纤维蛋白原联合抗凝血酶Ⅲ在ACS患者介入术后对比剂肾病的预测价值

Predictive Value of Combining the Level of Fibrinogen and AntithrombinⅢfor Contrast-induced Nephropathy in ACS Patients Undergoing CAG and/or PCI

目的探讨急性冠脉综合征(acute coronary syndromes,ACS)患者行介入诊疗术后对比剂肾病(contrast-induced nephropathy,CIN)的发生率与纤维蛋白原(fibrinogen,FIB)和抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)水平的关系,并进一步比较FIB、AT-Ⅲ以及两者联合对CIN的预测价值。方法选取2019年1~10月在徐州医科大学附属医院心内科诊断为ACS并行介入诊疗的患者425例。根据患者术前FIB及AT-Ⅲ水平,将患者分为低危组、中危组、高危组,比较3组之间CIN的发生率。按照术后肌酐变化情况将所有患者分为CIN组及非CIN组,比较两组之间的临床资料以及不同水平FIB、AT-Ⅲ患者CIN的发生率。绘制ROC曲线以评价FIB、AT-Ⅲ以及两者联合水平对ACS患者冠脉诊疗术后CIN的预测价值,并采用多因素Logistic回归分析研究ACS患者介入诊疗术后CIN的影响因素。结果高纤维蛋白原、低抗凝血酶Ⅲ水平的患者具有更高的CIN发生率。两者联合预测ACS患者介入诊疗术后CIN的ROC曲线下面积为0.761(95%CI:0.717~0.800;P<0.01),敏感度为70.2%,特异性为75.1%,并且敏感度和特异性比单独使用FIB或AT-Ⅲ要高。多因素Logistic回归分析结果显示,纤维蛋白原水平(OR=0.765,95%CI:0.700~0.837)、抗凝血酶Ⅲ水平(OR=0.981,95%CI:0.967~0.996)、白蛋白水平(OR=0.981,95%CI:0.967~0.996)是ACS患者介入诊疗术后CIN的独立影响因素(P<0.05)。结论术前纤维蛋白原与抗凝血酶Ⅲ水平对介入诊疗术后发生CIN具有一定的预测价值,两者联合能提高ACS患者介入诊疗术后CIN发生预测的准确性。

Objective To explore the relationship between the incidence of contrast-induced nephropathy(CIN)and the levels of fibrinogen(FIB)and antithrombinⅢ(AT-Ⅲ)in patients with acute coronary syndrome(ACS)undergoing coronary intervention,and to analyze the predictive value of FIB,AT-Ⅲand the combination for CIN in ACS patients undergoing coronary intervention.Methods From January 2019 to October 2019,425 patients with ACS were selected from our hospital.According to the preoperative FIB and AT-Ⅲlevels,the patients were divided into low-risk group,medium-risk group,and high-risk group.All patients were divided into CIN group and non-CIN group according to the postoperative creatinine changes.The clinical data between the two groups and the incidence of CIN in patients with different levels of FIB and AT-Ⅲwere compared.The clinical data between the two groups were compared and whether the incidence of CIN in patients with different levels of FIB and AT-Ⅲwas statistically different.The ROC curve was drawn to evaluate the predictive value of FIB,AT-Ⅲ,and the combined level of CIN after coronary intervention in ACS patients,and the multivariate Logistic regression analysis was used to study the influencing factors of CIN after coronary intervention in ACS patients.Results Patients with high fibrinogen or low antithrombinⅢlevels had a higher incidence of CIN.For predicting CIN,FIB combined with AT-Ⅲshowed an area under the receiver operating characteristic curve of 0.761 with optimal cut-off value 0.118,and the sensitivity and specificity were higher than FIB or AT-Ⅲalone.Multivariate Logistic regression analysis results showed that fibrinogen,antithrombinⅢ,and albumin level were independent influencing factors of CIN in patients with ACS after coronary intervention.Conclusion Preoperative fibrinogen and antithrombinⅢlevels have certain predictive value for the occurrence of CIN after coronary intervention.The combination of the two can improve the accuracy of the prediction of CIN in ACS patients undergoing coronary intervention.