胱抑素C和中性粒细胞明胶酶相关载脂蛋白对妊娠期高血压患者急性肾功能损伤早诊价值

目的 探讨胱抑素C（Cys-C）与中性粒细胞明胶酶相关载脂蛋白（NGAL）对妊娠期高血压患者急性肾功能损伤早诊价值。方法 以2015—2018年在自贡市某医院确诊或诊治的孕周为20~24周的妊娠期高血压患者为研究对象,在确诊或首次在本医院治疗时、4周后、8周后、产前1周内采集研究对象空腹静脉血5 mL用于Cys-C、血清肌酐（SCr）和NGAL检测。发生急性肾损伤妊娠期高血压患者为病例组,肾功能正常妊娠高血压患者为对照组,比较2组患者在不同时间血Cys-C、SCr和NGAL水平差异,并分别对Cys-C与SCr、NGAL与SCr相关性进行分析。结果 本研究共对488例妊娠期高血压患者进行研究,平均年龄（36.2 ± 3.8）岁,孕前BMI平均（22.45 ± 2.26）,44例（占9.0%）有过不良生育史。至妊娠结束共有39例发生急性肾损伤（病例组）,发病率为8.0%。病例组确诊妊娠期高血压时、妊娠期高血压患病4周时、妊娠期高血压患病8周时、妊娠结束前1周内的血SCr、Cys-C和NGAL水平差异均有统计学意义（均P<0.01）。妊娠期高血压患病4周时至妊娠期结束,病例组和对照组的血Cys-C、NGAL水平差异有统计学意义（P<0.05或P<0.01）,妊娠期高血压患病8周时至妊娠期结束,病例组和对照组的血SCr水平差异均有统计学意义（P<0.05或P<0.01）。病例组确诊妊娠期高血压时、妊娠期高血压患病4周时、妊娠期高血压患病8周时、妊娠结束前1周内的血Cys-C均与SCr水平呈正相关关系（r=0.075、0.145、0.256、0.365）,血NGAL均与SCr水平呈正相关关系（r=0.058、0.152、0.297、0.349）,随着急性肾损伤进程的发展相关系数显著增大。结论 血Cys-C和NGAL水平的检测对妊娠期高血压合并急性肾损伤具有较高的灵敏性,可对该人群的血Cys-C和NGAL水平作为常规检测项目以提高急性肾损伤早诊可能性。

Value of cystatin C and neutrophil gelatinase-associated apolipoprotein in early diagnosis of acute kidney injury in patients with gestational hypertension

Objective To explore the value of cystatin C （Cys-C） and neutrophil gelatinase-associated apolipoprotein （NGAL） in early diagnosis of acute kidney injury （AKI） in patients with gestational hypertension. Methods Patients diagnosed with gestational hypertension in a hospital in Zigong City were recruited from 2015 to 2018 as 20 to 24 gestational weeks. At the time of diagnosis of gestational hypertension or first treatment for it in the hospital, after 4 weeks, 8 weeks, and within one week before delivery 5 ml of fasting venous blood was collected for Cys-C, Serum creatinine （SCr）, and NGAL detection. Patients with AKI and pregnancy-induced hypertension were selected as the case group, and patients with normal renal function and pregnancy-induced hypertension were the control group. The levels of Cys-C, SCr, and NGAL were compared between the two groups at different times, and the correlations between Cys-C and SCr, and NGAL and SCr were analyzed separately. Results A total of 488 patients with gestational hypertension were studied. The average age was （36. 2 ± 3. 8） years. The average BMI before pregnancy was （22. 45 ± 2. 26）. Of the participants, 44 （9. 0%） had abnormal childbearing history. At the end of pregnancy, AKI occurred in 39 patients （case group）, with an incidence rate of 8. 0%. There were statistically significant differences in the levels of SCr, Cys-C and NGAL in the case group at the time when gestational hypertension was diagnosed, 4 weeks of gestational hypertension, 8 weeks of gestational hypertension, and 1 week before giving birth （P<0. 01 for all）. At 4 weeks of pregnancy-induced hypertension and the end of pregnancy, the differences in Cys-C and NGAL levels between the case and control groups were statistically significant （P<0. 05 or P<0. 01）, and at 8 weeks of gestational hypertension and the end of pregnancy, the differences in SCr level between the case and control groups were statistically significant （P<0. 05 or P<0. 01）. In the case group, Cys-C level was positively correlated with SCr level at the time of diagnosis of gestational hypertension, 4 weeks of gestational hypertension, 8 weeks of gestational hypertension, and 1 week before the end of pregnancy （r=0. 075, 0. 145, 0. 256, 0. 365）, NGAL level was positively correlated with SCr level（r=0. 058, 0. 152, 0. 297, 0. 349）, and the correlation coefficient increased significantly with the development of AKI. Conclusion The detection of blood Cys-C and NGAL levels is highly sensitive to pregnancy-induced hypertension combined with AKI. The blood Cys-C and NGAL levels of can be used as routine testing items for the early diagnosis of AKI in this population.