ACR联合尿β2-MG检测在妊娠合并糖尿病早期肾损害中的诊断价值

刘玲佩　陈光明　王华斌

[摘要] 目的 探究尿微量白蛋白与尿肌酐比值（ACR）联合尿β2-微球蛋白（β2-MG）检测对妊娠合并糖尿病患者早期肾损害的临床诊断效果。 方法 随机纳入2019年1—12月我院接收进行定期孕检的产妇150例。其中33例诊断为孕前糖尿病（PGDM）的产妇纳入PGDM组、70例妊娠期糖尿病（GDM）产妇纳入GDM组、47例健康产妇纳入对照组。检测产妇血清糖化血红蛋白（HbA1c）、ACR、尿β2-MG、血肌酐（Scr）、血尿素氮（BUN）水平，并比较各指标检测阳性率。 结果 GDM组、PGDM组尿β2-MG、ACR、Scr及HbA1c水平高于对照组（P<0.05），GDM组、PGDM组BUN水平与对照组比较，差异无统计学意义（P>0.05）。PGDM组尿β2-MG、ACR及HbA1c水平高于GDM组（P<0.05）;PGDM组Scr、BUN水平与GDM组比较，差异无统计学意义（P>0.05）;PGDM组、GDM组尿β2-MG、ACR检测阳性率高于对照组（P<0.05）;PGDM组、GDM组BUN及Scr检测阳性率与对照组比较，差异无统计学意义（P>0.05）。PGDM组ACR及尿β2-MG检测阳性率高于GDM组（P<0.05），PGDM组BUN及Scr检测阳性率与GDM组比较，差异无统计学意义（P>0.05）。GDM组内B亚组ACR、尿β2-MG、ACR联合尿β2-MG检测阳性率高于A亚组（P<0.05），A、B亚组患者BUN及Scr检测阳性率比较，差异无统计学意义（P>0.05）。 结论 临床针对GDM患者可结合HbA1c检测情况，进行ACR、尿β2-MG指标水平联合检测判断其早期肾损害及腎损害程度，及早接受治疗干预，以防止并延缓妊娠并糖尿病患者肾损害症状发展至不可逆期，该检测方法具有临床应用价值。

[关键词] 妊娠合并糖尿病;尿微量白蛋白与尿肌酐比值;尿β2-微球蛋白;早期肾损害;临床诊断

[中图分类号] R714.256;R587.24          [文献标识码] A          [文章编号] 1673-9701（2021）04-0013-05

The value of joint detection of ACR and urine β2-MG in the diagnosis of early renal damage in pregnancy complicated by diabetes mellitus

LIU Lingpei1   CHEN Guangming1   WANG Huabin2

1.General Medicine， Affiliated Jinhua Hospital， Zhejiang University School of Medicine， Jinhua   321000， China; 2.Central Laboratory， Affiliated Jinhua Hospital， Zhejiang University School of Medicine， Jinhua   321000， China

[Abstract] Objective To explore the effect of the joint detection of urine microalbumin/creatinine ratio（ACR） and urine β2-microglobumin（β2-MG） on clinical diagnosis of early renal damage in pregnant women with diabetes mellitus（DM）. Methods A total of 150 parturients who received regular pregnancy tests in our hospital from January to December 2019 were randomly selected. Among these parturients， 33 cases diagnosed with pregestational diabetes mellitus（PGDM） were included in the PGDM group， 70 with gestational diabetes mellitus（GDM） were included in the GDM group， and 47 healthy parturients were included in the control group. The levels of the indexes of serum glycosylated hemoglobin（HbA1c）， ACR， urine β2-MG， blood creatinine（Scr） and blood urea nitrogen （BUN） were detected， and the positive rate of each index was compared. Results The levels of the urine β2-MG， ACR， Scr and HbA1c of the patients in the GDM group and PGDM group were significantly higher than those in the control group（P<0.05）， and the levels of BUN were not significantly different from that in the control group（P>0.05）. The levels of urine β2-MG， Scr ACR and HbA1c of the patients in the PGDM group were significantly higher than those in the GDM group（P<0.05）. The levels Scr and BUN of the patients in the PGDM group were not significantly different from those in the GDM group（P>0.05）. The positive rates of the detection of urine β2-MG and ACR of the patients in the PGDM group and GDM group were significantly higher than those in the control group（P<0.05）. The positive rates of the detection of BUN and Scr of the patients in the PGDM group and GDM group were not significantly different from those in the control group（P>0.05）. The positive rates of the detection of ACR and urine β2-MG of the patients in the PGDM group were significantly higher than those in the GDM group（P<0.05）， and the positive rates of the detection of BUN and Scr were not significantly different from those in the GDM group（P>0.05）. In GDM group， the positive rates of ACR， urine β2-MG and ACR combined with urine β2-MG in subgroup B were higher than those in subgroup A（P<0.05）. There was no significant difference in the positive rates of BUN and Scr in subgroup A and B（P>0.05）. Conclusion In clinical practice， as far as the patients with GDM are concerned， with reference to the result of the detection of HbA1c， a joint detection of the levels of the indexes of ACR and urine β2-MG can be conducted for judging their early renal damage and the extent of the damage， so that they could receive treatment intervention as early as possible to prevent the symptoms of renal damage in pregnant women with DM from developing to the irreversible stage and delay the development. The detection method has application value in clinical practice.

[Key words] Pregnancy complicated by diabetes mellitus; Urine microalbumin/creatinine ratio; Urine β2-microglobumin; Early renal damage; Clinical diagnosis

妊娠并糖尿病类型主要包括妊娠糖尿病（Gestational diabetes，GDM）与孕前糖尿病（Pre-pregnancy diabetes，PGDM）[1]。其中GDM主要是指在妊娠期发生的一类糖代谢异常，产妇血糖水平升高但仍未达到糖尿病标准;而PGDM可能在产妇孕前已被确诊或在其妊娠期首次诊断的糖尿病，PGDM在临床上较为少见[2-3]，GDM占妊娠并糖尿病中的80%以上。随着当前妊娠期并糖尿病患病率的不断提高，临床对GDM的筛查也不断受到人们的广泛关注与重视。而妊娠并糖尿病也与流产、早产儿或巨大胎儿、先天畸形及子痫前期等多种妊娠不良结局存在相关性。……