血胱抑素C对冠脉造影患者早期肾毒性的评估

Evaluation of early renal toxicity with serum cystatin C in coronary angiography patients

目的了解血胱抑素C对进行冠状动脉造影患者早期肾毒性的评估。方法前瞻性观察了153例进行冠状动脉造影患者的肾功能变化,于造影前、造影后第1天、第2天分别测定血尿素氮(BUN)、血肌酐﹙SCr﹚、血胱抑素C﹙CysC﹚、尿微量白蛋白(mALB)、N-乙酰基-β-D氨基葡萄糖苷酶(NAG)及肌酐。结果血CysC测定值在行冠脉造影患者造影后第1天、造影后第2天与造影前比较,差异均有统计学意义(t分别=54.78、3.77,P均<0.05);造影后第2天血CysC与造影后第1天比较,差异有统计学意义(t=51.43,P<0.05)。造影后第1天、第2天BUN、SCr与造影前比较,差异均无统计学意义(t分别=0.65、0.22、0.54、0.58,P均>0.05);造影后第2天BUN、SCr与造影后第1天比较,差异均无统计学意义(t分别=0.45、1.12,P均>0.05);造影后第1天mALB与造影前比较,差异有统计学意义(t=3.48,P<0.05);造影后第2天mALB与造影前比较,差异无统计学意义(t=0.99,P>0.05);造影后第2天mALB与造影后第1天比较,差异有统计学意义(t=4.93,P<0.05)。造影后第1天、第2天NAG与造影前比较,差异均有统计学意义(t分别=9.99、4.68,P均<0.05);造影后第2天NAG与造影后第1天比较,差异有统计学意义(t=8.13,P<0.05)。结论在无基线肾功能不全患者中,未见造影后发生造影剂肾病的病例,部分患者存在一过性轻度蛋白尿、尿酶升高;血CysC、尿mALB和NAG是反映造影剂早期肾毒性的敏感指标,但血CysC检测的临床意义更大,尤其对冠脉造影及介入治疗后短期留院的患者。

Objective To understand the serum cystatin C in patients with coronary angiography for the assessment of early renal toxicity. Methods A total of 153 patients undergoing coronary angiography were selected. Serum creatinine, BUN, and cystatin C levels were assessed at start, 1 day and 2 days after the administration of a radio contrast agent.Furthermore,urinary mALB, NAG and creatinine were checked for evidence of tubular or glomerular damage at start, 1 day and 2 days after the administration of a radio contrast agent. Results In comparison with the value before coronary angiography, serum cystatin C significantly increased at 1-day and 2 days after angiography （t=54.78,3.77 ,P〈 0.05）.In comparison to the 1-day levels taken after angiography,cystatin C significantly decreased at 2-day after angiography（t=51.43 ,P〈0.05 ）.There was no significant change compared to baseline in BUN and serum creatinine levels after angiography （t =0.65,0.22,0.54,0.58,0.45,1.12,P〉0.05）;In comparison with the value before coronary angiography, urinary mALB and NAG significantly increased at 1-day after angiography （t =3.48,9.99,P〈O.O5）,urinary NAG significantly increased at 2-day after angiography（t=4.68,P〈0.05 ）, urinary mALB levels at 2-day after angiography had no significant change compared to baseline （t=0.99 ,P〉0.05） ;in comparison to the 1-day levels taken after angiography, urinary NAG significantly decreased at 2-day after angiography （t=8.13 ,P〈0.05）,urinary mALB obviously decreased at 2-day after angiography（t=4.93 ,P〈0.05）. Conclusions In patients without baseline renal failure,no contrast-induced nephropathy occurred.In part of ones,there were the light increase in urinary protein and enzyme. Serum cvstatin C,urinary mALB and NAG were sensitive markers to evaluate contrast-induced early nephrotoxicity. In the clinical assessment of contrast-induced nephropathy,urinary mALB and NAG may be of little importance,but serum cystatin C may be a future marker,especially in the upcoming setting of short-time hospitalizations for coronary angiographies and interventions.