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目的探讨随机测定尿微量白蛋白与尿肌酐比值(UACR)对妊娠期糖尿病(GDM)患者早期肾损伤的诊断价值,为早期防治GDM合并肾损伤,改善患者预后提供理论依据。方法随机纳入2013年3月-2016年10月收治的92例GDM孕妇(GDM组)及88例非GDM孕妇(非GDM组),另选取同期进行健康体检的90例非妊娠女性为健康对照组。根据尿蛋白定性检测结果,将GDM组孕妇进一步分为GDM尿蛋白阳性亚组(36例,尿蛋白弱阳性或阳性)和GDM尿蛋白阴性亚组(56例)。随机时间测定尿微量白蛋白、尿肌酐含量,计算随机UACR,并同步测定血肌酐和尿素氮(BUN)水平。比较3组女性随机UACR,比较GDM尿蛋白阳性亚组、GDM尿蛋白阴性亚组随机UACR;应用ROC分析随机UACR对GDM孕妇早期肾损伤的早期诊断效力。结果 GDM组女性随机UACR显著高于非GDM组和健康对照组女性,差异均有统计学意义(P<0.05);非GDM组女性与健康对照组女性随机UACR比较,差异无统计学意义(P>0.05)。GDM尿蛋白阳性亚组女性随机UACR及尿微量白蛋白水平均显著高于GDM尿蛋白阴性亚组、非GDM组和健康对照组,差异有统计学意义(P<0.05)。ROC分析显示:随机UACR预测GDM孕妇早期肾损伤的AUC=0.912(P<0.001),诊断敏感度为92.25%,高于血BUN和肌酐。结论随机UACR可作为诊断GDM孕妇早期肾损伤的敏感指标。
Objective To investigate the diagnostic value of random determination of urine microalbuminuria and urinary creatinine ratio (UACR) in the diagnosis of early renal injury in gestational diabetes mellitus (GDM) patients, and to provide a theoretical basis for the prevention and treatment of GDM with renal injury and prognosis in the early stage. Methods Ninety-two pregnant women with GDM (GDM group) and 88 non-GDM pregnant women (non-GDM group) were enrolled in this study from March 2013 to October 2016. 90 non-pregnant women who took part in the same period of physical examination were selected as healthy control group . According to the results of qualitative detection of urinary protein, pregnant women in GDM group were further divided into GDM urinary protein positive subgroup (36 cases, weakly positive or positive urinary protein) and GDM urinary protein negative subgroup (56 cases). Urine microalbuminuria and urinary creatinine were measured at random time, random UACR was calculated, and serum creatinine and blood urea nitrogen (BUN) levels were measured simultaneously. The randomized UACRs were compared among three groups of women to compare GDM urinary protein positive subgroup and GDM urinary protein negative subgroup random UACR. ROC analysis was used to analyze the early diagnosis efficacy of random UACR on early renal injury of GDM pregnant women. Results The random UACR of female in GDM group was significantly higher than that in non-GDM group and healthy control group (P <0.05). There was no significant difference in the random UACR between female and non-GDM group (P > 0.05). The levels of random UACR and urine microalbumin in GDM urinary protein subgroup were significantly higher than those in GDM urinary protein negative subgroup, non-GDM group and healthy control group (P <0.05). ROC analysis showed that AUC of random UACR predicting early renal injury in GDM pregnant women was 0.912 (P <0.001), the diagnostic sensitivity was 92.25%, higher than that of blood BUN and creatinine. Conclusion Randomized UACR can be used as a sensitive indicator of early renal damage in GDM pregnant women.