NGAL和Cys-C在妊娠高血壓疾病腎損傷診斷中的臨床價值
發(fā)布時間：2018-09-11 13:33
【摘要】：目的：妊娠期高血壓疾病患者均存在不同程度的腎臟損害,本研究利用中性粒細胞明膠酶相關脂質(zhì)運載蛋白(NGAL)和血清胱抑素C (Cys-C)在妊娠期高血壓疾病腎臟損傷早期腎小球和腎小管特異表達,通過聯(lián)合測定妊娠高血壓(PIH)患者血NGAL、Cys-C和肌酐(Cr),評價NGAL和Cys-C在預測妊娠高血壓疾病腎臟損傷的診斷價值。 方法：1、病歷選擇：選取2013年2月～2013年8月在天津醫(yī)科大學第二醫(yī)院產(chǎn)科收住的診斷為妊娠高壓綜合征(PIH組)的孕婦80例,診斷標準按照《婦產(chǎn)科學》第七版,分為四個亞組,妊娠期高血壓亞組、輕度子癇前期亞組、重度子癇前期亞組、子癇亞組。正常對照組40例,均為同期住院妊娠結(jié)局正常的孕婦。兩組均除外慢性高血壓史、糖尿病史、肝腎疾病及免疫性疾病史。2、兩組均于入院24h內(nèi)及產(chǎn)后72h取血,檢測血清NGAL、血清Cys-C和血Cr表達水平,分析其與疾病及其嚴重程度的關系。3、分別以配對t檢驗、單因素方差分析做統(tǒng)計學處理,采用Spearman rho分析法做相關性分析。 結(jié)果：1、受試者入院24h內(nèi)和產(chǎn)后72h結(jié)果比較：NGAL入院24h內(nèi)的濃度較產(chǎn)后72h的檢測結(jié)果明顯增高,差異有顯著性(P0.05),Cys-C入院24h內(nèi)的濃度較產(chǎn)后72h的檢測結(jié)果明顯增高,差異有顯著性(P0.05),Cr入院24h內(nèi)的濃度較產(chǎn)后72h的檢測結(jié)果明顯增高,差異有顯著性(P0.05)。 2、PIH組入院24h內(nèi)NGAL的檢測結(jié)果較正常對照組均明顯增高,差異有統(tǒng)計學意義(P0.05),PIH組入院24h內(nèi)Cys-C的檢測結(jié)果較正常對照組均明顯增高,差異有統(tǒng)計學意義(P＜0.05), PIH組產(chǎn)后72h NGAL的檢測結(jié)果和正常對照組比較,兩組間差異無統(tǒng)計學意義(均P0.05), PIH組產(chǎn)后72h Cys-C的檢測結(jié)果和正常對照組比較,兩組間差異無統(tǒng)計學意義(均P0.05)。 3、PIH組各亞組間比較發(fā)現(xiàn),隨著疾病進展,妊娠高血壓亞組、輕度子癇前期亞組、重度子癇前期亞組、子癇亞組,單因子組間兩兩比較,血中NGAL表達水平均增高,各組間差異均有統(tǒng)計學意義(均p0.05)；Cys-C各組間比較只有妊娠高血壓亞組和子癇亞組比較有顯著性差異(p0.05),其余各亞組均無統(tǒng)計學差異(p0.05)。 4、受試者入院24h內(nèi)NGAL和Cr相關性分析顯示NGAL和Cr呈正相關,相關系數(shù)為0.905 受試者入院24h內(nèi)Cys-C和Cr相關性分析顯示NGAL和Cr呈正相關,相關系數(shù)為0.663 5、對NGAL、Cys-C和Cr三個指標做ROC曲線結(jié)果顯示,Cr曲線下面積0.706,Cys-C曲線下面積0.812,NGAL曲線下面積0.835,說明NGAL對妊娠期高血壓疾病腎臟損傷的診斷價值最高,其次為Cys-C, Cr的診斷價值最低 結(jié)論：1、妊娠期高血壓疾病患者血液中均有NGAL和Cys-C的表達,產(chǎn)后表達降低。與正常對照組比較妊娠期高血壓疾病組血液中NGAL和Cys-C水平均顯著升高。說明NGAL和Cys-C含量與妊娠期高血壓疾病腎臟損傷高度相關。 2、不同嚴重程度妊娠期高血壓疾病患者血液NGAL的表達具有差異,NGAL的含量隨著患者血Cr的升高而增加,進一步分析證實NGAL含量與疾病的嚴重程度高度相關；Cys-C表達的差異性不強,這可能和本實驗選取的樣本過少有關,有待近一步做大樣本實驗分析。 3、同一患者血液中NGAL與Cr含量具有正相關性,說明NGAL含量與疾病的嚴重程度高度相關;Cys-C含量與Cr含量也具有正相關性,血NGAL與疾病嚴重程度的相關系數(shù)為0.905(p=0.000),Cys-C與疾病嚴重程度的相關系數(shù)為0.663(p=0.000)。血液NGAL的相關性大于Cys-C,血液NGAL比Cys-C更能有效的反應疾病的嚴重程度。 4、ROC曲線結(jié)果表明NGAL和Cys-C對預測妊娠期高血壓疾病腎臟損傷的價值高于血Cr, NGAL對妊娠期高血壓疾病腎臟損傷的診斷價值最高。 綜上所述,血液NGAL和Cys-C可以作為預測妊娠期高血壓疾病腎臟損傷及其嚴重程度的一個重要的指標。
[Abstract]:Objective: To investigate the expression of neutrophil gelatinase-associated lipoprotein (NGAL) and serum cystatin C (Cys-C) in glomeruli and tubules of patients with pregnancy-induced hypertension (PIH) at the early stage of renal injury. GAL, Cys-C and creatinine (Cr) were used to evaluate the diagnostic value of NGAL and Cys-C in predicting renal injury in hypertensive disorder complicating pregnancy.
