血清NGAL和胱抑素C检测在造影剂肾病早期诊断中的价值

Predictive value of serum neutrophil gelationase associated lipocalin and Cys-C in early diagnosis of contrast induced nephropathy

目的观察经皮冠状动脉介入治疗(PCI)术后血清中性粒细胞明胶酶相关脂质转运蛋白(NGAL)和胱抑素C(Cys-C)水平变化,探讨二者在造影剂肾病(CIN)早期诊断中的价值。方法选择冠心病支架置入术患者114例,以术后发生CIN患者12例为CIN组,以未发生CIN患者102例为非CIN组,测定两组患者手术前后血肌酐(SCr)、Cys-C、NGAL水平,并通过ROC曲线下面积(AUC)评估血清NGAL及Cys-C对早期CIN诊断的敏感度。结果 CIN组血清NGAL在术后6小时开始上升(P=0.01),CIN组血清Cys-C在术后12小时开始上升(P<0.01)。CIN组术后12小时、24小时及48小时血NGAL和Cys-C高于非CIN组,差异有统计学意义(P<0.01),但CIN组术后6小时SCr及Cys-C水平不高于非CIN组,差异无统计学意义(P=0.46,P=0.67)。术后6小时NGAL、Cys-C及SCr的AUC分别为0.81,0.75,0.57;术后12小时NGAL、Cys-C及SCr的AUC分别为0.89,0.83,0.8;术后24小时NGAL、Cys-C及SCr的AUC分别为0.88,0.86,0.85;术后48小时NGAL、Cys-C及SCr的AUC分别为0.77,0.7,0.88。结论冠心病支架置入术患者术后血清NGAL、Cys-C水平能较早反应肾功能变化,为CIN的早期诊断提供一定依据。

Objective To investigate the value of combined detection of serum neutrophil gelationase associated lipocalin（NGAL）and Cystatin C（Cys-C）in predicting the contrast induced nephropathy（CIN）after percutaneous coronary intervention.Methods A total of 114 patients with suspected coronary heart disease underwent PCI were included.The patients were divided into two groups：CIN（12 cases）and non-CIN（102 cases）.The level of SCr,CysC and NGAL were measured before and after operation.The area under receiver operating characteristic curve（AUC）was used to assess the sensitivity of NGAL and Cys-C in early diagnosis of CIN.Results The serum NGAL of CIN was significantly higher than that of non-CIN at 6 hours after operation（P =0.01）.The serum Cys-C of CIN was significantly higher than that of non-CIN at 12 hours after operation（P 0.01）.The serum NGAL and Cys-C of CIN were significantly higher than those of non-CIN at 12 hours,24 hours,48 hours after operation（P 0.01）.However,the serum SCr and Cys-C of CIN were not significantly higher than those of non-CIN at 6 hours after operation（P =0.46,P =0.67）.The area under receiver operating characteristic curve（AUC）of NGAL,Cys-C and SCr were 0.81,0.75 and 0.57 at 6 hours after operation.The AUC of NGAL,Cys-C and SCr were 0.89,0.83 and 0.8 at12 hours after operation.The AUC of NGAL,Cys-C and SCr were 0.88,0.86 and 0.85 at 24 hours after operation.The AUC of NGAL,Cys-C and SCr were 0.77,0.7 and 0.88 at 48 hours after operation.Conclusion For patients with coronary heart disease after PCI,serum NGAL and Cys-C levels can early reflect the kidney function and give an early prediction of CIN.