血清胱抑素C检测在造影剂肾病早期诊断中的价值

Value of serum cystatin C in early diagnosis of contrast induced nephropathy

目的:探讨血清胱抑素C(Cys-C)检测在造影剂肾病(CIN)早期诊断中的意义。方法:采用回顾性研究的方法,选择接受冠状动脉造影术和(或)经皮冠状动脉介入治疗术的冠心病患者为研究对象,收集患者造影前、造影后24h和48h血清Cys-C、血清肌酐等相关临床资料,比较血清Cys-C与Scr检测在造影剂肾病早期诊断的特异性和敏感度。结果:与造影前[(1.03±0.18)mg/L]比较,427例研究对象造影后24h[(1.27±0.21)mg/L]和48h[(1.31±0.26)mg/L]血清Cys-C升高,差异有统计学意义(F=39.542,P=0.031)。以血清肌酐变化为诊断指标,造影后24h和48hCIN的发生率分别为6.57%和7.20%,均低于以血清Cys-C法诊断标准下CIN的发生率(10.17%和10.81%,χ2=262.359和236.669,P均<0.001)。运用血清Cys-C法在造影后24h诊断CIN的灵敏度和特异度分别为96.77%和95.92%,造影后48h为91.18%和95.43%。结论:Cys-C可敏感地反映造影剂肾毒性程度,有利于造影剂肾病的早期诊断。

Aim：To study the value of detecting serum cystatin C（Cys-C） in early diagnosis of contrast induced nephropathy（CIN）.Methods：Taking retrospective analysis method,a total of 427 patients undergoing diagnostic coronary angiography or percutaneous coronary intervention were enrolled.Serum Cys-C,serum creatinine（Scr） and other relevant clinical data of the patients were collected before imaging and 24 hours,48 hours after imaging.Two methods were used to diagnose CIN.A：detecting the level of Scr;B：detecting the level of serum Cys-C.The specificity and sensitivity of the above two methods were analyzed respectively.Results：Compared with that before imaging[（1.03±0.18）mg/L],the serum Cys-C increased significantly at 24 hours[（1.27±0.21）mg/L] and 48 hours[（1.31±0.26）mg/L] after imaging（F=39.542,P=0.031）.By method A,the incidence of CIN were 6.57% at 24 hours after imaging and 7.20% at 48 hours after imaging,which were lower than those by method B（10.17% and 10.81%,χ2=262.359 and 236.669,P0.001）.By method B,the specificity and sensitivity of diagnosing CIN were 96.77% and 95.92% at 24 hours after imaging,91.18% and 95.43% at 48 hours after imaging.Conclusion：The level of serum Cys-C could be a sensitive marker to diagnose CIN in early stage.