血清RBP4、mALB、PODXL对子痫前期患者肾功能损伤的评价研究-东南大学学报医学版

血清RBP4、mALB、PODXL对子痫前期患者肾功能损伤的评价研究

单位：1. 河南中医药大学第五临床医学院产科, 河南郑州 450000;
2. 华中科技大学同济医学院附属同济医院产科, 湖北武汉 430030

分类号：R714.252

出版年·卷·期（页码）：2023·42·第四期（560-566）

摘要：

目的:探讨视黄醇结合蛋白4(RBP4)、尿微量白蛋白(mALB)、足糖萼蛋白(PODXL)对子痫前期患者肾功能损伤的评价价值。方法:选取郑州人民医院2021年2月至2022年3月收治的105例子痫前期患者作为疾病组,根据病情分为轻度子痫前期组(50例)和重度子痫前期组(55例),同时选取同期于本院孕检的110例健康孕妇作为对照组。两组均检测血清RBP4、mALB、PODXL水平。根据随访期间疾病组肾损伤发生情况将其分为肾功能损伤组(45例)和肾功能正常组(60例),比较两组初诊RBP4、mALB、PODXL水平。分析子痫前期患者初诊RBP4、mALB、PODXL水平与肾功能指标的相关性,并绘制受试者工作特征(ROC)曲线分析初诊RBP4、mALB、PODXL水平联合对子痫前期患者肾功能损伤的预测价值。结果:疾病组与对照组年龄、体质量指数、孕周和产妇类型比较差异均无统计学意义(P＞0.05),疾病组收缩压、舒张压、尿素氮、尿酸、肌酐、RBP4、mALB水平均高于对照组(P＜0.05),PODXL水平低于对照组(P＜0.05);重度子痫前期组初诊RBP4、mALB水平均高于轻度子痫前期组(P＜0.05),PODXL水平低于轻度子痫前期组(P＜0.05);肾功能损伤组初诊RBP4、mALB水平均高于肾功能正常组(P＜0.05),PODXL水平低于肾功能正常组(P＜0.05);子痫前期患者初诊RBP4、mALB水平与尿素氮、尿酸、肌酐均呈正相关(P＜0.05),PODXL与尿素氮、尿酸、肌酐均呈负相关(P＜0.05);ROC曲线分析结果显示,初诊RBP4、mALB、PODXL水平联合预测子痫前期患者肾功能损伤的灵敏度和曲线下面积分别为95.56%、0.914,均高于单独预测(P＜0.05),但其特异度与单独预测比较差异无统计学意义(P＞0.05)。结论:子痫前期患者初诊RBP4、mALB水平均升高,PODXL水平降低,且与肾功能指标相关,并对肾功能损伤具有一定的预测价值,但三者联合预测价值更高。

Objective: To investigate the value of retinol binding protein 4(RBP4), urinary microalbumin(mALB), and podcalyx protein(PODXL) in evaluating renal function impairment in patients with preeclampsia. Methods: A total of 105 patients with preeclampsia admitted to our hospital from February 2021 to March 2022 were selected into disease group, who were divided into the mild preeclampsia group(50 cases) and the severe preeclampsia group(55 cases) according to their conditions. A total of 110 healthy pregnant women who underwent pregnancy examination in our hospital at the same time were selected into control group. The levels of RBP4, mALB, PODXL were detected in both groups. The patients were divided into the renal function injury group(45 cases) and the normal renal function group(60 cases) according to the occurrence of renal injury during the follow-up, and the newly diagnosed levels of RBP4, mALB, PODXL in the two groups were compared. The correlation between the newly diagnosed levels of RBP4, mALB, PODXL and renal function indicators in patients with preeclampsia was analyzed, and the receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of newly diagnosed RBP4, mALB, PODXL levels on renal function impairment in patients with preeclampsia. Results: There was no significant difference in age, body mass index, gestational age and type of parturient between the two groups(P>0.05), and the levels of systolic blood pressure, diastolic blood pressure, urea nitrogen, uric acid, creatinine, RBP4 and mALB in the disease group were higher than those in the control group(P<0.05), while the level of PODXL was lower than that of the control group(P<0.05). The newly diagnosed levels of RBP4 and mALB in the severe preeclampsia group were higher than those in the mild preeclampsia group(P<0.05), while the newly diagnosed level of PODXL was lower than that in the mild preeclampsia group(P<0.05). The newly diagnosed levels of RBP4 and mALB in the renal function injury group were higher than those in the normal renal function group(P<0.05), while the newly diagnosed level of PODXL was lower than that in the normal renal function group(P<0.05). The newly diagnosed levels of RBP4 and mALB in patients with preeclampsia were positively correlated with urea nitrogen, uric acid and creatinine(P<0.05), while the newly diagnosed level of PODXL was negatively correlated with urea nitrogen, uric acid and creatinine(P<0.05). The results of ROC curve analysis showed that the sensitivity and area under curve of newly diagnosed RBP4, mALB and PODXL to predict renal function damage in patients with preeclampsia were 95.56% and 0.914 respectively, which were higher than those predicted alone(P<0.05), but there was no statistical significance in its specificity compared with the prediction alone(P>0.05). Conclusion: The newly diagnosed levels of RBP4 and mALB in patients with preeclampsia are increased, while the newly diagnosed level of PODXL is decreased, which are related to renal function indicators. All of them have a certain predictive value for renal function damage in patients with preeclampsia, but their combined predictive value is higher.

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