子痫前期与妊娠合并慢性肾脏病孕妇血清及尿液β2-微球蛋白水平的比较
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摘要
目的:比较子痫前期(PE)与妊娠合并慢性肾脏病孕妇血清和尿液β2-微球蛋白(β2-MG)的差异以及初步研究正常孕妇参考值。方法:收集2017年2月至2018年1月住院的孕妇共149例,其中PE孕妇(PE组) 42例(28. 2%),妊娠合并慢性肾脏病孕妇(肾脏病组) 53例(35. 6%),正常孕妇(对照组) 54例(36. 2%),分别检测其血清及尿液中β2-MG水平。结果:(1)肾脏病组孕妇尿液β2-MG水平明显高于PE组及对照组孕妇(P<0. 01),而PE组和对照组孕妇尿液β2-MG水平差异无统计学意义(P=0. 980)(分别为5. 97±11. 26 mg/L、0. 33±0. 12 mg/L、0. 36±0. 13 mg/L)。(2)肾脏病组孕妇血清β2-MG水平明显高于PE组及对照组孕妇(P<0. 01),而PE组和对照组孕妇血清β2-MG水平差异无统计学意义(P=0. 068)(分别为3. 98±3. 40 mg/L、2. 76±0. 60 mg/L、1. 98±0. 79 mg/L)。(3)将血清及尿液β2-MG值纳入ROC曲线,并计算AUC值后初步发现尿液β2-MG相应的AUC为0. 652(P=0. 002),正常孕妇尿液β2-MG水平参考值为0～0. 51 mg/L;血清β2-MG相应的AUC为0. 843(P<0. 01),正常孕妇血清β2-MG水平参考值为0～2. 35 mg/L。(4)PE组尿液β2-MG阴性及血清β2-MG阳性患者共31例,占73. 8%(31/42),无单纯尿液β2-MG阳性患者。结论:PE与妊娠合并慢性肾脏病孕妇的血清及尿液β2-MG水平存在明显差异,建议重新定义正常孕妇的血清及尿液β2-MG参考值。
Objective: To study the difference of serum and urinary β2-microglobulin in pre-eclampsia( PE)and pregnancies complicated with chronic kidney disease. Methods: 42( 28. 2%) pregnancies with PE( PE group),53( 35. 6%) pregnancies with chronic kidney disease( chronic kidney disease group) and 54( 36. 2%)normal pregnancies( control group) delivered in our hospital were resuicted in this study from February 2017 to January 2018.Serum and urinary β2-microglobulin were detected to know their expression characteristics in pregnancies with PE and with chronic kidney disease.Results:(1)Urinary β2-globulin in chronic kidney disease group was significantly higher than those in PE and control groups( 5. 97±11. 26 mg/L vs 0. 33±0. 12 mg/L vs 0. 36±0. 13 mg/L,P<0. 01).(2)Serum β2-globulin in chronic kidney disease group was significantly higher than those in PE and control groups( 3. 98±3. 40 mg/L vs 2. 76±0. 60 mg/L vs 1. 98±0. 79 mg/L,P<0. 01).(3)All serum and urinary β2-globulin values were taken into ROC and the corresponding AUC was calculated.The AUC of urinaryβ2-globulin was 0. 652,with a reference value of 0-0. 51mg/L in normal pregnancies.The AUC of serum β2-globulin was 0. 843,with a reference value of 0-2. 35mg/L in normal pregnancies.(4) 73. 8% PE showed increased serum β2-globulin with normal urinary β2-globulin and simply increased urinary β2-globulin was not detected.Conclusions: The serum and urinary levels of β2-microglobulin in pregnancies with PE and with chronic kidney disease are significantly different. Meanwhile it was recommended that the reference values of serum and urinaryβ2-globulin in pregnancy should be re-defined.
