分为肾功能正常组（n=88）和肾功能异常组（n=94）；另选择同期来院进行产检的正常妊娠孕妇177例为正常对照组。采用酶循环法检测血清HCY水平，酶联免疫分析法检测血清NGAL水平，乳胶增强免疫比浊法检测尿样中U-mAlb水平，应用受试者工作特征（ROC）曲线分析HCY、NGAL、U-mAlb单独检测及三者联合检测对HDP早期肾损伤的诊断价值。结果　HDP组患者血清HCY、NGAL和U-mAlb水平显著高于正常对照组（P<0.05）；子痫前期重度组患者血清HCY、NGAL和U-mAlb水平显著高于子痫前期轻度组和妊娠期高血压组，子痫前期轻度组患者血清HCY、NGAL和U-mAlb水平显著高于妊娠期高血压组（P<0.05）。肾功能异常组患者血清HCY、NGAL和U-mAlb水平显著高于肾功能正常组（P<0.05）。HCY、NGAL、U-mAlb 诊断HDP早期肾损伤的临界值分别为14.65 μmol·L-1、13.27 μg·L-1、87.21 mg·L-1。HCY、NGAL、U-mAlb单独检测诊断HDP早期肾损伤ROC曲线下面积（AUC）比较差异无统计学意义（P>0.05）。HCY、U-mAlb单独检测诊断HDP早期肾损伤的灵敏度大于NGAL（P<0.05），HCY、U-mAlb单独检测诊断HDP早期肾功能损伤的灵敏度比较差异无统计学意义（P>0.05）。HCY单独检测诊断HDP早期肾功能损伤的特异度小于NGAL和U-mAlb（P<0.05），NGAL单独检测与U-mAlb单独检测诊断HDP早期肾损伤的特异度比较差异无统计学意义（P>0.05）。HCY、NGAL、U-mAlb联合检测诊断HDP早期肾损伤的AUC、灵敏度和特异度大于HCY、NGAL、U-mAlb 单独检测（P<0.05）。结论　妊娠期高血压疾病可导致血清HCY、NGAL和U-mAlb水平增高，且血清HCY、NGAL与U-mAlb水平随高血压及肾损伤程度的增加而显著增高，血清HCY、NGAL与U-mAlb联合检测诊断妊娠期高血压疾病早期肾损伤的灵敏度与特异度较高。
Abstract:
Objective　To explore the diagnostic value of serum homocysteine (HCY),neutrophil gelatinase-associated lipid carrier protein (NGAL) and urinary microalbumin (U-mAlb) for early renal injury of patients with hypertensive disease of pregnancy(HDP).Methods　A total of 182 patients with HDP admitted to the Third Affiliated Hospital of Xinxiang Medical University from November 2018 to July 2020 were selected as the HDP group,they were divided into gestational hypertension group (n=61),mild preeclampsia group (n=59) and severe preeclampsia group (n=62)according to the degree of hypertension,and they were divided into normal renal function group (n=88) and abnormal renal function group (n=94)according to creatinine clearance rates.In addition,a total of 177 normal pregnant women who came to our hospital for labor examination during the same period were selected as the normal control group.The serum HCY level was detected by enzyme circulation method,the serum NGAL level was detected by enzyme-linked immunosorbent assay,and the U-mAlb level in urine was detected by latex enhanced immunoturbidimetry.The diagnostic value of single detection of HCY,NGAL,U-mAlb and their combined detection for early renal injury of gestational hypertension was analyzed by receiver operating characteristic (ROC) curve.Results　The levels of HCY,NGAL in serum and U-mAlb of patients in the HDP group were significantly higher than those in the normal control group (P<0.05).The levels of HCY,NGAL in serum and U-mAlb of patients in the severe preeclampsia group were significantly higher than those in the mild preeclampsia group and gestational hypertension group,the levels of HCY,NGAL in serum and U-mAlb of patients in the mild preeclampsia group were significantly higher than those in the gestational hypertension group(P<0.05).The critical values of HCY,NGAL and U-mAlb in diagnosing the early renal injury of patients with HDP were 14.65 μmol·L-1,13.27 μg·L-1,87.21 mg·L-1,respectively.There was no significantly difference in the area under curve(AUC) of ROC of HCY,NGAL and U-mAlb alone in diagnosing early renal injury of patients with HDP(P>0.05).The sensitivity of HCY and