| Background Hypertensive disorders of pregnancy(HDP)are the main reason of maternal and child mortality in developing countries.Hypertensive disorders of pregnancy can cause a decrease in perfusion of blood in various organs,especially kidney damage.Therefore,early detection of hypertensive disorders of pregnancy and diagnosis of early kidney injury are urgent problems to be solved.In clinical currently used indicators for assessing renal function include serum creatinine,urea,and 24-hour urine protein,but are not the best indicators for detecting early kidney damage.Many studies found that serum cystatin(Cys C),urine β2-microglobulin(β2-MG)and kidney injury molecule-1(KIM-1)have important significance in the detection of early renal injury,but there is no clear determination in the hypertensive disorders of pregnancy.Clarifying the diagnostic value of these three indicators in early renal injury of hypertensive disorders of pregnancy will provide a scientific basis for the diagnosis and treatment of renal injury in pregnancy and reduce the adverse outcomes of mother and child,and lay the foundation for further research.Objective To evaluate the application of serum cystatin,urine β2-microglobulin and kidney injury molecule-1 for early renal injury in hypertensive disorder of pregnancy.Materials and Methods 195 pregnant women from 20 weeks to 40 weeks of gestation diagnosed with HDP in obstetric impatient department of the third Affiliated Hospital of Zhengzhou University from August 2017 to August 2018 were involved.Pregnant women with systolic blood pressure ≥140mm Hg and/or diastolic blood pressure ≥90mm Hg were in gestational hypertension group(n=47);Pregnant women with systolic blood pressure ≥140mm Hg and/or diastolic blood pressure ≥90mm Hg accompanied by urinary protein ≥0.3g/24 h or random urine protein(+),but systolic blood pressure <160mm Hg and diastolic blood pressure <110mm Hg were in the preeclampsia group(n=50);Pregnant women with systolic blood pressure ≥160 mm Hg and/or diastolic blood pressure ≥110 mm Hg were in the severe preeclampsia group(n=48);50 cases of normal pregnant women in the same period were used as control group.From all selected women,3 m L of elbow venous blood and 5 ml of clean middle urine were collected in the morning with 8h empty stomach,then 24 h urine after emptying the bladder were collected.Compare serum Cys C,urine β2-MG,urine KIM-1 and 24 h 24h urine protein in four groups,and analyze the correlation;Compare the sensitivity and specificity of serum Cys C,urine β2-MG and urine KIM-1 single and combined detection in early renal injury of hypertensive disorder complicating pregnancy;Analyze the relations between serum Cys C,urine β2-MG and urine KIM-1 and the severity of hypertensive disorder of pregnancy.Results 1.The average levels of serum Cys C,urine β2-MG and urine KIM-1 were gradually increased in the control group,gestational hypertension group,preeclampsia group and severe preeclampsia group,and the differences were statistically significant(P<0.05).2.Serum Cys C,urine β2-MG,urine KIM-1 and 24 h urine protein levels were all significant correlated.3.When serum Cys C,urinary β2-MG and urinary KIM-1 combined detect for early renal injury in hypertensive disorder of pregnancy,the area under the ROC curve(AUC)is the largest 0.952,and the sensitivity and specificity are 91.3% and 94.4%.Conclusion 1.The levels of serum Cys C,urine β2-MG and urine KIM-1 can reflect the progression of hypertensive disorder of pregnancy and the extent of renal damage.2.The combined detection of serum Cys C,urine β2-MG and urine KIM-1 greatly improved the sensitivity and specificity of diagnosis,and have higher value to discover early renal injury and the development of hypertensive disorder of pregnancy. |
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