血清中性粒细胞明胶酶相关性载脂蛋白胱抑素C在早期诊断冠状动脉介入术后对比剂肾病中的意义

Significance of neutrophil gelatinase - associated Medicine lipocalin and cystatin C in early diagnosis of contrast - induced nephropathy after coronary angiography

目的 前瞻性研究血清中性粒细胞明胶酶相关性载脂蛋白（NGAL）、胱抑素C（CYSC）在早期预测和诊断冠状动脉介入术后对比剂肾病（CIN）中的临床意义.方法 收集360例接受冠脉造影及介入治疗的患者资料.用酶法测定所有入选患者术前及术后12 、24 及48 h血清肌酐（Scr）值 用免疫比浊法检测所有入选患者术前及术后12及24 h血清CYSC值 用ELISA方法检测所有入选患者术前、术后2及24 h血清NAGL值 对比剂肾病以传统方法定义.将发生对比剂肾病的病例与未发生对比剂肾病的病例进行比较.结果 360例患者中,发生CIN的患者12例（发生率为3.33%）.CIN组与非CIN组的血NGAL水平在术后2 h 及24 h差异均有统计学意义（P＜0.05）.在CIN组内,术后2 h血NGAL水平较术前显著升高（P＜0.05） 术后24 h血NGAL水平较术后2 h也有明显升高（P＜0.05）.CIN组中,术后24 h CYSC值与术前对比差异有统计学意义 （P＜0.05）,而CIN组术后24 h CYSC值与非CIN组相比差异有统计学意义（P＜0.01）.CIN组内,血NGAL值及CYSC值均与Scr值呈正相关.血CYSC与血NGAL正相关.ROC分析证实,血NGAL的ROC曲线下面积为0.887,以102.29 ng/mL为诊断截点时,其在CIN诊断中的敏感性及特异性分别是75.0%及82.4%.血CYSC的ROC曲线下面积为0.978,以1.925 mg/L为诊断截点时,其在CIN诊断中的敏感性及特异性分别是91.7%及91.4%.结论 血清NAGL、CYSC均是较好的CIN早期预测指标,其中血NGAL是能最早发现肾功能受损的指标,血清CYSC是预测CIN准确率最高的指标.

Objective To study significance of neutrophil gelatinase - associated lipocalin （NGAL） and cystatin C in early diagnosis of contrast- induced nephropathy（CIN） in order to look for the better, earlier predictive hiomarkers of CIN. Methods Three hundred and sixty patients undergone coronary angiography were enrolled in this study, and CIN was defined following the traditional criteria. Before and 12, 24 and 48 h ＇after the operation, the serum creatinine was tested by enzymic method. Before and 12, 24 h after the operation, the cystatin C was test by immunoturdimetric method and were compared between CIN and non - CIN groups. Before and 2, 24 h after the operation, the NGAL was tested by ELISA method and were compared between CIN and non - CIN groups. Results CIN occurred in 12 of 360 enrolled patients, the incidence was 3.33%. In CIN group and non - CIN group , 2 h and 24 h after the use of the contrast, the levels of plasma NGAL elevated significantly [ （ 109.40 ± 41. 59） vs （13.33 ±7.49） ,P 〈0.05;and （164.12 ±84.49） vs （21.59 ±8.32） ,P 〈0.05] ;In CIN group, 24 h after the use of the contrast, the levels of cystatin C elevated significantly compared with that before the operation [ （3.22 ± 1.29） vs （ 1.94 ± 0.78 ）, P 〈 0. 05 ]. Compare with the non - CIN group, all the levels of the eystatin C and the NGAL were inereased signifieantly after the operation. Significant positive correlation was found between the levels of serum NGAL and Ser （ r = 0. 803, P = 0.02） , so did the cystatin C （r = 0. 795, P = 0.02）. Significant positive correlation was found between the levels of serum NGAL and eystatin C （r = 0.777, P = 0. 003）. ROC analysis eonfirmed the diagnostic accuracy of the serum NGAL in CIN, and the area under the eurve was 0.887）. With the cut - off value of NGAL as 102.29 ng/mL, the diagnostie sensitivity and the speeifieity in CIN were 75% and 82.4%. ROC analysis also eonfirmed the diagnostie accuracy of eystatin C in CIN, the area under the eurve was 0. 978. With the eut- off value of eystatin C as 1. 925 mg/L, the diagnostic sensitivity and the specificity in CIN were 91.7% and 91.2%. Conclusion Serum NGAL and the cystatin C ean diagnose CIN earlier than Scr, which may be better biomarkers for early prognosis of CIN. Serum NGAL can predict acute kidney injury earlier than and the eystatin C,whereas the cystatin C was the most aeeurate biomarker for early prognosis of CIN.