2022 年第 9 期 第 17 卷

血管内皮功能指标对妊娠高血压综合征孕妇发生急性肾损伤的诊断价值

Diagnostic value of vascular endothelial function indicators in acute kidney injury in pregnant women with pregnancy-induced hypertension syndrome

作者：林楠1蔡锦梅2梁秋红1石丽1林晓岚1余艳萍1池向耿3

英文作者：Lin Nan1 Cai Jinmei2 Liang Qiuhong1 Shi Li1 Lin Xiaolan1 Yu Yanping1 Chi Xianggeng3

单位：1南方医科大学附属小榄医院妇产科，中山528415；2南方医科大学附属小榄医院检验科，中山528415；3南方医科大学附属小榄医院肾内科，中山528415

英文单位：1Department of Obstetrics and Gynecology the Affiliated Xiaolan Hospital of Southern Medical University Zhongshan 528415 China; 2Department of Clinical Laboratory the Affiliated Xiaolan Hospital of Southern Medical University Zhongshan 528415 China; 3Department of Nephrology the Affiliated Xiaolan Hospital of Southern Medical University Zhongshan 528415 China

关键词：妊娠高血压综合征；急性肾损伤；血管内皮功能指标

英文关键词：Pregnancy-inducedhypertensionsyndrome;Acutekidneyinjury;Vascularendothelialfunctionindicator

• 摘要：

• 目的 探讨血管内皮功能指标对妊娠高血压综合征（PIH）孕妇发生急性肾损伤（AKI）的诊断价值。方法  选取南方医科大学附属小榄医院于2020年1月至2021年11月收治的148例PIH患者作为研究对象，根据随访结果，按照是否发生AKI分为AKI组和非AKI组。比较2组患者血管内皮功能指标白细胞介素1β（IL-1β）、肿瘤坏死因子α（TNF-α）、血管内皮素1（ET-1）、一氧化氮及可溶性细胞间黏附分子1（sICAM-1）水平。采用Logistic回归方法评价上述指标对PIH患者发生AKI的影响，采用受试者工作特征（ROC）曲线评价血管内皮功能指标对PIH患者发生AKI的诊断价值。结果  148例PIH 患者中有33例（22.3%）患者出现AKI。AKI组患者血清IL-1β、TNF-α、ET-1及sICAM-1水平均明显高于非AKI组［（23.0±3.2）ng/L比（19.4±2.4）ng/L、（21±5）ng/L比（16±4）ng/L、（71±9）ng/L比（52±8）ng/L、（1 421±276）μg/L比（1 056±257）μg/L］，而一氧化氮水平明显低于AKI组［（2.6±0.9）μmol/L比（4.1±0.9）μmol/L］，差异均有统计学意义（均P＜0.001）。Logistic回归分析结果显示，血清IL-1β、TNF-α、ET-1及sICAM-1水平升高是PIH患者发生AKI的独立危险因素，而一氧化氮水平升高是其独立保护因素（均P＜0.05）。ROC曲线分析结果显示，IL-1β、TNF-α、ET-1、一氧化氮及sICAM-1诊断PIH患者发生AKI的AUC分别为0.797、0.709、0.758、0.734和0.669，而五者联合诊断的AUC为0.931，明显高于各单个指标（均P＜0.01）。结论 IL-1β、TNF-α、ET-1、一氧化氮及sICAM-1与PIH患者并发AKI具有密切关系，可以作为该类患者早期肾功能损伤的敏感性生物标志物，联合检测五项指标可明显提高对PIH患者并发AKI的诊断效能。

• Objective  To investigate the diagnostic value of vascular endothelial function indicators in acute kidney injury (AKI) in pregnant women with pregnancy-induced hypertension (PIH) syndrome. Methods  Totally 148 patients with PIH admitted to the Affiliated Xiaolan Hospital of Southern Medical University from January 2020 to November 2021 were selected as research objects. They were divided into AKI group and non AKI group according to whether AKI occurred or not during the follow-up. The vascular endothelial function indicators such as interleukin-1β（IL-1β）, tumor necrosis factor-α（TNF-α）, endothelin-1(ET-1), nitric oxide and soluble intercellular adhesion molecule-1(sICAM-1) were compared between the two groups. Logistic regression method was used to evaluate the effect of the above indicators on AKI in PIH patients, and receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of vascular endothelial function indicators on AKI in PIH patients. Results  There were 33 cases (22.3%) of 148 patients with PIH developed AKI. The levels of serum IL-1β, TNF-α, ET-1 and sICAM-1 in AKI group were significantly higher than those in non AKI group［（23.0±3.2）ng/L vs （19.4±2.4）ng/L, （21±5）ng/L vs （16±4）ng/L, （71±9）ng/L vs （52±8）ng/L, （1 421±276）μg/L vs （1 056±257）μg/L］, while the level of nitric oxide in AKI group was significantly lower than that in non AKI group［（2.6±0.9）μmol/L vs （4.1±0.9）μmol/L］(all P＜0.001). Logistic regression analysis showed that serum IL-1β, TNF-α, ET-1 and sICAM-1 were independent risk factors for AKI in PIH patients, while nitric oxide was an independent protective factor(all P＜0.05). ROC curve analysis showed that the area under the curve(AUC) of AKI in PIH patients diagnosed by IL-1β， TNF-α， ET-1, nitric oxide and sICAM-1 were 0.797, 0.709, 0.758, 0.734 and 0.669 respectively, and the AUC of those combination was 0.931, which were significantly higher than those of a single index (all P＜0.01). Conclusions  IL-1β, TNF-α, ET-1, nitric oxide and sICAM-1 are closely related to AKI in PIH patients, and can be used as sensitive biomarkers of early renal function injury in the patients. The combination of five indicators can significantly improve the diagnostic efficiency of AKI in PIH patients.