氨基末端脑钠肽前体与冠脉介入术后对比剂肾病的相关性

Association between NT-proBNP and contrast induced nephropathy after coronary intervention

目的评估氨基末端脑钠肽前体(NT-proBNP)对于择期冠状动脉介入术后对比剂肾病(CIN)的预测价值。方法入选2017年6月至2018年9月在广东省佛山市第一人民医院心内科行冠状动脉介入治疗的患者共662例,入院时抽取静脉血测定NT-proBNP,入院当天以及术后第1天、术后第2天连续测定血清肌酐评估使用对比剂后CIN的发生率,并根据患者的临床及实验室指标计算Mehran积分。结果共有49例(7.4%)患者发生CIN,与非CIN患者相比,CIN患者年龄更大,更多合并高血压和糖尿病,术中对比剂的用量也更多(P <0.05),CIN患者的NT-proBNP和Mehran评分显著高于非CIN患者(P <0.05)。ROC曲线分析显示NT-proBNP和Mehran评分预测CIN的价值差异无统计学意义(P> 0.05)。多因素分析显示NT-proBNP是CIN的独立危险因素(OR=14.220,95%CI:6.629~30.506,P <0.001)。结论 NT-proBNP是择期冠脉介入术后发生CIN的独立危险因素,其预测CIN的能力与经典的Mehran评分类似。

Objective To evaluate the predictive value of NT-proBNP for contrast induced nephropathy (CIN) after elective coronary intervention. Methods Totally 662 patients who received coronary intervention in Cardiology Department of the First People′s Hospital of Foshan between June 2017 and September 2018 were enrolled. Venous blood was extracted at admission to determine NT-proBNP,and serum creatinine was continuously measured on the day of admission and the first and second day after the procedure to assess the incidence of CIN. Mehran score was calculated according to the clinical and laboratory indicators of the patient. Results CIN occurred in 49 patients( 7.4%). Compared with non-CIN patients,CIN patients were older,m ore complicated with hypertension and diabetes,and more usage of contrast agent(P < 0.05). The NT-proBNP and Mehran score in CIN patients were significantly higher than those in non-CIN patients(P < 0.05). ROC curve analysis showed that there was no significant difference between the value of NT-proBNP and Mehran score in predicting CIN(P > 0.05). Multivariate logistic analysis showed that NT-proBNP was an independent risk factor for CIN(OR = 14.220,95% CI:6.629 ~ 30.506,P < 0.001). Conclusion NT-proBNP is an independent risk factor for CIN after selective coronary intervention,and its value to predict CIN is similar to that of Mehran score.