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目的探讨血清热休克蛋白70(HSP70)联合胱抑素C(CysC)水平测定对糖耐量异常孕妇肾功能评估的价值。方法依据2011年《妊娠合并糖尿病临床诊断与治疗推荐指南(草案)》4项标准,收集该院143例空腹血糖异常孕妇,分为4组,GIGT组(38例);GDM-A组(39例);GDM-B组(34例);GDM-C组(32例)。同时选择该院糖耐量正常孕妇40例为对照组(NGT组)。比较各组孕妇空腹血糖(FPG)、餐后2 h血糖(2h PG)、1,3-β-D-葡聚糖(BG)、HbA1c和空腹胰岛素(FIns)5个血糖相关指标,HSP70以及CysC、尿素氮(BUN)、血清肌酐(SCr)3个肾功能相关指标。对HSP70与CysC联合测定的诊断价值进行评估。结果各组糖代谢指标比较,差异有统计学意义(P<0.01),各组肾功能指标及HSP70、Cys C比较,差异有统计学意义(P<0.01),各组HSP70、Cys C单独及联合比较,HSP70联合CysC在肾功能判断方面,灵敏度、特异度及准确度均优于单独测定。孕妇空腹血糖耐量受损越大,血糖相关指标及肾功能相关指标均不断增大。HSP70联合CysC在糖耐量异常孕妇肾功能评估方面,灵敏度、特异度及准确度均优于单独HSP70与CysC测定。结论 HSP70与CysC均能用于评估糖耐量异常孕妇肾功能,两者联合可提高诊断的灵敏度、特异度及准确度。
Objective To investigate the value of serum heat shock protein 70 (HSP70) combined with cystatin C (CysC) in the assessment of renal function in impaired glucose tolerance in pregnant women. Methods According to the four criteria of “Recommended Guideline for Clinical Diagnosis and Treatment of Diabetes Mellitus in Pregnancy” (Draft) in 2011, 143 pregnant women with abnormal fasting blood glucose were collected and divided into 4 groups: GIGT group (38 cases), GDM-A group Cases); GDM-B group (34 cases); GDM-C group (32 cases). Forty patients with normal glucose tolerance in the hospital were selected as the control group (NGT group). The levels of fasting blood glucose (FPG), postprandial blood glucose (2h PG), 1,3-β-D-glucan (BG), HbA1c and fasting insulin (FIns) CysC, blood urea nitrogen (BUN), serum creatinine (SCr) 3 renal function related indicators. The diagnostic value of HSP70 combined with CysC was evaluated. Results There were significant differences in the indexes of glucose metabolism among all groups (P <0.01). There was significant difference in the renal function index and HSP70, Cys C in each group (P <0.01) In combination, the sensitivity, specificity and accuracy of HSP70 combined with CysC in determining renal function were better than that of single assay. Pregnant women impaired fasting glucose tolerance, blood glucose-related indicators and renal function-related indicators are increasing. HSP70 combined with CysC in the assessment of renal function in pregnant women with impaired glucose tolerance, sensitivity, specificity and accuracy are better than HSP70 alone and CysC determination. Conclusion Both HSP70 and CysC can be used to evaluate the renal function of pregnant women with impaired glucose tolerance. The combination of the two can improve the sensitivity, specificity and accuracy of diagnosis.