血浆N末端脑钠肽前体水平与急性心肌梗死患者造影剂肾病的相关性研究

Correlation between plasma NT-pro BNP level and contrast-induced nephropathy in patients with acute myocardial infarction

目的探讨血浆N末端脑钠肽前体(NT-pro BNP)水平与急性心肌梗死患者造影剂肾病(CIN)的相关性。方法本研究收集2015年1月~2016年6月于清华大学第一附属医院心血管内科接受经皮冠状动脉介入治疗(PCI)的急性心肌梗死患者318例,记录患者的病历资料,根据是否发生CIN分为CIN组和非CIN组,分析两组患者的病历资料差异。结果非CIN组和CIN组在年龄、高血压、糖尿病、利尿药用药、他汀类药物用药、收缩压、舒张压、术前心率、左室射血分数(LVEF)、血红蛋白、血小板、胆固醇、高密度脂蛋白、低密度脂蛋白、Killip分级、造影剂用量、术前NT-pro BNP差异有统计学意义(P<0.05)。以是否发生CIN为应变量,将赋值的自变量引入二元多因素Logistic回归分析,结果显示,年龄≥70岁、糖尿病、LVEF<43%、造影剂用量≥148 ml、NT-pro BNP≥874 pg/ml是影响CIN发生的独立危险因素。NT-pro BNP预测CIN的灵敏度为74.51%,特异性为82.77%,符合度为81.45%,最佳截断值为874 pg/ml,曲线下面积(AUC)为0.841。结论 NT-pro BNP水平对急性心肌梗死患者PCI术后CIN的发生率有相关性,对CIN的发生有一定预测价值。

Objective To discuss the correlation between level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and contrast-induced nephropathy (CIN) in patients with acute myocardial infarction (AMI). Methods AMI patients (n=318) undergone percutaneous coronary intervention (PCI) were chosen from the Department of Cardiology of the First Hospital of Tsinghua University from Jan. 2015 to Jun. 2016. The clinical data of all patients were recorded and they were divided into CIN group and non-CIN group according to whether or not CIN occurring. The difference in clinical data was analyzed between 2 groups. Results The difference in age,hypertension, diabetes, diuretics, statins, systolic blood pressure, diastolic blood pressure, preoperative heart rate,LVEF, hemoglobin, platelet, cholesterol, high-density lipoprotein, low-density lipoprotein, Killips grade, dosage of contrast agent and preoperative NT-proBNP level had statistical significance between 2 groups (P<0.05). The results of multiple Logistic regression analysis showed that age≥70, diabetes, LVEF<43%, dosage of contrast agent ≥148 ml and NT-proBNP≥874 pg/ml were independent risk factors of CIN occurrence. The sensitivity of NTproBNP for predicting CIN was 74.51%, specificity was 82.77%, conformity was 81.45%, optimal cutoff value was 874 pg/ml, and AUC was 0.841. Conclusion The level of NT-proBNP is correlated to CIN incidence after PCI in AMI patients, and it has some predictive value to the occurrence of CIN.