凌聪 薛亮 李小悦

[摘要] 目的 分析血清胱抑素C与尿β2微球蛋白在妊娠期高血压患者肾功能评价中的应用价值。 方法 回顾性分析117例2012年1月～2014年1月于本院门诊产检并确诊妊娠期高血压患者的资料（血清胱抑素C、尿β2微球蛋白、血清尿素氮、尿微量白蛋白检测和随访）。绘制受试者工作特征曲线分析血清胱抑素C、尿β2微球蛋白、血清尿素氮、尿微量白蛋白对妊娠期高血压患者急性肾损伤的预测价值。117例妊娠期高血压患者中诊断急性肾损伤29例。急性肾损伤总患病率达到24.79%。根据急性肾损伤的定义，将117例妊娠期高血压患者分为急性肾损伤组（n=29）和非急性肾损伤组（n=88）。分析血清胱抑素C、尿β2微球蛋白、血清尿素氮、尿微量白蛋白与妊娠期高血压患者血肌酐的相关性。 结果 急性肾损伤组的血清胱抑素C[（1.24±0.22）mg/L vs.（0.82±0.12）mg/L]和尿β2微球蛋白[（27.7±3.7）mg/L vs.（22.4±2.8）mg/L]均显著高于非急性肾损伤组（P=0.000）。血清胱抑素C、尿β2微球蛋白、血清尿素氮、尿微量白蛋白的受试者工作特征曲线下面积分别为0.897（0.816～0.978）、0.871（0.788～0.954）、0.429（0.310～0.549）、0.614（0.510～0.718）。当血清胱抑素C临界值为1.17 mg/L时，灵敏度和特异度分别为82.8%和96.6%。当尿β2微球蛋白临界值为24.3 mg/L时，灵敏度和特异度分别为82.8%和84.1%。血清胱抑素C、尿β2微球蛋白与血肌酐均呈正相关（r=0.754、r=0.749，P<0.05）。为提高联合试验的灵敏度，采用平行试验。当血清胱抑素C、尿β2微球蛋白分别取临界值为1.17、24.3 mg/L时，联合灵敏度为97.0%，联合特异度为81.2%。 结论 血清胱抑素C与尿β2微球蛋白可用于妊娠期高血压患者急性肾损伤的早期诊断。

[关键词] 血清胱抑素C；尿β2微球蛋白；妊娠期高血压；急性肾损伤；相关性

[中图分类号] R714.24+6 [文献标识码] A [文章编号] 1674-4721（2016）03（c）-0119-04

[Abstract] Objective To analyze application value of serum cystatin C and urinary β2 microglobulin in the evaluation of renal function in patients with hypertensive disorders complicating pregnancy. Methods From January 2012 to January 2014，data （including the detection of serum cystatin C，urinary β2 microglobulin，serum urea nitrogen，and microalbuminuria and follow-up） of 117 patients conducted antenatal examination in our outpatient and definitely diagnosed as hypertensive disorders complicating pregnancy was retrospectively analyzed.Receiver operating characteristic curve （ROC） was drawn to analyze the predication value of serum cystatin C，urinary β2 microglobulin，serum urea nitrogen，and microalbuminuria for acute kidney injury in patients with hypertensive disorders complicating pregnancy.Among these patients，29 cases （24.79%） were diagnosed as acute kidney injury.Based on conception of acute kidney injury，they were divided into acute kidney injury group （n=29） and non-acute kidney injury group （n=88）.Correlation between serum cystatin C，urinary β2 microglobulin，serum urea nitrogen，and microalbuminuria and serum creatinine in patients with hypertensive disorders complicating pregnancy was analyzed. Results In acture renal injury group，serum cystatin C [（1.24±0.22） mg/L vs. （0.82±0.12） mg/L] and urinary β2 microglobulin [（27.7±3.7） mg/L vs. （22.4±2.8） mg/L] was significantly higher than that in non-acute renal injury group （P=0.000）.Area under the curve of ROC in serum cystatin C，urinary β2 microglobulin，serum urea nitrogen，and microalbuminuria was 0.897 （0.816-0.978），0.871 （0.788-0.954），0.429 （0.310-0.549），and 0.614 （0.510-0.718） respectively.When the critical value of serum cystatin C was 1.17 mg/L，the sensitivity and specificity was 82.8% and 96.6% respectively.When the critical value of urinary β2 microglobulin was 24.3 mg/L，the sensitivity and specificity was 82.8% and 84.1% respectively.The Serum cystatin C and urinary β2 microglobulin had positive correlation with serum creatinine （r=0.754，r=0.749，P<0.05）.In order to improve the sensitivity of the joint test，parallel test was adopted.When the critical values of serum cystatin C and urinary β2 microglobulin was 1.17 mg/L and 24.3 mg/L respectively，the joint sensitivity and specificity was 97.0% and of 81.2% in turn. Conclusion Serum cystatin C and urinary β2 microglobulin can be used for early diagnosis of acute kidney injury in patients with hypertensive disorders complicating pregnancy.

[Key words] Serum cystatin C；Urinary β2 microglobulin；Hypertensive disorders complicating pregnancy；Acute kidney injury；Correlation

妊娠期高血压（hypertensive disorders complicating pregnancy，HDP）是妊娠期特有疾病，是导致孕产妇及围生儿死亡的主要原因之一[1]。HDP患者由于全身和肾脏局部血流动力学波动，容易发生肾功能不全[2]。早期监测并识别HDP患者的肾功能，有助于早期干预和改善预后，具有重要的临床意义。……