妊娠高血压综合征患者血清NGAL、Hcy变化及其对早期肾损害的诊断价值

Diagnostic value of serum NGAL and Hcy changes for early renal damage in patients with pregnancy induced hypertension

摘要:

目的 探讨妊娠高血压综合征（以下简称妊高征）患者血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、同型半胱氨酸（Hcy）变化及其对早期肾损害的诊断价值。方法 选取2020年5月—2021年5月武威市人民医院妊高征患者94例作为研究组，并选取同期该院正常妊娠女性90例作为对照组。并将妊高征患者根据是否发生肾损害分为肾损害组和非肾损害组，分别有26例和68例。比较研究组与对照组血清NGAL、Hcy水平，比较肾损害组与非肾损害组一般资料及血清NGAL、Hcy水平，分析早期肾损害的影响因素及血清NGAL、Hcy水平对早期肾损害的诊断价值。结果 研究组血清NGAL、Hcy水平高于对照组（P <0.05）。肾损害组与非肾损害组年龄、孕周、BMI、孕次、产次、分娩经历、文化程度、TC、TG、Cr比较，差异无统计学意义（P >0.05）。肾损害患者妊娠期高血压低于非肾损害组，UA、ACR、NGAL、Hcy高于非肾损害组（P <0.05）。多因素Logistic逐步回归分析结果显示：病情严重程度［O^R=3.888（95% CI：1.692，8.937）］、UA水平［O^R=4.158（95% CI：1.809，8.556）］、ACR水平［O^R=4.600（95% CI：2.001，10.571）］、NGAL水平［O^R=4.792（95% CI：2.085，11.014）］、Hcy水平［O^R=5.013（95% CI：2.181，11.521）］是早期肾损害的影响因素（P <0.05）。ROC曲线分析结果显示，血清NGAL、Hcy水平诊断早期肾损害的截断值为185.26 ng/mL、28.57 μmol/L，敏感性分别为76.92%（95% CI：0.559，0.902）、80.77%（95% CI：0.600，0.927），特异性分别为92.65%（95% CI：0.830，0.973）、80.88%（95% CI：0.692，0.890），AUC分别为0.869、0.830。两者联合检测的敏感性为96.15%（95% CI：0.784，0.998），特异性为86.76%（95% CI：0.758，0.934），AUC为0.962。结论 妊高征患者血清NGAL、Hcy水平异常升高，对早期肾损害具有较高诊断价值。

Abstract:

Objective To study the changes of serum neutrophil gelatinase associated lipid carrier protein (NGAL) and homocysteine (Hcy) in patients with pregnancy induced hypertension and their diagnostic value for early renal damage.Methods Ninety-four patients with PIH in our hospital from May 2020 to may 2021 were selected as the study group, and 90 normal pregnant women in the same period were selected as the control group; Patients with PIH were divided into renal damage (n = 26) and non renal damage (n = 68) according to whether renal damage occurred. The serum levels of NGAL and Hcy were compared between the two groups. The general data and serum levels of NGAL and Hcy were compared between patients with renal damage and non renal damage. The influencing factors of early renal damage and the diagnostic value of serum levels of NGAL and Hcy in early renal damage were analyzed.Results Compared the levels of serum NGAL and Hcy between the study group and the control group, the difference was statistically significant by T test (P < 0.05). The levels of serum NGAL and Hcy in the study group were higher than those in the control group. There was no significant difference in age, gestational week, BMI, pregnancy times, labor times, delivery experience, education level, TC level, TG level, and Cr level between patients with renal damage and those without renal damage (P > 0.05). The composition ratio, UA level, ACR level, NGAL level and Hcy level of the severity of the disease in patients with renal impairment and patients without renal impairment were compared χ² or T test, the difference was statistically significant (P < 0.05). The severity, UA, ACR, NGAL, and Hcy of patients with renal impairment were greater than those of patients without renal impairment. Logistic stepwise regression analysis showed that severity of disease [ O^R = 3.888 (95% CI: 1.692, 8.937), UA level [ O^R = 4.158 (95% CI: 1.809, 8.556) ], ACR level [ O^R = 4.600 (95% CI: 0.001, 10.571) ], NGAL level [ O^R = 4.792 (95% CI: 2.085, 11.014) ], and Hcy level [ O^R = 5.013 (95% CI: 2.181, 11.521) ] were the influencing factors of early renal damage (P < 0.05). ROC analysis showed that the cut off values of serum NGAL and Hcy levels for diagnosing early renal damage were 185.26 ng/mL and 28.57 μ mol/L, with sensitivity of 76.92% (95% CI: 0.559, 0.902), 80.77% (95% CI: 0.600, 0.927), specificity of 92.65% (95% CI: 0.830, 0.973), 80.88% (95% CI: 0.692, 0.890), AUC of 0.869 and 0.830. The sensitivity of their combination was 96.15% (95% CI: 0.784, 0.998), specificity was 86.76% (95% CI: 0.758, 0.934), anf AUC value was 0.962.Conclusion The serum levels of NGAL and Hcy in patients with pregnancy induced hypertension are significantly increased, which has high diagnostic value for early renal damage.