本文選題：妊娠期高血壓疾病 + 重度子癇前期　； 參考：《吉林大學(xué)》2016年碩士論文

【摘要】：目的:妊娠期高血壓疾病孕婦往往存在不同程度的腎臟損害,本文利用血清胱抑素C和尿RBP、m ALB、NAG在腎小球、腎小管的特異性表達(dá),通過(guò)聯(lián)合測(cè)定這些指標(biāo)的變化評(píng)價(jià)其對(duì)妊娠期高血壓疾病早期腎損傷的臨床診斷價(jià)值及應(yīng)用前景。方法:1)選取2015年6月~2015年12月在吉大二院產(chǎn)科門(mén)診和住院部臨床診斷為妊娠期高血壓疾病的孕婦46例,根據(jù)謝幸主編的《婦產(chǎn)科學(xué)》第八版中的診斷標(biāo)準(zhǔn),將研究對(duì)象分為重度子癇前期組31例,慢性高血壓并發(fā)子癇前期組15例,正常對(duì)照組20例,均為同期住院妊娠婦女。所有研究對(duì)象均無(wú)妊娠期高血壓疾病以外的其他妊娠合并癥,無(wú)高血壓史、糖尿病史、腎病等慢性病史,亦未應(yīng)用影響腎功能的任何藥物。2)兩組均于入院24小時(shí)內(nèi)、產(chǎn)后42天留取血、尿標(biāo)本,檢測(cè)血清胱抑素C、尿酸、肌酐(Scr)和尿液中RBP、m ALB、NAG表達(dá)水平,采用受試者正作特征曲線(xiàn)下面積(AUCR0c)評(píng)價(jià)指標(biāo)的可靠性。3)采用Windows SPSS 21分析軟件。臨床資料以X士S表示,兩組間均數(shù)比較采用兩獨(dú)立樣本t檢驗(yàn),多組組間均數(shù)兩兩比較采用方差分析。實(shí)驗(yàn)結(jié)果的數(shù)據(jù)采用Graph Pad Prism 5.0作圖,PO.05表示差異有顯著性。結(jié)果:(1)妊娠期高血壓疾病組與正常妊娠組相比,身高、體重?zé)o明顯差異(P0.05),Scr和UA水平、產(chǎn)前及產(chǎn)后2h血壓顯著高于正常妊娠組(P0.01,差異具有統(tǒng)計(jì)學(xué)意義),但終止妊娠周數(shù)、新生兒體重顯著低于正常妊娠組(P0.01,差異具有統(tǒng)計(jì)學(xué)意義)。(2)慢性高血壓并發(fā)子癇前期組與重度子癇前期組比較,產(chǎn)前血壓、早產(chǎn)率、新生兒體重?zé)o明顯差異(P0.05),產(chǎn)后2h血壓明顯高于重度子癇前期組(P0.05,差異具有統(tǒng)計(jì)學(xué)意義)。(3)與正常妊娠組相比,重度子癇前期組和慢性高血壓并發(fā)子癇前期組中s Cys C、u RBP、u MALB、u NAG水平明顯升高(P0.01,差異具有統(tǒng)計(jì)學(xué)意義)。(4)對(duì)s Cys C、u RBP、u MALB、u NAG四個(gè)指標(biāo)做ROC曲線(xiàn)結(jié)果顯示,s Cystain C曲線(xiàn)下面積:0.743;u RBP曲線(xiàn)下面積:0.909;u MALB曲線(xiàn)下面積:0.982;u NAG曲線(xiàn)下面積:0.720。說(shuō)明u MALB對(duì)妊娠期高血壓疾病早期腎臟損傷的診斷價(jià)值最高,其次為u RBP、s Cystain C,u NAG的診斷價(jià)值最低。(5)s Cys C、u RBP、u MALB、u NAG四個(gè)標(biāo)志物對(duì)于妊娠期高血壓疾病早期腎損傷的預(yù)測(cè),兩兩聯(lián)合的敏感性及特異性大于單個(gè)指標(biāo),三個(gè)指標(biāo)聯(lián)合其敏感性及特異性大于兩兩聯(lián)合。(6)產(chǎn)后42天復(fù)查,妊娠期高血壓疾病組s Cys C、u RBP、u MALB、u NAG水平明顯低于妊娠期高血壓疾病組產(chǎn)前水平(P0.01,差異具有統(tǒng)計(jì)學(xué)意義)。結(jié)論:1.妊娠期高血壓疾病組孕婦血尿標(biāo)本中均有s Cys C、u RBP、u MALB、u NA的表達(dá),產(chǎn)后42天表達(dá)水平降低。與正常對(duì)照組比較,妊娠期高血壓疾病組血液中s Cys C、u RBP、u MALB、u NAG水平均顯著升高。說(shuō)明四個(gè)指標(biāo)的濃度對(duì)妊娠期高血壓疾病早期腎臟損傷有預(yù)測(cè)價(jià)值。2.慢性高血壓并發(fā)子癇前期組與重度子癇前期比較,s Cys C、u RBP、u MALB、u NAG表達(dá)無(wú)顯著性差異,說(shuō)明其早期腎損傷程度可能無(wú)顯著差別,但此結(jié)論有待進(jìn)一步行腎活檢來(lái)驗(yàn)證。3.ROC曲線(xiàn)結(jié)果表明u MALB和u RBP對(duì)預(yù)測(cè)妊娠期高血壓疾病早期腎臟損傷的價(jià)值較高,根據(jù)其敏感度和特異性得出的最佳截?cái)嘀祵?duì)臨床工作有一定的指導(dǎo)意義。4.四個(gè)標(biāo)志物對(duì)于妊娠期高血壓疾病早期腎損傷的預(yù)測(cè),兩兩聯(lián)合的敏感性及特異性大于單個(gè)指標(biāo),三個(gè)指標(biāo)聯(lián)合其敏感性及特異性大于兩兩聯(lián)合,說(shuō)明聯(lián)合檢測(cè)對(duì)于腎早期損傷更有診斷價(jià)值及應(yīng)用前景,有助于臨床上判斷腎損傷部位,針對(duì)性用藥,更好的、更科學(xué)的監(jiān)管妊娠期高血壓疾病患者,力求母嬰結(jié)局的完美。
[Abstract]:Objective: pregnant women with hypertension often have different degrees of renal damage. In this paper, the specific expression of serum cystatin C and urinary RBP, m ALB, NAG in the glomeruli and renal tubules is used to evaluate the clinical diagnostic value and application prospect of the early renal injury of pregnancy induced hypertension by combined determination of these indexes. 1) 46 cases of pregnant women who were diagnosed as pregnancy induced hypertension in the Department of Obstetrics outpatient department and inpatient department of jjda in June 2015 ~2015 were divided into 31 cases of severe preeclampsia group, 15 cases of chronic high blood pressure and preeclampsia, and 20 normal control group, according to the diagnostic criteria of the eighth edition of Obstetrics and gynecology. All the subjects were hospitalized for pregnancy in the same period. All the subjects had no pregnancy complications other than hypertensive disorder complicating pregnancy, no history of hypertension, diabetes history, kidney disease and any other chronic medical history, and no drugs affecting the renal function of any drug.2) two groups were