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目的:探讨血清肌酐(SCr)、内皮素-1(ET-1)、肾损伤分子-1(KIM-1)和β2-微球蛋白(β2-MG)的水平在妊娠期高血压疾病并发早期肾损伤的临床意义。方法:将妊娠期高血压疾病并发肾损伤的孕产妇40例设为肾病组,同期正常孕产妇40例设为对照组,分别在孕龄30周、32周、34周、36周检测孕妇血SCr、ET-1、尿KIM-1和β2-MG的水平。结果:1肾病组与对照组比较,患者的年龄、孕次和流产史均无统计学差异(P>0.05),尿量、尿素氮(BUN)、SCr及尿蛋白定量均存在统计学差异(P<0.001);2肾病组和对照组整体比较,SCr、ET-1、KIM-1和β2-MG的组间、时间点间的交互作用均有统计学差异(P<0.05);3孕36周SCr、孕32周KIM-1及孕34周ET-1和β2-MG水平肾病组与对照组组间存在统计学差异(P<0.05);4对照组组内不同孕周间SCr、ET-1、KIM-1和β2-MG水平无统计学差异(P>0.05);肾病组组内与孕30周时比,KIM-1水平在孕32周显著升高(P<0.05),在孕34周、36周进一步升高(P<0.01);ET-1和β2-MG水平在孕34周显著升高(P<0.05),而SCr在孕36周显著升高(P<0.05)。结论:妊娠期高血压疾病孕妇产前监控中,联合检测SCr、ET-1、KIM-1和β2-MG能及时发现肾损伤的存在;妊娠期高血压疾病并发肾损伤时KIM-1、ET-1和β2-MG的改变早于SCr的改变。
Objective: To investigate the relationship between the levels of serum creatinine (SCr), ET-1, KIM-1 and β2-microglobulin (β2-MG) in patients with hypertensive disorder complicating pregnancy The clinical significance of kidney injury. Methods: Forty pregnant women with hypertensive disorder complicated with renal injury during pregnancy were enrolled as nephropathy group. Forty normal pregnant women at the same period were enrolled as control group. Pregnant women’s blood was tested at gestational age of 30 weeks, 32 weeks, 34 weeks and 36 weeks respectively SCr, ET-1, urinary KIM-1 and β2-MG. Results: There was no significant difference in the age, pregnancy time and abortion history between the nephropathy group and the control group (P> 0.05). The urine volume, urine urea nitrogen (BUN), SCr and urine protein were statistically different P <0.001). There was a significant difference in the interaction of SCr, ET-1, KIM-1 and β2-MG between the two nephropathy groups and the control group (P <0.05) 36 weeks SCr, 32 weeks pregnant KIM-1 and 34 weeks pregnant ET-1 and β2-MG levels of kidney disease group and control group there was a significant difference (P <0.05); 4 control group within different gestational age SCr, The levels of KIM-1 and ET-1, KIM-1 and β2-MG were not significantly different between the two groups (P> 0.05) The levels of ET-1 and β2-MG were significantly increased at 34 weeks of gestation (P <0.05), while the levels of SCr at 36 weeks of gestation were significantly higher at 36 weeks of gestation (P <0.05) ). CONCLUSIONS: The detection of SCr, ET-1, KIM-1 and β2-MG in prenatal monitoring of gestational hypertensive disorders in pregnant women can detect the presence of renal injury in time. The incidence of renal damage in hypertensive disorders complicating pregnancy is significantly higher than that of KIM-1, ET -1 and β2-MG change earlier than SCr changes.