U-mAlb alone in diagnosing early renal injury of patients with HDP was greater than that of NGAL alone (P<0.05),there was no significant difference in the sensitivity of HCY and U-mAlb alone in diagnosing early renal injury of patients with HDP(P>0.05).The specificity of HCY alone in diagnosing early renal injury of patients with HDP was lower than that of NGAL and U-mAlb alone(P<0.05),there was no significant difference in the specificity of NGAL alone and U-mAlb alone in diagnosing early renal injury of patients with HDP(P>0.05).The AUC,sensitivity and specificity of HCY,NGAL and U-mAlb combined detection in diagnosing early renal injury of patients with HDP were higher than those of HCY,NGAL and U-mAlb alone(P<0.05).Conclusion　HDP can increase the levels of HCY,NGAL in serum and U-mAlb,and the levels of HCY,NGAL in serum and U-mAlb increase significantly with the increase of hypertension and renal injury.The combined detection of serum HCY,NGAL and U-mAlb has higher sensitivity and specificity in the diagnosis of early renal injury of patients with HDP.

参考文献/References:

［1］　 LI Y,SONG B,RUAN C,et al.Adiporon attenuates hypertension-induced epithelial mesenchymal transition and renal fibrosis via promoting epithelial autophagy［J］.J Cardiovasc Transl Res,2021,14(3):538-545.
［2］　ZHANG C,FANG X,ZHANG H W,et al.Genetic susceptibility of hypertension induced kidney disease［J］.Physiol Rep,2021,9(1):e14688.
［3］　GAO N,ZHANG Y Z,LEI L,et al.Low doses of folic acid can reduce hyperhomocysteinemia-induced glomerular injury in spontaneously hypertensive rats［J］.Hypertens Res,2020,43(11):1182-1191.
［4］　VELLANKI V S,MUCSI I,VELAGALA S,et al.Quiz:hypertension and acute kidney injury during pregnancy［J］.Am J Kidney Dis,2017,69(3):A13-A17.
［5］　MAN S L,YANG L,XIANG H,et al.Antihypertensive and renal protective effect of shunaoxin pill combined with captopril on spontaneous hypertension rats［J］.Biomed Pharmacother,2020,125(1):109977.
［6］　OYAGBEMI A A,OMOBOWALE T O,ADEJUMOBI O A,et al.Antihypertensive power of naringenin is mediated via attenuation of mineralocorticoid receptor(MCR)/angiotensin coverting enzyme(ACE)/kidney injury molecule(Kim-1) signaling pathway［J］.Eur J Pharmacol,2020,880(5):173142.
［7］　GUO B,GUO Y,LIU C.Predictive factors of progression in renal function after unilateral nephrectomy in renal malignancy［J］.J Buon,2020,25(3):1650-1657.
［8］　中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南（2020）［J］.中华妇产科杂志,2020,55(4):227-238.
HYPERTENSIVE DISORDERS IN PREGNANCY SUBGROUP,CHINESE SOCIETY OF OBSTETRICS AND GYNECOLOGY,CHINESE MEDICAL ASSOCIATION.Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy:a clinical practice guideline in China（2020）［J］.Chin J Obstet Gynecol,2020,55(4):227-238.
［9］　BERHE A K,KASSA G M,FEKADU G A,et al.Prevalence of hypertensive disorders of pregnancy in Ethiopia:a systemic review and meta-analysis［J］.BMC Pregnancy Child Birth,2018,18(1):34.
［10］　LEAVITT K,OBI CˇAN S,YANKOWITZ J.Treatment and prevention of hypertensive disorders during pregnancy［J］.Clin Perinatol,2019,46(2):173-185.
