血清NGAL和Cys C在冠心病患者PCI术后CIAKI中的诊断价值

Value of serum NGAL and Cys C in diagnosis of contrast-induced acute kidney injury in patients with coronary heart disease after percutaneous coronary intervention

目的:研究血清NGAL和Cys C在冠心病(CHD)患者PCI术后造影剂所致急性肾损伤(CIAKI)中的诊断价值。方法:纳入我院内科行PCI手术的CHD患者435例,于术前,术后12 h、24 h、48 h分别抽血检测sCr、NGAL和Cys C等,将患者分为造影剂急性肾损伤组(CIAKI组)21例和非急性肾损伤组(Non-AKI组)组414例,比较两组术前及术后不同时间点的sCr、NGAL和Cys C水平差异,采用ROC曲线计算NGAL和Cys C诊断急性肾损伤的效能。结果:PCI术后,21例发生CIAKI;术前CIAKI组NGAL水平显著高于Non-AKI组(P<0.05);CIAKI组术后sCr、NGAL和Cys C水平呈递增趋势,与术前相比,sCr水平在术后24 h、48 h,NGAL和Cys C水平在术后12 h、24 h、48 h有统计学差异(P<0.05);根据ROC曲线,PCI术后12 h,NGAL和Cys C联合诊断CIAKI的AUC高于单独诊断CIAKI的AUC(P<0.05)。结论:NGAL和Cys C是预测PCI患者发生CIAKI的早期敏感性指标,两者联合监测可以提高早期CIAKI的诊断效能。

Objective:To study the value of serum neutrophil gelatinase-associated lipocalin(NGAL)and Cys C in the diagnosis of contrast-induced acute kidney injury in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods:435 patients with CHD who underwent PCI were enrolled in our hospital.Before operation,and at 12,24 and 48 hours after operation,blood samples were taken to detect sCr,NGAL and Cys C.The patients were divided into contrast-induced acute kidney injury group(CIAKI group,21 cases)and non-acute kidney injury group(non-AKI group,414 cases).The sCr,NGAL at different time points before and after operation were compared between the two groups.The ROC curve was used to calculate the diagnostic efficacy of NGAL and Cys C in acute renal injury.Results:After PCI,21 patients developed CIAKI;before PCI,the level of NGAL in CIAKI group was significantly higher than that in non-AKI group(P<0.05);the levels of sCr,NGAL and Cys C in CIAKI group were increasing after operation.Compared with those before PCI,the levels of sCr in CIAKI group increased at 24 hours,48 hours after operation,and the levels of NGAL and Cys C in CIAKI group were statistically different at 12 hours,24 hours and 48 hours after operation(P<0.05).At 12 hours after operation,the AUC of combined NGAL and Cys C for CIAKI diagnosis was higher than that of NGAL alone or Cys C alone for CIAKI diagnosis(P<0.05).Conclusion:NGAL and Cys C are sensitive indexes for predicting diagnosis of AKI.The combination detection of NGAL and Cys C can improve the predictive performance of AKI.