Zhang Lihong, Zhou Yunjiao, Wu Qing, Fan Weifeng, Ye Jun, Chen Yaping, Wu Yun, Niu Jianying, Gu Yong
Department of Nephrology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China.
Exp Ther Med. 2017 Jul;14(1):391-397. doi: 10.3892/etm.2017.4484. Epub 2017 May 22.
The aim of the current study was to analyze serum angiotensin II (Ang II), urinary angiotensinogen (AGT) and urinary transforming growth factor β1 (TGFβ1) levels in relation to the clinical manifestation of preeclampsia, and to explore the effects of circulating and renal renin angiotensin system (RAS) in preeclampsia patients. An enzyme-linked immunosorbent assay was used to evaluate serum Ang II, urinary AGT and urinary TGFβ1 in preeclampsia, pregnancy-induced hypertension and normotensive pregnancy patients. The correlation between urinary AGT and serum Ang II, urinary TGFβ1, blood pressure and urinary albumin/creatinine ratio (ACR) were then analyzed. Receiver operating characteristic (ROC) curve were also constructed. Negative correlations were observed between urinary AGT and blood pressure, and urinary AGT and ACR, whereas positive correlations were found between urinary AGT and serum Ang II, and urinary AFT and TGFβ1. Moreover, the area under the curve (AUC) of AGT was 0.841 [95% confidence interval (CI): 0.742-0.940, P<0.001], which was significantly higher than that of serum Ang II or urinary TGFβ1 (P<0.001). The optimal cut-off value of urinary AGT at 193 ng/l showed a high diagnostic value in preeclampsia. The AUC of combined serum Ang II, urinary AGT and urinary TGFβ1 was 0.918 (95% CI: 0.845-0.990, P<0.001), with a sensitivity of 83.9% and a specificity of 89.7%. Decreased levels of urinary AGT in preeclampsia patients suggested that local renal RAS was suppressed, and this was associated with hypertension and proteinuria. A high value preeclampsia diagnosis could be achieved by measuring urinary AGT or a combination of urinary AGT, serum Ang II and urinary TGFβ1.
本研究的目的是分析血清血管紧张素II（Ang II）、尿血管紧张素原（AGT）和尿转化生长因子β1（TGFβ1）水平与子痫前期临床表现的关系，并探讨循环和肾脏肾素血管紧张素系统（RAS）在子痫前期患者中的作用。采用酶联免疫吸附测定法评估子痫前期、妊娠高血压和血压正常孕妇的血清Ang II、尿AGT和尿TGFβ1。然后分析尿AGT与血清Ang II、尿TGFβ1、血压和尿白蛋白/肌酐比值（ACR）之间的相关性。还构建了受试者工作特征（ROC）曲线。观察到尿AGT与血压、尿AGT与ACR之间呈负相关，而尿AGT与血清Ang II、尿AFT与TGFβ1之间呈正相关。此外，AGT的曲线下面积（AUC）为0.841[95%置信区间（CI）：0.742 - 0.940，P<0.001]，显著高于血清Ang II或尿TGFβ1（P<0.001）。尿AGT的最佳截断值为193 ng/l，在子痫前期具有较高的诊断价值。血清Ang II联合尿AGT和尿TGFβ1的AUC为0.918（95%CI：0.845 - 0.990，P<0.001），敏感性为83.9%，特异性为89.7%。子痫前期患者尿AGT水平降低表明局部肾脏RAS受到抑制，这与高血压和蛋白尿有关。通过检测尿AGT或尿AGT、血清Ang II和尿TGFβ1的组合可实现子痫前期的高值诊断。