［11］　TABER-HIGHT E,SHAH S.Acute kidney injury in pregnancy［J］.Adv Chronic Kidney Dis,2020,27(6):455-460.
［12］　GAMA R M,CLARK K,BHADURI M,et al.Acute kidney injury e-alerts in pregnancy:rates,recognition and recovery［J］.Nephrol Dial Transplant,2021,36(6):1023-1030.
［13］　袁雪莲,曲首辉.妊娠期高血压疾病患者血清β-痕迹蛋白和尿β2-微球蛋白水平与早期肾损伤的相关性［J］.新乡医学院学报,2019,36(3):238-241.
YUAN X L,QU S H.Correlation between the levels of serum β-trace protein and urinary β2-microglobulin and early renal injury in patients with gestational hypertension［J］.J Xinxiang Med Univ,2019,36(3):238-241.
［14］　赵阳,崔丽艳.microRNA作为急性肾损伤早期诊断生物标志物的研究进展［J］.中华检验医学杂志,2017,40(8):633.
ZHAO Y,CUI L Y.Progress in microRNA as biomarker for the early diagnosis of acute renal injury［J］.Chin J Lab Med,2017,40 (8):633.
［15］　KIL J S,JEONG S O,CHUNG H T,et al.Piceatannol attenuates homocysteine-induced endoplasmic reticulum stress and endothelial cell damage via heme oxygenase-1 expression［J］.Amino Acids,2017,49(4):735-745.
［16］　LI T,YU B,LIU Z,et al.Homocysteine directly interacts and activates the angiotensin II type I receptor to aggravate vascular injury［J］.Nat Commun,2018,9(1):11.
［17］　周宇涵,樊伍峰,董金菊.肾损伤分子-1、β2-微球蛋白、内皮素-1和肌酐在妊娠期高血压疾病并发急性肾损伤的临床研究［J］.生殖与避孕,2016,36(3):189-194.
ZHOU Y H,FAN W F,DONG J J.Clinical research of kidney injury molecule-1,β2-microglobulin,endothelin-1 and creatinine in gestational hypertension complicated with acute renal injury［J］.Chin J Reproduct Contracept,2016,36(3):189-194.
［18］　刘利婷,张慧杰,阿丁嘎,等.尿液生物标志物在狼疮性肾炎诊断和进展评估中的应用研究进展［J］.新乡医学院学报,2021,38(7):696-700.
LIU L T,ZHANG H J,ADINGA,et al.Research progress in application of urine biomarkers in the diagnosis and evaluation of lupus nephritis［J］.J Xinxiang Med Univ,2021,38(7):696-700.
［19］　COSENTINO N,GENOVESE S,CAMPODONICO J,et al.High-sensitiveity C reactive protein and acute kidney injury in patients with acute myocardial infarction:a prospective observational study［J］.J Clin Med,2019,8(12):2192.
［20］　张会芬,杨宏秀,刘丽,等.血清中性粒细胞明胶酶相关脂质运载蛋白、胱抑素C及尿白蛋白肌酐比值、N-乙酰-β-D-氨基葡萄糖苷酶检测在早期糖尿病肾脏疾病中的应用价值［J］.中国糖尿病杂志,2018,26(4):309-315.
ZHANG H F,YANG H X,LIU L,et al.Application value of serum neutrophil gelatinase-associated lipocalin,cystatin C,urinary albumin creatinine rate and N-acetyl-β-D-glucosaminidase in early diabetic kidney disease［J］.Chin J Diabetes,2018,26(4):309-315.
［21］　董虹,谢芳,谢良才,等.CysC、β2-MG、U-mAlb检测在糖尿病早期肾损伤诊断中的应用［J］.检验医学与临床,2016,13(8):1079-1081.
DONG H,XIE F,XIE L C,et al.Application of CysC,β2-MG and U-mAlb in diagnosis of early renal injury in diabetes mellitus［J］.Lab Med Clin,2016,13(8):1079-1081.

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更新日期/Last Update: 2022-02-05