血管紧张素转换酶在妊娠高血压综合征早期诊断中的价值

doi:10.3969/j.issn.1673-8640.2018.06.007

摘要/Abstract

摘要：

目的探讨血管紧张素转换酶（ACE）在妊娠高血压综合征（简称妊高征）早期诊断中的价值。方法检测55例妊高征孕妇及45名正常孕妇（对照组）孕中期和孕后期的肾功能指标[肌酐（Cr）、尿素氮（BUN）、尿酸（UA）、胱抑素C（Cys C）、视黄醇结合蛋白（RBP）、β₂-微球蛋白（β₂-MG）]、血糖（Glu）及ACE水平。采用受试者工作特征（ROC）曲线评估各项指标诊断妊高征的价值。结果妊高征组孕中期Cr、BUN、UA、Cys C、RBP均明显高于同期对照组（P<0.05）,孕晚期Cr、UA、Glu、β₂-MG、RBP、ACE水平明显高于同期对照组（P<0.05）。妊高征组孕晚期BUN、β₂-MG、RBP、ACE水平明显高于孕中期（P<0.05）,其他指标2个组之间差异均无统计学意义（P>0.05）。ROC曲线分析显示,肾功能各项指标诊断妊高征的曲线下面积（AUC）孕中期最大的是Cr,但其AUC也仅为0.716;孕晚期AUC最大的是ACE（0.924）,其次为β₂-MG（0.897）。从孕中期到孕晚期,AUC升高最明显的是ACE。以临床诊断为标准,β₂-MG诊断妊高征的敏感性从孕中期的63.6%升高至孕晚期的67.3%,特异性从55.6%升高至88.9%;ACE的敏感性从70.9%升高至83.6%,特异性从95.6%升高至97.8%。β₂-MG与ACE无相关性（r=0.278,P>0.05）。结论 ACE是早期诊断妊高征的敏感指标,具有一定的临床价值。

关键词: 血管紧张素转换酶, 肾功能, 诊断, 妊娠高血压综合征

Abstract:

Objective To evaluate the role of serum angiotensin-converting enzyme（ACE） in the early diagnosis of pregnancy-induced hypertension. Methods A total of 55 pregnant women with pregnancy-induced hypertension and 45 healthy pregnant women（control group） were enrolled. Renal function indices [creatinine（Cr）,blood urea nitrogen（BUN）,uric acid（UA）,cystatin C（Cys C）,retinol-binding protein（RBP） and beta₂-microglobulin（β₂-MG） levels],glucose（Glu）and ACE level were determined at the middle- and later-periods of pregnancy. Receiver operating characteristic（ROC） curve was used to evaluate the roles of renal function indices and ACE level for the diagnosis of pregnancy-induced hypertension. Results The levels of Cr,BUN,UA,Cys C and RBP in pregnancy-induced hypertension group at the middle-period of pregnancy were higher than those in control group（P<0.05）. The levels of Cr,UA,Glu,β₂-MG,RBP and ACE at the later-period of pregnancy were higher than those in control group（P<0.05）. The levels of BUN,β₂-MG,RBP and ACE in pregnancy-induced hypertension group at the later-period of pregnancy were higher than those at the middle-period of pregnancy（P<0.05）,and the other indices had no statistical significance（P>0.05）. ROC curve showed that the area under curve（AUC） of Cr（0.716） was the biggest at the middle-period of pregnancy. At the later-period of pregnancy,the AUC of ACE（0.924） was the biggest,followed by the AUC of β₂-MG（0.897）. From the middle-period of pregnancy to later-period of pregnancy,ACE had the most obvious increasing of AUC. The sensitivities of β₂-MG for the diagnosis of pregnancy-induced hypertension were increased from 63.6% at the middle-period of pregnancy to 67.3% at the later-period of pregnancy,and the specificities were increased from 55.6% to 88.9%. The sensitivities of ACE were increased from 70.9% to 83.6%,and the specificities were increased from 95.6% to 97.8 %. There was no correlation between β₂-MG and ACE（r=0.278,P>0.05）. Conclusions ACE is a sensitive index for the early diagnosis of pregnancy-induced hypertension.

Key words: Angiotensin-converting enzyme, Renal function, Diagnosis, Pregnancy-induced hypertension

中图分类号:

R446.1

李治锋, 刘大标, 郭兰芳. 血管紧张素转换酶在妊娠高血压综合征早期诊断中的价值[J]. 检验医学, 2018, 33(6): 495-498.

