尿ACR 联合尿β2-MG 检测在妊娠合并糖尿病 早期肾损害诊断中的临床应用
| 作者: |
1梁霞,
1田甜,
1赵爱巧,
1姚漫漫,
1刘翠平,
1韩翠欣,
2刘欢
1 石家庄市第二医院产科，石家庄 050051 2 无极县医院妇产科，石家庄 050000 |
| 通讯: |
田甜
Email: 76186426@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.09.012 |
| 基金: | 石家庄市科学技术研究与发展计划项目 (161462543)。 |
摘要
目的：探讨联合检测尿微量白蛋白与尿肌酐比值(albumin-creatinine ratio，ACR)、尿β2-微球蛋白(β2-microglobulin，β2-MG)对妊娠合并糖尿病患者早期肾损害的诊断价值。方法：选取2016年3月至2017年10月在石家庄市第二医院定期孕检的孕妇为研究对象，其中孕前糖尿病(pre-gestational diabetes mellitus，PGDM)患者30例为PGDM组，妊娠期糖尿病(gestational diabetes mellitus，GDM)患者72例为GDM组，GDM组进一步分为A组(HbA1c<5.5%)43例，B组(HbA1c>5.5%)29例，正常妊娠孕妇72例为正常孕妇组。检测所有孕妇尿ACR、尿β2-微球蛋白(β2-MG)、血尿素氮(blood urea nitrogen，BUN)、血肌酐(creatinine，Cr)、血清糖化血红蛋白(glycosylated hemoglobin，HbA1c)的水平并分析。结果：PGDM组、GDM组尿ACR、尿β2-MG、血Cr、血HbA1c水平均显著高于正常孕妇组，差异均有统计学意义(P<0.05)；血BUN水平差异无统计学意义(P>0.05)。PGDM组、 GDM组尿ACR、尿β2-MG阳性率均显著高于正常孕妇组，差异有统计学意义(P<0.05)；血BUN、血Cr阳性率差异无统计学意义(P>0.05)。GDM组内B组尿ACR、尿β2-MG及尿ACR与尿β2-MG联合阳性率均高于A组，差异有统计学意义(P<0.05)。受试者工作特征(receiver-operating characteristic， ROC)曲线分析显示：尿ACR、尿β2-MG的预测GDM早期肾损害的曲线下面积(area under cur ve， AUC)分别为0.933，0.838；95%CI分别为0.839~0.999，0.715~0.961，差异有统计学意义(P<0.01)。结论：尿ACR与尿β2-MG联合检测可早期发现妊娠合并糖尿病患者肾损害，二者可作为诊断GDM患者早期肾损害的敏感指标。
关键词：
妊娠合并糖尿病；孕前糖尿病；妊娠期糖尿病；尿微量白蛋白与尿肌酐比值；尿β2-微球蛋白；肾损害
Clinical application of combined detection of urine albumincreatinine ratio and urine β2-microglobulin for the diagnosis of the early renal injury of pregnancy with diabetes
CorrespondingAuthor: TIAN Tian Email: 76186426@qq.com
DOI: 10.3978/j.issn.2095-6959.2018.09.012
Foundation: This work was supported by the Science and Technology Research and Development Program Project of Shijiazhuang, China (161462543).
Abstract
Objective: To study the diagnostic value of the combined detection of urine albumin-creatinine ratio (ACR) and urine β2-microglobulin (β2-MG) for the pregnancy with diabetes with early renal injury. Methods: Women who were checked regularly in Shijiazhuang Second Hospital were selected as research subjects from March 2016 to October 2017. Thirty cases were selected as a PGDM group, who were diagnosed as diabetes mellitus before pregnancy (PGDM), 72 cases were selected as a GDM group, who were diagnosed as gestational diabetes mellitus (GDM), and the GDM group was divided further into A group included 43 cases (HbA1c <5.5%) and B group included 29 cases (HbA1c >5.5%), 72 cases of normal pregnant women were selected as a normal pregnant group. For all the pregnant women, the levels of the urine ACR, urine β2-MG, blood urea nitrogen (BUN), serum creatinine (Cr), serum glycosylated hemoglobin (HbA1c) were measured and analyzed. Results: The levels of urine ACR, urine β2-MG, serum Cr and HbA1c of the PGDM group or GDM group were all significantly higher than those in the normal pregnant group, and the differences were all statistically significant (P<0.05), the differences of the levels of BUN were not statistically significant between these three groups (P>0.05). The positive rate of urine ACR, urine β2-MG of the PGDM group or GDM group were all significantly higher than those in the normal pregnant group, and the differences were all statistically significant (P<0.05), the differences of the positive rate of BUN and serum Cr of the PGDM group or GDM group were not statistically significant between these three groups (P>0.05). In the GDM group, the positive rate of urine ACR, β2-MG, combined ACR and β2-MG of the B group were all significantly higher than those in A group, and the differences were statistically significant (P<0.05). The receiver-operating characteristic (ROC) curve analysis showed that the area under curve (AUC) about prediction early renal injury of GDM of urine ACR and β2-MG were 0.933 and 0.838 respectively, and 95%CI were 0.821–0.977, 0.624–0.872 and 0.640–0.881 respectively, the differences were statistically significant (P<0.01). Conclusion: The combined detection of urine ACR and urine β2-MG could early discover the renal injury of pregnancy with diabetes. And then they could serve as the sensitive indicators for diagnosing of the early renal injury of GDM patients.
Keywords：
gestational diabetes mellitus; pre-gestational diabetes mellitus; gestational diabetes mellitus; urine albumin-creatinine ratio; urine β2-microglobulin; renal injury