hospitalized for 24 hours, 42 days after postpartum blood, urine specimens, serum cystatin C, uric acid, The expression level of creatinine (Scr) and urine RBP, m ALB, NAG, the reliability.3 of the area (AUCR0c) evaluation index under the positive characteristic curve of the subjects was adopted. The Windows SPSS 21 analysis software was used. The clinical data was expressed in X S, and the average number of the two groups was compared with two independent sample t tests. The results of the multiple groups were compared with the analysis of variance. Experimental results were used. The data were made with Graph Pad Prism 5, and PO.05 showed significant difference. Results: (1) there was no significant difference in height and weight (P0.05), Scr and UA, and significantly higher in pre natal and postpartum blood pressure than in the normal pregnancy group (P0.01, the difference was statistically significant) compared with the normal pregnancy group (P0.05). The weight of the children was significantly lower than that of the normal pregnancy group (P0.01, the difference was statistically significant). (2) the preeclampsia group and the severe preeclampsia group had no significant difference in preeclampsia and preeclampsia (P0.05), and the postpartum 2H blood pressure was significantly higher than that of the severe preeclampsia group (P0.05, the difference was statistically significant). (3) and normal The s Cys C, u RBP, u MALB and u NAG levels in the severe preeclampsia group and the preeclampsia group were significantly higher (P0.01, the difference was statistically significant). (4) the area under the curve of s Cys was 0.743; the area under the curve of 0.909; Area below line: 0.982; area under u NAG curve: 0.720. indicates that u MALB has the highest diagnostic value for early renal injury in pregnancy induced hypertension, followed by u RBP, s Cystain C, and u NAG. The sensitivity and specificity of three indexes were greater than that of 22. (6) 42 days after postpartum reexamination, s Cys C, u RBP, u MALB, u NAG levels were significantly lower than the prenatal level of hypertensive disorder complicating pregnancy (P0.01, difference was statistically significant). Conclusion: 1. pregnancy induced hypertension group The expression of s Cys C, u RBP, u MALB, u NA and the 42 day postpartum expression level decreased in pregnant women's hematuria. Compared with the normal control group, the level of s Cys C in the blood of pregnancy induced hypertension group was significantly higher than that of the normal control group. There was no significant difference in s Cys C, u RBP, u MALB, u NAG expression in preeclampsia group and severe preeclampsia, indicating that there may be no significant difference in the degree of early renal injury. The value is higher, and the best truncation value based on its sensitivity and specificity has certain guiding significance for clinical work..4. four markers are used to predict early renal injury in pregnancy induced hypertension. The sensitivity and specificity of the 22 combination are greater than that of a single index, and the sensitivity and specificity of the three indicators are greater than that of 22. It shows that joint detection is of more diagnostic value and application prospect for early renal injury. It is helpful to judge the site of renal injury in clinic, and to improve and scientifically supervise the patients with pregnancy induced hypertension, and strive to perfect the outcome of mother and baby.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R714.246

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