血清胱抑素C、视黄醇结合蛋白在冠脉介入术后造影剂肾病诊断中的预测价值

Predictive value of serum cystatin C and retinol-binding protein in contrast-induced nephropathy after percutaneous coronary intervention

目的探讨血清胱抑素C(Cys-C)、视黄醇结合蛋白(RBP)在冠脉介入术后造影剂肾病诊断中的预测价值。方法入选经皮行冠脉介入(PCI)术的患者219例,造影剂肾病(CIN)定义为应用含碘造影剂造影后72h内血清肌酐(Scr)值比造影前基础水平上升25%或者达到44.2μmol/L。将符合标准的对象分为两组(CIN组和Non-CIN组),通过比较两组间的临床资料探讨血清Cys-C、RBP与CIN的相关性。结果①CIN组患者女性居多,年龄更大,使用造影剂剂量更大,糖尿病比例、RDW、Hb A1c、UA、Cys-C、RBP、基线Scr及术后72h内Scr水平均高于Non-CIN组,同时RBC、HGB、TBIL和e GFR水平均低于Non-CIN组,差异有统计学意义(P<0.05);②Cys-C、RBP与Scr均呈正相关(r=0.291,P<0.001;r=0.195,P=0.004),Cys-C、RBP与e GFR均呈负相关(r=-0.394,P<0.001;r=-0.154,P=0.022);③多因素Logistic回归分析显示,Cys-C、RBP、Scr、性别均为CIN发生的独立危险因素。结论血清Cys-C、RBP在PCI术后CIN诊断中有较高的预测价值。

Objective To investigate the predictive value of serum cystatin C(Cys-C)and retinol-binding protein(RBP)in contrast-induced nephropathy after percutaneous coronary intervention.Methods The 219 patients with percutaneous coronary intervention(PCI)were enrolled in the study,contrast-induced nephropathy(CIN)was defined as an increase in serum creatinine(Scr)by 25%or 44.2μmol/L within 72 h after contrast with iodine.The objects meeting the standard were divided into two groups(CIN group and Non-CIN group)and clinical data between the two groups were compared to explore the correlation between serum Cys-C,RBP and CIN.Results①Patients in CIN group were older.They used more contrast mediums.The proportion of diabetes,RDW,HbA1 c,BUN,UA,Cys-C,RBP,baseline Scr and Scr within 72 h after surgery were all higher than those in Non-CIN group.The levels of RBC,HGB,TBIL and e GFR in CIN group were all lower than those in Non-CIN group(P<0.05);②Cys-C and RBP were positively correlated with SCr(r=0.291,P<0.001;r=0.195,P=0.004),Cys-C and RBP were negatively correlated with e GFR(r=-0.394,P<0.001;r=-0.154,P=0.022);③Multivariate logistic regression analysis showed that Cys-C,RBP,Scr and gender were independent risk factors for CIN.Conclusion Serum Cys-C and RBP have high value in early prediction and diagnosis of CIN.