NGAL、CysC及NLR联合检测对脑血管造影介入术后发生CI-AKI的预测价值

The predictive value of combined detection of NGAL,CysC,and NLR in the incidence of CI⁃AKI after cerebrovascular angiography intervention

目的研究中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(CysC)及中性粒细胞与淋巴细胞比值(NLR)联合检测对脑血管造影介入术后发生对比剂急性肾损伤(CI-AKI)的预测价值。方法选取2021年5月至2023年5月于首都医科大学附属北京世纪坛医院行脑血管造影介入术的患者131例为研究对象,参考改善全球肾脏病预后组织(KDIGO)制定的指南标准,分为CI-AKI组30例,非CI-AKI组101例。比较CI-AKI组与非CI-AKI组一般资料与实验室指标,将具有统计学意义的指标,进一步纳入多因素二元回归Logistic回归方程,分析影响CI-AKI的危险因素。采用Pearson相关性分析NGAL、CysC及NLR与术后Scr的相关性。绘制受试者工作特征(ROC)曲线,分析NGAL、CysC及NLR单一与联合对术后CI-AKI的预测价值。结果两组性别、年龄、脑血管疾病类型、体质量指数、术前Scr、UA、BUN、血红蛋白、血小板、术前应用药物比较差异无统计学意义(P>0.05);两组术后Scr、Scr增值、e GFR、NGAL、CysC、NLR水平及造影剂剂量比较差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,术后Scr、Scr增值、NGAL、CysC、NLR水平及造影剂剂量均上升是影响CI-AKI的危险因素(P<0.05)。Scr增值、NGAL、CysC、NLR水平及造影剂剂量均与术后Scr水平呈正相关(P<0.05)。NGAL、CysC及NLR联合预测灵敏度、特异度分别为0.902、0.843,AUC为0.755,95%CI为0.631~0.809(P<0.05)。结论NGAL、CysC及NLR水平上升是影响脑血管造影介入术后CI-AKI发生的危险因素,三指标对于早期诊断CI-AKI发生具有重要的预测价值,可为后续治疗及预后提供重要信息,且三者联合检测对CI-AKI诊断具有更高效能。

Objective To study the predictive value of combined detection of neutrophil gelatinase⁃associated lipocalin(NGAL),cystatin C(CysC)and neutrophil⁃to⁃lymphocyte ratio(NLR)in the incidence of contrast agent acute kidney injury(CI⁃AKI)after cerebrovascular angiography intervention.Methods 131 patients who underwent cerebral angiography interventional surgery at Beijing Millennium Temple Hospital,Capital Medical University from May 2021 to May 2023 were selected as the study subjects.Following the guideline standards established by the Improving Kidney Outcomes Worldwide Organization(KDIGO),there were 30 cases in the CI⁃AKI group and 101 cases in the non⁃CI⁃AKI group.General information and laboratory indicators of both groups were compared,and statistically significant indicators were then incorporated into a multi⁃factor binary regression logistic regression equation to analyze the risk factors affecting CI⁃AKI.Pearson correlation was used to analyze the correlation between NGAL,CysC,NLR,and postoperative Scr.A receiv⁃er operating characteristic(ROC)curve was drawn to analyze the single and combined predictive value of NGAL,CysC,and NLR for postoperative CI⁃AKI.Results There were no statistically significant differences in gender,age,type of cerebrovascular disease,body mass index,preoperative Scr,UA,BUN,hemoglo⁃bin,platelets,and preoperative medications between the two groups(P>0.05).However,there were statisti⁃cally significant differences in postoperative Scr,Scr increment,eGFR,NGAL,CysC,NLR levels,and con⁃trast agent doses between the two groups(P<0.05).Logistic regression results showed that Scr,Scr incre⁃ment,NGAL,CysC,NLR levels and contrast dose increased after surgery were risk factors for CI⁃AKI(P<0.05).Scr proliferation,NGAL,CysC,NLR levels,and contrast dose were positively correlated with postop⁃erative Scr levels(P<0.05).The joint prediction sensitivity and specificity of NGAL,CysC,and NLR were 0.902 and 0.843 respectively,with an AUC of 0.755,and a 95%CI of 0.631~0.809(P<0.05).Conclusion Elevated levels of NGAL,CysC,and NLR are risk factors for the development of CI⁃AKI following cerebral angiography intervention.These three indicators hold significant predictive value for the early diagnosis of CI⁃AKI and can offer crucial information for subsequent treatment and prognosis.Combined detection of all three markers yields higher efficiency in diagnosing CI⁃AKI.