Sema 3A、KIM-1和Cys C在子痫前期患者肾功能损害早期诊断中的临床价值

［摘要］ 〖HTH〗目的〖HTSS〗〖KG*2〗探讨信号素3A（semakin 3A，Sema 3A）、肾损伤因子1（renal injury molecule 1，KIM-1）和血清胱抑素（cystatin C，Cys C）在子痫前期（pre-eclampsia，PE）患者肾功能损害早期诊断中的临床价值。 〖HTH〗方法〖HTSS〗〖KG*2〗选择PE患者116例，根据病情严重程度分为轻度PE组（67例）和重度PE组（49例），另选择同期行产检并分娩的孕妇60例作为对照组。观察3组24 h尿蛋白、血肌酐(serum creatinine,SCr)、尿素氮(blood urea nitrogen，BUN)、尿酸(uric acid，UA)、肾小球滤过率、Sema 3A、KIM-1和Cys C水平变化，PE患者Sema 3A、KIM-1和Cys C的相关性及其与肾功能损害的关系，探讨联合Sema 3A、KIM-1和Cys C检测对肾功能损害的早期诊断价值。 〖HTH〗结果〖HTSS〗〖KG*2〗轻度PE组和重度PE组24 h尿蛋白、SCr、BUN、UA明显高于对照组，肾小球滤过率明显低于对照组；重度PE组24 h尿蛋白和UA明显高于轻度PE组，肾小球滤过率明显低于轻度PE组（P＜0.05）。轻度PE组和重度PE组尿液Sema 3A、KIM-1和血清Cys C水平明显高于对照组，重度PE组尿液Sema 3A、KIM-1和血清Cys C水平明显高于轻度PE组（P＜0.05）。PE患者尿液Sema 3A水平与尿液KIM-1和血清Cys C水平呈正相关，尿液KIM-1与血清Cys C水平呈正相关（P＜0.05）。肾功能异常组尿液Sema 3A、KIM-1和血清Cys C水平明显高于肾功能正常组（P＜0.05）。以Sema 3A、KIM-1、Cys C水平和联合检测（Sema 3A+KIM-1+Cys C）作为检验变量，以肾功能损害为状态变量绘制受试者工作特征曲线。联合检测诊断早期肾功能损害的最佳截断值为>0.258，其灵敏度为72.5%，特异度为93.8%，曲线下面积为0.890，联合检测的曲线下面积明显大于Sema 3A、KIM-1和Cys C（P＜0.05），Sema 3A、KIM-1和Cys C的曲线下面积差异无统计学意义（P＞0.05）。 〖HTH〗结论〖HTSS〗〖KG*2〗Sema 3A、KIM-1和Cys C参与了PE合并肾功能损害的发生发展过程，PE患者联合检测Sema 3A、KIM-1和Cys C能够提示早期肾功能损害，具有重要的临床价值。

Clinical value of Sema 3A,KIM-1 and Cys C in the early diagnosis of renal impairmentin pre-eclampsia

［Abstract］Objective〖HTSS〗To observe the clinical value of urinary semakin 3A(Sema 3A), renal injury molecule 1(KIM-1) and serum cystatin C(Cys C) in the early diagnosis of renal function impairment in patients with pre-eclampsia(PE). 〖HTH〗〖WTHZ〗Methods〖HTSS〗One hundred and sixteen patients with PE were divided into mild PE group(49 cases) and severe PE group(67 cases). Sixty pregnant women undergoing physical examination in our hospital at the same period were selected as the control group. The changes of Sema 3A, KIM-1, and Cys C levels were observed in three groups, the correlation among Sema 3A, KIM-1, and Cys C levels were observed in patients with preeclampsia and those levels which related with renal impairment were also observed, as well as the early diagnostic value of combined Sema 3A, KIM-1 and Cys C detection for renal dysfunction was explored. 〖HTH〗〖WTHZ〗Results〖HTSS〗The levels of 24 h urine protein, serum creatinine, blood urea nitrogen, uric acid in mild PE group and severe PE group were significantly higher than those in control group, and the glomerular filtration rate was significantly lower than that in control group; the 24-hour urine protein and uric acid levels in severe PE group were significantly higher than those in mild PE group, and the glomerular filtration rate was significantly lower than that in mild PE group(P＜0.05). The levels of urine Sema 3A, KIM-1 and serum Cys C in mild PE group and severe PE group were significantly higher than those in control group, the levels of those in severe PE group were significantly higher than those in mild PE group(P＜0.05). The level of urine Sema 3A in PE patients was positively correlated with urine KIM-1 and serum Cys C, and urine KIM-1 was positively correlated with serum Cys C(P＜0.05). Urine Sema 3A, KIM-1 and serum Cys C levels in renal dysfunction group were significantly 〖JP2〗higher than thosein normal renal function group(P＜0.05). The Sema 3A, KIM-1, Cys C levels and combined detection(Sema 3A+〖JP〗KIM-1+Cys C) were used as test variables, and the receiver operating characteristic curve was plotted with renal impairment as a state variable. The best cut-off value of combined detection for diagnosis of early renal dysfunction was >0.258, sensitivity was 72.5%, specificity was 93.8%, and area under curve of 0.890 which was significantly better than Sema 3A, KIM-1 and Cys C(P＜0.05), there was no significant difference in the area under the curve between Sema 3A, KIM-1 and Cys C(P＞0.05). 〖HTH〗〖WTHZ〗Conclusion〖HTSS〗Sema 3A, KIM-1 and Cys C are involved in the development of pregnancy with eclampsia and renal impairment. It has important clinical value that combination detection of ema 3A, KIM-1 and Cys C markers in eclampsia can predict early renal impairment.