血清铁蛋白对急性冠脉综合征介入术后造影剂引起肾病发生的预测研究

Diagnostic value of serum ferritin in contrast-induced nephropathy after percutaneous coronary intervention in patients with acute coronary syndrome

目的探讨血清铁蛋白(SF)对急性冠脉综合征(ACS)患者经皮冠脉介入术(PCI)后造影剂引起肾病(CIN)发生的影响。方法选取2015年1月—2017年6月承德市中心医院心内科行PCI治疗的ACS患者368例。据入院发病时血清铁蛋白水平以三分位数法分为3组(A组SF<160 ng/ml,B组SF 160 ng/ml～<258 ng/ml,C组SF≥258 ng/ml),比较不同组ACS患者PCI术后CIN发生率,分析其影响因素。结果 368例患者发生CIN 39例,发生率为10.6%;A组106例,发生CIN 9例,发生率为8.5%;B组153例,发生CIN 11例,发生率为7.2%;C组109例,发生CIN 19例,发生率为17.4%;3组间比较差异有统计学意义(P <0.05)。ROC曲线显示SF为239.5 ng/ml时预测CIN发生具有68.4%的敏感性和65.2%的特异性(曲线下面积为0.727,95%CI:0.663,0.790);多因素Logistic回归分析显示术前SF≥258 ng/ml,[O^R=2.677(95%CI:1.606,4.462),P=0.000]、血清肌酐升高[O^R=1.029(95%CI:1.001,1.058),P=0.046]、血清尿素升高[O^R=1.553(95%CI:1.145,2.107),P=0.005]是CIN发生的危险因素,射血分数升高[O^R=-0.054(95%CI:0.898,0.999),P=0.048]是CIN发生的保护因素。结论高水平SF、术前肾功能异常对ACS患者介入治疗后CIN具有预测作用,射血分数是CIN发生的保护因素。

Objective To study the diagnostic value of serum ferritin(SF)in contrast-induced nephropathy(CIN)after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods Totally 368 hospitalized patients with acute coronary syndrome received percutaneous coronary intervention during January 2015 to June 2017.Patients were enrolled in this study and were divided into three groups according to levels of serum ferritin:A group(SF<160 ng/ml,n=106),B group(SF 160 ng/ml~<258 ng/ml,n=153),and C group(SF≥258 ng/ml,n=109).Incidence of CIN was recorded.Results CIN occurred in 39 of 368 patients(10.6%),of which 9 cases(8.5%)in group A,11 cases(7.2%)in group B,19 cases(17.4%)in group C.The incidence of contrastinduced nephropathy was statistically significant among three groups(P<0.05).ROC curve showed sensitivity and specificity of SF was 65.2%and 68.4%,respectively when SF was 239.5ng/ml.Multivariate Logistic regression analysis manifested that SF≥258 ng/ml,serum creatinine and serum urea were identified as risk factors for CIN.Ejection fraction was identified as protective factor for CIN[OR=-0.054,(95%CI:0.898,0.999),P=0.048].Conclusions High levels of serum ferritin and renal injury may increase the risk of contrast-induced nephropathy after percutaneous coronary intervention in patients with acute coronary syndrome.