冠状血管造影术前血浆氨基末端脑钠肽前体水平与造影剂肾病发生的相关性研究

Correlation between the Level of NT-proBNP before CAG and the Occurrence of Contrast-induced Nephropathy

目的探讨冠状血管造影术(CAG)前血浆氨基末端脑钠肽前体(NT-proBNP)水平与术后造影剂肾病(CIN)发生的相关性及其对CIN预测的临床价值。方法收集郑州大学第一附属医院2012年8月—2013年1月心血管内科就诊并行CAG的患者250例,记录患者一般资料,于造影前12 h内检测NT-proBNP、血清肌酐(Scr)、尿素氮(BUN)、尿酸(UA)水平,造影后第1、2、3、4、5天分别检测Scr、BUN、UA水平,根据简化的肾脏病饮食调整研究公式(MDRD公式)推算肾小球滤过率(eGFR),根据患者造影后48 h内是否发生CIN,分为CIN组(36例)和非CIN组(214例)。结果 CIN组与非CIN组患者性别构成、年龄、高脂血症发生率、平均动脉压(MAP)、心脏射血分数(EF)、术前12 h输液量比较,差异均无统计学意义(P>0.05)。CIN组糖尿病发生率、术后48 h输液量、造影剂用量、经皮冠状动脉介入治疗(PCI)、冠状动脉狭窄>50%较非CIN组升高(P<0.05)。CIN组造影前NT-proBNP水平与造影后Scr升高幅度(造影后Scr值-造影前Scr值)呈正相关(r=0.786,P<0.05),与造影后eGFR呈负相关(r=-0.368,P=0.027);非CIN组造影前NT-proBNP水平与造影后Scr水平呈正相关(r=0.307,P<0.05),与造影前、后eGFR呈负相关(r=-0.138,P=0.044;r=-0.203,P=0.003),而与Scr升高幅度则无相关性。以造影前NT-proBNP>150 ng/L预测CIN发生率其敏感度为86.1%,特异度为59.3%,阳性预测值为26.3%,阴性预测值为96.2%;以造影前NT-proBNP>400 ng/L预测CIN发生率其敏感度为47.2%,特异度为68.7%,阳性预测值为20.2%,阴性预测值为88.6%。结论 CAG前检测NT-proBNP对术后CIN发生有一定预测价值,NT-proBNP水平与CAG后CIN患者Scr升高程度存在一定相关性。

Objective To investigate the correlation between the level of NT -proBNP before coronary angiography （CAG） and the occurrence of contrast -induced nephropathy （CIN） and its clinical predictive value to CIN. Methods Data of 250 patients underwent CAG and admitted to the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from August 2012 to January 2013 were recorded. NT -proBNP, serum creatinine （Scr）, blood urea nitrogen （BUN） and uric acid （UA） were detected 12 h before CAG. Scr, BUN and UA were detected again one, two, three, four and five days after CAG respectively, and simplified MDRD formula was used to estimate the eGFR. All the patients were divided into CIN group （36 cases） and non - CIN group （214 cases） 48 h within CAG. Results The gender composition, age, incidence of hyperlipidemia, mean arterial pressure （ MAP）, cardiac ejection fraction （EF） and preoperative 12 h infusion volume showed no statistically significant difference between two groups （ P 〉 0. 05 ） . The incidence of diabetes, postoperative 48 h infusion volume, dosage of contrast agent, PCI and coronary artery stenosis 〉 50% were significantly higher in CIN group than non - CIN group （ P 〈 0. 05 ） . In CIN group, the NT - proBNP before CAG was positively correlated with the rise of Scr （ r = 0. 786, P 〈 0. 05 ）, but negatively correlated with eGFR after CAG （ r = - 0. 368, P = 0. 027） . In non - CIN group, the NT - proBNP before CAG was positively correlated with Scr after CAG （ r= 0. 307, P 〈 0. 05）, but negatively correlated with eGFR before and after CAG （ r = - 0. 138, P = 0. 044 ; r = - 0. 203, P = 0. 003 ）, but showed no correlation with the rise of Scr. When predicting the prev- alence of CIN through the increase in NT -proBNP by 150 ng/L, the sensitivity was 86. 1%, specificity was 59. 3% , positive predictive value was 26. 3% and negative predictive value was 96. 2%. When predicting the prevalence of CIN through the increase in NT - proBNP by 400 ng/L, the sensitivity was 47.2% , specificity was 68.7% , positive predictive value was 20. 2% and negative predictive value was 88. 6%. Conclusion Detecting the level of NT - proBNP before CAG is of good value in predicting the prevalence of CIN. NT - proBNP is related to the rise degree of Set in CIN.