LI Zhifeng, LIU Dabiao, GUO Lanfang. Serum angiotensin-converting enzyme in the early diagnosis of pregnancy-induced hypertension[J]. Laboratory Medicine, 2018, 33(6): 495-498.

图/表 3

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组别	例数	Cr （μmol/L）	BUN （mmol/L）	UA （μmol/L）	Glu （mmol/L）	β₂-MG （mg/L）	Cys C （mg/L）	RBP （mg/L）	ACE （U/L）
妊高征组
孕中期	55	35.45±3.65	2.40±0.47	220.2±45.2	4.31±0.39	1.16±0.29	0.51±0.08	33.9±6.0	40（24~45）
孕晚期	55	35.20±5.13	3.39±0.74^#	225.0±46.2	4.59±0.50^#	1.24±0.22	1.12±0.30^#	27.2±5.0^#	41（29~48）
正常对照组
孕中期	45	38.87±5.26^*	2.82±0.54^*	250.2±50.3^*	4.46±0.52	1.23±0.28	0.62±0.09^*	37.5±11.2^*	42（32~68）^*
孕晚期	45	40.80±7.54^*	3.60±0.56^#	270.0±53.6^*	4.84±0.58^*	1.83±0.46^*#	1.25±0.24^*	32.6±12.0^*#	62（54~75）^*#

组别	例数	Cr （μmol/L）	BUN （mmol/L）	UA （μmol/L）	Glu （mmol/L）	β₂-MG （mg/L）	Cys C （mg/L）	RBP （mg/L）	ACE （U/L）
妊高征组
孕中期	55	35.45±3.65	2.40±0.47	220.2±45.2	4.31±0.39	1.16±0.29	0.51±0.08	33.9±6.0	40（24~45）
孕晚期	55	35.20±5.13	3.39±0.74^#	225.0±46.2	4.59±0.50^#	1.24±0.22	1.12±0.30^#	27.2±5.0^#	41（29~48）
正常对照组
孕中期	45	38.87±5.26^*	2.82±0.54^*	250.2±50.3^*	4.46±0.52	1.23±0.28	0.62±0.09^*	37.5±11.2^*	42（32~68）^*
孕晚期	45	40.80±7.54^*	3.60±0.56^#	270.0±53.6^*	4.84±0.58^*	1.83±0.46^*#	1.25±0.24^*	32.6±12.0^*#	62（54~75）^*#

项目	孕中期		孕晚期		AUC变化
项目	AUC	95%CI	AUC	95%CI	AUC变化
Cr	0.716	0.615~0.816	0.736	0.637~0.834	↑
BUN	0.703	0.602~0.805	0.583	0.463~0.700	↓
UA	0.630	0.532~0.720	0.745	0.648~0.840	↑
Glu	0.539	0.424~0.653	0.620	0.510~0.730	↑
β₂-MG	0.517	0.402~0.633	0.897	0.838~0.956	↑↑
Cys C	0.702	0.612~0.804	0.635	0.522~0.747	↓
RBP	0.537	0.490~0.654	0.633	0.522~0.743	↑
ACE	0.606	0.494~0.718	0.924	0.866~0.982	↑↑↑

项目	孕中期		孕晚期		AUC变化
项目	AUC	95%CI	AUC	95%CI	AUC变化
Cr	0.716	0.615~0.816	0.736	0.637~0.834	↑
BUN	0.703	0.602~0.805	0.583	0.463~0.700	↓
UA	0.630	0.532~0.720	0.745	0.648~0.840	↑
Glu	0.539	0.424~0.653	0.620	0.510~0.730	↑
β₂-MG	0.517	0.402~0.633	0.897	0.838~0.956	↑↑
Cys C	0.702	0.612~0.804	0.635	0.522~0.747	↓
RBP	0.537	0.490~0.654	0.633	0.522~0.743	↑
ACE	0.606	0.494~0.718	0.924	0.866~0.982	↑↑↑

项目	敏感性（%）	特异性（%）	阳性预测值（%）	阴性预测值（%）	+LR	-LR
β₂-MG
孕中期	63.6	55.6	63.6	55.6	1.43	0.65
孕晚期	67.3	88.9	81.0	69.0	6.05	0.37
ACE
孕中期	70.9	95.6	95.1	72.9	15.95	0.30
孕晚期	83.6	97.8	97.9	83.0	37.60	0.17