老年患者造影剂肾损害的诊断指标探讨

Diagnostic biomarker of contrast media induced kidney injury in elderly patients

目的通过对比分析老年患者造影前后血清肌酐（SCr）及血清胱抑素C（CysC）等生物学指标的变化，探讨更适用于老年患者造影剂肾损害的诊断指标。方法收集2010年5月至2011年2月于北京友谊医院医保中心及心内科接受血管造影检查的年龄≥60岁患者的相关资料共41例。用酶法测定入选患者造影前及造影后2h，24h，48h，72hSCr值。留取患者造影前及造影后2h、24h、48h、72h血清及尿液样本，予酶联免疫吸附测定法检测患者血清CysC、中性粒细胞明胶酶相关性载脂蛋白（NGAL）及尿液NGAL、肾损伤分子1（KIM-1）数值，进行造影前后的对比分析。结果依照传统造影剂肾病（CIN）的诊断标准，入选患者中1例发生CIN，患病率为2．44％。依照急性肾损伤网络（AKIN）诊断标准，入选患者中3例发生急性肾损伤，患病率为7．32％。造影后CysC升高≥25％的患者有27例，所占比例为65．9％。CysC水平在造影后24h及48h较造影前水平显著升高，SCr水平在造影前后未见明显改变。造影后CysC升高≥25％患者的血清NGAL、尿NGAL及尿KIM-1造影后的上升幅度明显高于CysC升高〈25％的患者。结论以SCr为指标的传统CIN诊断标准不适合老年患者，CysC可能更加及时、准确地反映老年患者的造影剂肾损害。

Objective To explore the suitable biomarker for timely and accurate diagnosis of contrast media induced kidney injury in elderly patients by comparing the concentration of serum creatinine （SCr）, serum cystatin C （CysC）and other biomarkers before and after the angiography. Methods Forty-one old patients aged over 60 years having undergone angiography were enrolled in this study. Before the angiography, 2h, 24h, 48h and 72h after the angiography, the SCr value were tested by enzymic method. The serum and urine sample were also collected to test the serum CysC, serum neutrophil gelatinase-associated lpipocalin （NGAL） and urine kidney injury molecule-1（KIM-1） value with enzyme linked immunosorbent assay （ELISA） method. The levels of the biomarkers from the different time points were compared and analyzed. Results Contrast-induced nephropathy （CIN） occurred in 1 of 41 enrolled patients （2.44%）. Acute kidney injury （AKI） occurred in 3 of 41 enrolled patients （7.32%）. The concentration of serum CysC increased by over 25% in 27 patients after angiography （65.9%）. Before and after angiography, the levels of SCr had no significant change. The levels of serum CysC elevated significantly at 24h and 48h after angiography. Serum NGAL, urine NGAL and urine KIM-1 elevated significantly in the patients with CysC increased by over 25%. Conclusion The traditional diagnostic biomarker of CIN is not suitable for elderly patients. CysC may be a timely and accurate biomarker for the diagnosis of contrast media induced kidney injury in elderly patients.