Methods: 1. Medical Record Selection: Eighty pregnant women with pregnancy-induced hypertension (PIH) admitted to the Obstetrics Department of the Second Hospital of Tianjin Medical University from February 2013 to August 2013 were divided into four subgroups according to the diagnostic criteria of < Obstetrics and Gynecology > 7th edition: pregnancy-induced hypertension subgroup, mild preeclampsia subgroup, severe preeclampsia subgroup, and eclampsia subgroup. Epilepsy subgroup. 40 normal pregnant women with normal pregnancy outcome were enrolled in the same period. The two groups were excluded from the history of chronic hypertension, diabetes, liver and kidney disease and immune disease. 2. Blood samples were taken within 24 hours after admission and 72 hours after delivery. The levels of serum NGAL, Cys-C and Cr were detected, and their relationship with the severity of the disease was analyzed. Paired t test and one-way ANOVA were used for statistical analysis and Spearman Rho was used for correlation analysis.
Results: 1. Comparing the results within 24 hours after admission and 72 hours after delivery, the concentration of NGAL in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cys-C in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cr in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The difference was significant (P0.05).
2. The results of NGAL detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P 0.05). The results of Cys-C detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P < 0.05). The results of NGAL detection in PIH group were significantly higher than those in normal control group 72 hours after delivery (P < 0.05). Significance (all P 0.05). There was no significant difference between PIH group and normal control group (all P 0.05).
3. Comparing with each subgroup of PIH group, the expression of NGAL in blood increased with the progress of disease, pregnancy induced hypertension subgroup, mild pre-eclampsia subgroup, severe pre-eclampsia subgroup, eclampsia subgroup and single factor group, and the difference was statistically significant (all p0.05). There was a significant difference in the epileptic subgroup (P0.05), but there was no significant difference between the other subgroups (P0.05).
4, NGAL and Cr correlation analysis showed that NGAL and Cr were positively correlated with 24h, and the correlation coefficient was 0.905.
Correlation analysis between Cys-C and Cr in 24h showed that NGAL and Cr were positively correlated, with a correlation coefficient of 0.663.
5. The ROC curves of NGAL, Cys-C and C r showed that the area under C R curve was 0.706, the area under Cys-C curve was 0.812, and the area under NGAL curve was 0.835, indicating that NGAL had the highest diagnostic value for renal injury in pregnancy-induced hypertension, followed by Cys-C and C r had the lowest diagnostic value.
Conclusion: 1. Both NGAL and C ys-C are expressed in the blood of patients with gestational hypertension, and the expression of NGAL and C ys-C is decreased postpartum.
2. The expression of NGAL was different in patients with different severity of gestational hypertension. The content of NGAL increased with the increase of serum Cr. Further analysis confirmed that the content of NGAL was highly correlated with the severity of the disease. Large sample analysis.
3. There was a positive correlation between serum NGAL and CR levels in the same patient, indicating that NGAL levels were highly correlated with the severity of the disease; Cys-C levels were positively correlated with CR levels; the correlation coefficient between serum NGAL and the severity of the disease was 0.905 (p = 0.000), and that between Cys-C and the severity of the disease was 0.663 (p = 0.000). In Cys-C, blood NGAL is more effective than Cys-C in reflecting the severity of the disease.
