纤维蛋白原与白蛋白的比值对于冠脉介入术后造影剂肾病的预测价值

The ratio of fibrinogen to albumin as a predictor of contrast-induced nephropathy after coronary intervention

目的探讨冠脉介入术后患者纤维蛋白原与白蛋白的比值与造影剂肾病的相关性及其预测价值。方法选取2017年1月至2018年1月在延安大学附属医院行冠脉介入患者252例,CIN患者42例,NoCIN患者210例。入选患者均于冠脉介入手术前及手术后48~72 h采集静脉血。对两组一般资料进行比较,利用单因素及多因素Logistic回归分析CIN的独立危险因素,相关分析采用Spearman分析,利用ROC曲线分析PLR、NLR及FAR对CIN的预测价值。结果CIN组与NoCIN组相比较,年龄、糖尿病比例、SCr、空腹血糖和FAR、NLR、PLR三比值明显升高,血清白蛋白明显下降(P<0.05)。单因素Logistic回归分析提示年龄、纤维蛋白原、白蛋白、糖尿病及其上述各比值均为CIN的独立危险因素(P<0.05)。多元Logistic回归分析提示年龄、糖尿病及上述各比值均为CIN的独立危险因素(P<0.05)。Spearman相关分析提示上述各比值和年龄均呈正相关(P<0.05)。FAR预测CIN的ROC曲线下面积为0.802,它的最佳截止值、敏感性、特异性、阳性预测值和阴性预测值分别为57.3%、75.1%、61.2%、26.7%和93.1%。结论FAR水平升高与冠脉介入患者CIN的发生与发展密切相关,对CIN的预测价值较高。

Objective To investigatethe correlation and predictive value of the fibrinogen to albumin ratio to determine the risk of CIN in patients who underwent coronary intervention.Methods 252 patients who underwent coronary intervention in the Affiliated Hospital of Yanan University between January 2017 and January 2018 were included in the study,including 42 CIN patients and 210 no CIN patients.All patients in this study were collected venous blood 48~72 hours before and after coronary intervention.The general data of the two groups were compared to analyze the independent risk factors of CIN by univariate and multivariate logistic regression.Spearman analysis was used for correlation analysis.The predictive value of PLR,NLR and FAR to CIN was analyzed by ROC curve.Results Compared with no CIN group,age,diabetes proportion,SCr,fasting blood sugar,FAR,NLR and PLR in CIN group increased significantly,while serum albumin decreased significantly(P<0.05).Univariate Logistic regression analysis showed that age,fibrinogen,albumin,FAR,diabetes mellitus,PLR and NLR were independent risk factors for CIN(P<0.05).Multivariate logistic regression analysis showed that age,FAR,diabetes mellitus,PLR and NLR were independent risk factors for CIN(P<0.05).Multivariate logistic regression analysis showed that age,FAR,diabetes mellitus,PLR and NLR were independent risk factors for CIN(P<0.05).Spearman correlation analysis showed that FAR was positively correlated with NLR,PLR and age(P<0.05).The area under ROC curve of FAR predicted CIN was 0.802.The best cut-off value,sensitivity,specificity,positive predictive value and negative predictive value were 57.3%,75.1%,61.2%,26.7%and 93.1%,respectively.Conclution The increase of FAR level is closely related to the occurrence and development of CIN in patients undergoing coronary intervention,and FAR has a high predictive value for CIN.