尿胱抑素C对冠脉诊疗术后对比剂肾病的早期诊断价值

Value of Cystatin C in Early Diagnosis of Contrast-induced Nephropathy after Coronary Angiography and Intervention

目的用受试者特征工作曲线(ROC曲线)评价尿液中尿胱抑素C(Cystatin C)水平在诊断对比剂肾病(Contrast-induced Nephropathy,CIN)的早期临床价值。方法收集行CAG和/或PCI的患者共200例,于术前及术后24 h、48h检测患者血肌酐(Scr)值,并于术前和术后2 h、6 h、12 h、24 h、48 h留取尿液检测Cystatin C水平。通过分析ROC曲线评价它们对CIN早期诊断价值。结果共有23例患者诊断为CIN,其术后12 h、24 h、48 h尿Cystatin C的浓度为(196.83±43.05)ng/ml、(302.15±70.60)ng/ml、(130.84±30.99)ng/ml,与术前的(47.45±17.02)ng/ml比较,差异有统计学意义(P<0.05),而术后24 h Scr与术前比较差异无统计学意义,证实尿胱抑素C较Scr至少提前24 h诊断CIN。术后12 h ROC曲线下的面积为0.718,AUC 95%的可信区间为(0.608,0.828)。据此假定尿胱抑素C预测CIN的临界点为181.71 ng/ml,那么对应的灵敏度则为82.6%,而特异度为62.0%。术前及术后24 h、48 h尿Cystatin C浓度与术前及术后24 h、48 h的Scr表明有正相关关系。结论尿胱抑素C对于冠心病患者冠脉诊疗术后发生的CIN具有良好的预测诊断作用。

Objective To discuss the clinical value of cystatin C in the early diagnosis of contrast-induced nephropathy （CIN） after coronary angiography（CAG） and/or percutaneous coronary intervention （PCI）. Methods A total of 200 patients underwent CAG and/or PCI were enrolled in this study. The levels of serum creatinine（Scr） were tested on 24 hours and 48 hours before and after the operations. The urine of patients was collected before the operation and 2 h ,6 h, 12 h ,24 h ,48 h after the op- eration to test the level of Cystatin C. Receiver operating characteristic （ROC） analyses were conducted to evaluate their value in the early diagnosis of CIN. Results There were 23 cases of CIN. The level of Cystatin C at 12 h ,24 h and 48 h after the opera- tion were 196.83 ± 43.05 ng/ml, 302.15 ± 70.60 ng/ml and 130.84 ± 30.99 ng/ml, respectively, and were higher than that （47.45± 17.02 ng/ml） before the operations. The difference was significant（ P 〈 0.05 ）. There was no significant difference in Scr level before and after the operation （24 h）, revealed that CIN can be diagnosed by urine Cystatin C at least 24 h ahead of Scr. AUC（95% CI） was 0.608 to 0. 828. If the cutoff value of the diagnosis of CIN by the urine Cystatin C was 181.71ng/ml,the sensitivity should be 82.6% and the specificity should be 62.0%. Bivariate shows that the level of Cystatin C before and 24 h ,48 h after the operation was positively correlated with Scr levels at the same time points. Conclusion Urinary Cystatin C may be a good biomarker for the early diagnosis of CIN after coronary angiography （CAG） and/or percutaneous coronary intervention （PCI）.