Study on the correlation between serum HDAC4,ROCK2,Gas6 levels with acute kidney injury in patients with pre-eclampsia

Hou Xiyuan; Qiao Pengyan; He Sujuan; Feng Yanlin; Lyu Zhenjiao

doi:10.3969/j.issn.1671-6450.2026.01.012

Abstract：Objective To explore the correlation between serum histone deacetylase 4(HDAC4),Rho-associated coiled-coil containing protein kinase 2(ROCK2),and growth arrest-specific gene 6(Gas6)levels with acute kidney injury(AKI)in patients with preeclampsia(PE).Methods A total of 150 patients diagnosed with PE admitted to the Obstetrics De-partment of Shanxi Children's Hospital(Shanxi Maternal and Child Health Hospital)between March 2022 and March 2025 were selected as the disease group.Based on the presence or absence of AKI,they were further divided into an AKI subgroup(n=71)and a non-AKI subgroup(n=79).Additionally,94 healthy pregnant women without gestational hypertension identified during obstetric examinations at the hospital during the same period were selected as the control group.ELISA was used to de-tect serum levels of HDAC4,ROCK2,and Gas6.Pearson correlation analysis was performed to assess the relationship between serum HDAC4,ROCK2,and Gas6 levels and renal injury markers.Multivariate logistic regression analysis was con-ducted to identify factors influencing the development of AKI in patients with PE.ROC curve analysis was used to evaluate the predictive value of serum HDAC4,ROCK2,and Gas6 levels for AKI in patients with PE.Furthermore,the bootstrap meth-od was employed for internal validation of the joint prediction model.Results The disease group had higher serum HDAC4,ROCK2,and Gas6 levels than the control group(t=22.552,22.632,12.355,all P＜0.001).SBP,DBP,SCr,BUN,and serum HDAC4,ROCK2,and Gas6 levels were significantly higher in the AKI subgroup than in the non-AKI subgroup(t=2.412,6.320,16.167,11.268,8.602,7.719,8.157;P=0.017,＜0.001,＜0.001,＜0.001,＜0.001,＜0.001,＜0.001).Serum HDAC4,ROCK2,and Gas6 were positively correlated with SCr(r=0.493,0.527,0.504,all P＜0.001)and BUN(r=0.482,0.539,0.526,all P＜0.001).Elevated SBP,DBP,SCr,BUN,HDAC4,ROCK2,and Gas6 were all risk factors for AKI in PE patients[OR(95％CI)=1.613(1.036-2.512),1.542(1.056-2.251),1.879(1.162-3.037),1.924(1.223-3.026),2.581(1.529-4.356),2.396(1.381-4.156),2.015(1.279-3.175)].The risk of AKI in PE patients with high serum levels of HDAC4,ROCK2,and Gas6 was 1.604,1.536,and 1.593 times higher,respectively,than in patients with low levels.The AUC values for predicting AKI in PE patients using serum HDAC4,ROCK2,Gas6 alone and their combination were 0.824,0.805,0.809,and 0.934,respectively.The combined prediction outperformed the individual predictions of serum HDAC4,ROCK2,and Gas6(Z=3.404,3.380,3.335;all P=0.001).Internal validation results indicated that the calibration curve between the model's predicted probabilities and actual occurrence rates closely aligned with the ideal reference line,demonstrating the model's strong calibration capability and internal consistency.Conclusion Serum HDAC4,ROCK2,and Gas6 levels are all elevated in PE patients with concurrent AKI.The combined detection of these three biomarkers can provide a reference for predicting concurrent AKI in PE patients.