Diagnostic Significance Of Urinary RBP、mALB、NAG And SCystatin C Combined Detection For Hypertensive Disorders Complicating Pregnancy With Early Renal Injury

Objective:Patients with hypertensive disorders in pregnancy are varying degrees of renal impairment,this study urinary RBP 、m ALB 、NAG and s Cystatin C of hypertensive disorders in pregnancy kidney damage early — specific expression, through joint determination of pregnancy—induced hypertension(PIH)in patients with urinary RBP 、m ALB、NAG and s Cystatin C,evaluation of urinary RBP、m ALB、NAG and s Cystatin C in the forecast the diagnostic value and Clinical application of gestational hypertension kidney damage.Methods:46 patients of PIH were enrolled to the study group,during June 2015 to December2015,of whom 31 cases are severe preeclampsia patients,15 cases are chronic hypertension complicated by preeclampsia patients.During the same period of time,the control group was composed of 20 normal Pregnant women.According to diagnostic standard of the second edition of the obstetrics and gynecology.All women in two groups had no history of chronic hypertension,diabetes mellitus,renal disease and hepatic disease.All samples were collected without using any drugs affect kidney function.The blood and urine samples from hospitalized pregnant women were collected within24 hours and 42 days postpartum. The serum Cystatin C、UA、 Cr and urinary RBP、m ALB 、NAG were measured respectively. The ROC(receiver operating characteristic)curve was used to determine the cutoff values of biomarkers that gave the best sensitivity and specificity.Establish a database using the SPSS 21.0 statistical package.Between the two groupsusing T test,analysis of variance Was used to compare the groups,Correlation analysis of parameters using Person correlation analysis. According to the data obtained from experiments, mapping with Graph Pad Prism Version 5.0, α =0.05 as the inspection level,P<0.05 show it is statically significant.Results:(1) There was no significant difference in height、weight between normal pregnancy group and gestational hypertension group(P > 0.05), while women with gestational hypertension had higher s Cr and UA, antepartum postnatal 2h SBP and DBP(P < 0.01,a statistically significant difference), but women in gestational hypertension group deliver earlier,have lower birth weight infants(P < 0.01,a statistically significant difference).(2) There was no significant difference in antepartum blood pressure、premature、birth weight infant between severe preeclampsia and Chronic hypertension complicated by preeclampsia group(P > 0.05),while women with severe preeclampsia had higher postpartum 2 h blood pressure(P < 0.05,a statistically significant difference).(3) SCys C, u RBP, u MALB, u NAG were sensitive biomarker to predict hypertensive disorders complicating pregnancy with early renal injury.When two or three biomarkers were combined,sensitivity and specificity were increased.(4) Compared with normal pregnancy group, the s Cys C, u RBP, u MALB, u NAG concentration in Chronic hypertension complicated by preeclampsia group and severe preeclampsia group,is significantly higher.(P < 0.01, a statistically significant difference).(5) For s Cys C、u RBP、u MALB and u NAG four indicators do ROC curves showed that the area under the curve of s Cys C 0.743,the area under the curve of u RBP 0.909,the area under the curve of u MALB 0.982,u NAG area under the curve 0.720,indicating that u NAG hypertensive disorders of pregnancy diagnosis of kidney damage highest value,followed by u RBP、s Cys C,u NAG diagnostic value minimum.(6) 42 days postpartum, the s Cys C, u RBP, u MALB, u NAG concentration in hypertensive disorders complicating pregnancy group is significantly lower than prenatal level.(P < 0.01, a statistically significant difference).Conclusion:1. The specimen in patients with hypertensive disorders in pregnancy expression in s Cys C, u RBP, u MALB,and u NAG,and postnatal expression decreased.Compared with normal control group of hypertensive disorders in pregnancy were significantly elevated s Cys C, u RBP, u MALB,and u NAG levels were.Description s Cys C, u RBP, u MALB,and u NAG levels are highly correlated with gestational hypertensive disorders of kidney damage.2. ROC curve results showed that u MALB and u RBP in predicting hypertensive disorders of kidney damage in pregnancy is higher than the value of the s Cys C and u NAG,the best cutoff value based on its sensitivity and specificity results have certain guiding significance for clinical work.3. Chronic hypertension complicated by pre-eclampsia compared with severe preeclampsia, s Cys C, u RBP, u MALB, u NAG was no significant difference, indicating that the extent of early renal injury may not significantly different, but this conclusion needs to be further renal biopsy to verify.4. SCys C, u RBP, u MALB, u NAG were sensitive biomarker to predict hypertensive disorders complicating pregnancy with early renal injury.When two or three biomarkers were combined, sensitivity and specificity were increased.This result is consistent with some of the country reports.which indicated that the combined detection of early renal damage has more diagnostic value and clinical applications, helping determine kidney injury site and using of drugs in clinical.Therefore,patients with hypertensive disorders in pregnancy can strive to get Better regulation and improve maternal and neonatal outcomes.