Objective: To study the difference of serum and urinary β2-microglobulin in pre-eclampsia( PE)and pregnancies complicated with chronic kidney disease. Methods: 42( 28. 2%) pregnancies with PE( PE group),53( 35. 6%) pregnancies with chronic kidney disease( chronic kidney disease group) and 54( 36. 2%)normal pregnancies( control group) delivered in our hospital were resuicted in this study from February 2017 to January 2018.Serum and urinary β2-microglobulin were detected to know their expression characteristics in pregnancies with PE and with chronic kidney disease.Results:(1)Urinary β2-globulin in chronic kidney disease group was significantly higher than those in PE and control groups( 5. 97±11. 26 mg/L vs 0. 33±0. 12 mg/L vs 0. 36±0. 13 mg/L,P<0. 01).(2)Serum β2-globulin in chronic kidney disease group was significantly higher than those in PE and control groups( 3. 98±3. 40 mg/L vs 2. 76±0. 60 mg/L vs 1. 98±0. 79 mg/L,P<0. 01).(3)All serum and urinary β2-globulin values were taken into ROC and the corresponding AUC was calculated.The AUC of urinaryβ2-globulin was 0. 652,with a reference value of 0-0. 51mg/L in normal pregnancies.The AUC of serum β2-globulin was 0. 843,with a reference value of 0-2. 35mg/L in normal pregnancies.(4) 73. 8% PE showed increased serum β2-globulin with normal urinary β2-globulin and simply increased urinary β2-globulin was not detected.Conclusions: The serum and urinary levels of β2-microglobulin in pregnancies with PE and with chronic kidney disease are significantly different. Meanwhile it was recommended that the reference values of serum and urinaryβ2-globulin in pregnancy should be re-defined.
引文
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[9]Saudan PJ,Farrell TJ,Brown MA.Beta2-microglobulin in hypertensive pregnancies[J].Am J Kidney Dis,1998,31(2):308-312.
[10]王鸿利主编.实验诊断学(第2版)[M].北京:人民卫生出版社,2010:289-290.
[11]李玥桦.HLA-G基因在妊娠期高血压疾病中的研究进展[J].现代妇产科进展,2014,23(2):144-145,149.
[2]张剑,魏殿军.Cys-C、β2-MG联合检测在早期糖尿病肾病中的诊断价值[J].中国实验诊断学,2017,21(12):2050-2052.
[3]纪桂贤,高福来,付丽坤,等.血清Cys C、β2-MG联合尿α1-MG、β2-MG在亚临床肝肾综合征诊断中的意义[J].胃肠病学和肝病学杂志,2017,26(7):802-804.
[4]朱海兵.尿微量白蛋白、胱抑素C、β2微球蛋白和尿微量白蛋白/肌酐比值检测在2型糖尿病早期肾损害诊断的临床意义[J].实验与检验医学,2016,34(1):84-86.
[5]Choe JY,Park SH,Kim SK.Urineβ2-microglobulin is associated with clinical disease activity and renal involvement in female patients with systemic lupus erythematosus[J].Lupus,2014,23(14):1486-1493.
[6]庄旭,林建华.尿蛋白在子痫前期诊断中的价值[J].实用妇产科杂志,2016,32(7):500-502.
[7]Risch M,Purde MT,Baumann M,et al.High first-trimester maternal blood cystatin C levels despite normal serum creatinine predict pre-eclampsia in singleton pregnancies[J].Scand J Clin Lab Invest,2017,77(8):634-643.
[8]庄旭,陆漪婷,陈云燕,等.子痫前期与妊娠合并慢性肾脏病孕妇血清免疫球蛋白、β2微球蛋白和转铁蛋白水平的比较[J].中华妇产科杂志,2018,53(2):77-81.
[9]Saudan PJ,Farrell TJ,Brown MA.Beta2-microglobulin in hypertensive pregnancies[J].Am J Kidney Dis,1998,31(2):308-312.
[10]王鸿利主编.实验诊断学(第2版)[M].北京:人民卫生出版社,2010:289-290.
[11]李玥桦.HLA-G基因在妊娠期高血压疾病中的研究进展[J].现代妇产科进展,2014,23(2):144-145,149.