单核细胞与高密度脂蛋白比值与急性冠脉综合征患者造影剂肾病发生的关系

The Relationship Between Monocyte to High-density Lipoprotein Ratio and Contrast-induced Nephropathy in Patients with Acute Coronary Syndrome

目的:探讨单核细胞与高密度脂蛋白比值(MHR)与经皮冠脉介入术(PCI)后发生造影剂肾病(CIN)的关系。方法:选取2013年1月-2018年1月在本院行PCI的急性冠脉综合征(ACS)患者。统计患者的人口统计学特征、临床变量、入院后使用的药物,统计CIN患者的发生情况,并将其纳入CIN组,其余为非CIN组,评估住院期间、随访1、6个月的主要不良心血管事件(MACE),分析影响CIN的独立预测因素。结果:研究共入选647例ACS患者行PCI术,发生CIN70例(10.8%),住院期间及随访1、6个月发生的MACE分别为55、80、121例,其中CIN组MACE发生率均高于非CIN组(P<0.05);与非CIN组比较,CIN组年龄较高,合并高血压、糖尿病和入院时KillipⅢ/Ⅳ级比例、肌酐、MHR水平和造影剂使用剂量更高,左室射血分数(LVEF)、ST段抬高心肌梗死(STEMI)、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)使用比例、血红蛋白、肾小球滤过率(eGFR)、低密度脂蛋白、总胆固醇水平均较低,比较差异均有统计学意义(P<0.05);多因素分析显示,校正CIN的其他危险因素后,MHR是CIN的独立危险因素(P<0.001),其余危险因素包括年龄、糖尿病、造影剂量和eGFR(P<0.05);ROC曲线显示,MHR预测CIN的最佳临界值为17.42,敏感性和特异性分别为65.7%和64.0%,曲线下面积达到0.70[95%CI(0.66,0.74),P<0.001]。结论:术前MHR可以作为CIN新的危险因素,有助于早期发现高危CIN患者,从而制定相应的保护性措施。

Objective:To investigate the relationship between the ratio of monocytes to high-density lipoprotein(MHR)and contrast-induced nephropathy(CIN)after percutaneous coronary intervention(PCI).Method:The patients with acute coronary syndrome(ACS)who underwent PCI in our hospital from January 2013 to January 2018 were selected.The demographic characteristics,clinicalvariables,drugs used after admission were analyzed.The incidence of CIN patients was counted and as CIN group,the rest were non-CIN group,major adverse cardiovascular events(MACE)during hospitalization and follow-up for 1 and 6 months were assessed and independent predictors of CIN were analyzed.Result:A total of 647 patients with ACS underwent PCI,70 patients (10.8%) developed CIN,55,80 and 121 patients developed MACE during hospitalization and 1,6 months follow-up,the incidence of MACE in CIN group were higher than those of non-CIN group(P<0.05).Compared with non-CIN group,CIN group had higher age,higher Killip gradeⅢ/Ⅳ,creatinine,MHR level and dosage of contrast medium at admission,higher left ventricular ejection fraction(LVEF),ST-segment elevation myocardial infarction(STEMI),angiotensin converting enzyme inhibitor/angiotensin receptor blocker(ACEI/ARB),hemoglobin and glomerular filtration,the levels of eGFR,low density lipoprotein and total cholesterol were lower,the differences were statistically significant(P<0.05).Multivariate analysis showed that MHR was an independent risk factor for CIN(P<0.001),the other risk factors included age,diabetesmellitus,contrast dose and eGFR(P<0.05).ROC curve showed that the optimum critical value for predicting CIN by MHR was 17.42,the sensitivity and specificity were 65.7%and 64.0%respectively,and the area under the curve was 0.70[95%CI(0.66,0.74),P<0.001].Conclusion:Preoperative MHR can be used as a new risk factor for CIN,which is helpful for early detection of high-risk CIN patients and formulation of corresponding protective measures.