4. ROC curves showed that NGAL and C ys-C had higher value in predicting renal injury in pregnancy-induced hypertension than that in blood Cr. NGAL had the highest value in diagnosing renal injury in pregnancy-induced hypertension.
To sum up, blood NGAL and C ys-C can be used as an important index to predict renal injury and its severity in pregnancy-induced hypertension.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.246
本文編號：2236831
[Abstract]:Objective: To investigate the expression of neutrophil gelatinase-associated lipoprotein (NGAL) and serum cystatin C (Cys-C) in glomeruli and tubules of patients with pregnancy-induced hypertension (PIH) at the early stage of renal injury. GAL, Cys-C and creatinine (Cr) were used to evaluate the diagnostic value of NGAL and Cys-C in predicting renal injury in hypertensive disorder complicating pregnancy.
Methods: 1. Medical Record Selection: Eighty pregnant women with pregnancy-induced hypertension (PIH) admitted to the Obstetrics Department of the Second Hospital of Tianjin Medical University from February 2013 to August 2013 were divided into four subgroups according to the diagnostic criteria of < Obstetrics and Gynecology > 7th edition: pregnancy-induced hypertension subgroup, mild preeclampsia subgroup, severe preeclampsia subgroup, and eclampsia subgroup. Epilepsy subgroup. 40 normal pregnant women with normal pregnancy outcome were enrolled in the same period. The two groups were excluded from the history of chronic hypertension, diabetes, liver and kidney disease and immune disease. 2. Blood samples were taken within 24 hours after admission and 72 hours after delivery. The levels of serum NGAL, Cys-C and Cr were detected, and their relationship with the severity of the disease was analyzed. Paired t test and one-way ANOVA were used for statistical analysis and Spearman Rho was used for correlation analysis.
Results: 1. Comparing the results within 24 hours after admission and 72 hours after delivery, the concentration of NGAL in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cys-C in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The concentration of Cr in 24 hours after admission was significantly higher than that in 72 hours after delivery (P 0.05). The difference was significant (P0.05).
2. The results of NGAL detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P 0.05). The results of Cys-C detection in PIH group were significantly higher than those in normal control group within 24 hours after admission (P < 0.05). The results of NGAL detection in PIH group were significantly higher than those in normal control group 72 hours after delivery (P < 0.05). Significance (all P 0.05). There was no significant difference between PIH group and normal control group (all P 0.05).
3. Comparing with each subgroup of PIH group, the expression of NGAL in blood increased with the progress of disease, pregnancy induced hypertension subgroup, mild pre-eclampsia subgroup, severe pre-eclampsia subgroup, eclampsia subgroup and single factor group, and the difference was statistically significant (all p0.05). There was a significant difference in the epileptic subgroup (P0.05), but there was no significant difference between the other subgroups (P0.05).
4, NGAL and Cr correlation analysis showed that NGAL and Cr were positively correlated with 24h, and the correlation coefficient was 0.905.
Correlation analysis between Cys-C and Cr in 24h showed that NGAL and Cr were positively correlated, with a correlation coefficient of 0.663.
5. The ROC curves of NGAL, Cys-C and C r showed that the area under C R curve was 0.706, the area under Cys-C curve was 0.812, and the area under NGAL curve was 0.835, indicating that NGAL had the highest diagnostic value for renal injury in pregnancy-induced hypertension, followed by Cys-C and C r had the lowest diagnostic value.
Conclusion: 1. Both NGAL and C ys-C are expressed in the blood of patients with gestational hypertension, and the expression of NGAL and C ys-C is decreased postpartum.
2. The expression of NGAL was different in patients with different severity of gestational hypertension. The content of NGAL increased with the increase of serum Cr. Further analysis confirmed that the content of NGAL was highly correlated with the severity of the disease. Large sample analysis.
3. There was a positive correlation between serum NGAL and CR levels in the same patient, indicating that NGAL levels were highly correlated with the severity of the disease; Cys-C levels were positively correlated with CR levels; the correlation coefficient between serum NGAL and the severity of the disease was 0.905 (p = 0.000), and that between Cys-C and the severity of the disease was 0.663 (p = 0.000). In Cys-C, blood NGAL is more effective than Cys-C in reflecting the severity of the disease.
4. ROC curves showed that NGAL and C ys-C had higher value in predicting renal injury in pregnancy-induced hypertension than that in blood Cr. NGAL had the highest value in diagnosing renal injury in pregnancy-induced hypertension.
To sum up, blood NGAL and C ys-C can be used as an important index to predict renal injury and its severity in pregnancy-induced hypertension.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.246
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