uNGAL对老年冠心病患者对比剂肾病的早期评估

uNGAL for early evaluation of contrast-induced nephropathy in elderly patients with coronary heart disease

目的探讨尿中性粒细胞明胶酶相关载脂蛋白(uNGAL)的测定对老年冠心病(CHD)患者经皮冠状动脉造影及介入术后对比剂肾病(CIN)的早期诊断价值。方法连续入选2017年6月至2019年1月于河北医科大学第一医院心内科住院择期行冠脉造影及经皮冠状动脉介入治疗(PCI)术的CHD患者348例。分别检测术前、术后4、24小时uNGAL及血清肌酐(Scr)水平。根据术后是否发生CIN,将患者分为CIN组和非CIN组,根据年龄分为老年组(≥60岁)和中青年组(<60岁),分别计算各组uNGAL及Scr变化情况。结果348例CHD患者中58例发生了CIN,CIN组年龄、糖尿病病史、Merhan评分(≥60岁)、置入支架数和应用造影剂剂量均高于非CIN组。老年CIN组与非CIN组Scr水平在术后24小时差异有统计学意义(P<0.05),uNGAL水平在术后4小时及24小时差异均有统计学意义(P<0.05)。中青年CIN组与非CIN组间uNGAL水平在术后24小时差异有统计学意义(P<0.05)。术后4小时uNGAL诊断CIN的曲线下面积为0.658,界值为47.50 ng/ml,灵敏度为0.661,特异度为0.686。结论经皮冠状动脉介入术后早期uNGAL水平即有升高,尤其对老年CHD患者CIN的早期诊断具有较高的灵敏度和特异度,可以作为其早期诊断CIN的参考指标。

Objective To investigate the early diagnostic value of urinary neutrophil gelatinase-associated lipocalin(uNGAL)in contrast-induced nephropathy(CIN)in elderly patients with coronary heart disease(CHD)after percutaneous coronary angiography and intervention.Methods A total of 348 CHD patients who underwent selective coronary angiography and percutaneous coronary intervention(PCI)in the First Hospital of Hebei Medical University from June 2017 to January 2019 were selected.The levels of uNGAL and serum creatinine(Scr)of patients were assessed before the surgery,4 and 24 hours after the surgery.According to whether CIN occurred after the surgery,the patients were divided into CIN group and non-CIN group,and they were divided into the elderly group(≥60 years old)and the young and middle-aged group(<60 years old).The changes of uNGAL and Scr of the two groups were calculated.Results The study included 348 patients,and 58 had CIN.Compared with patients in non-CIN group,those in CIN group were older,had longer diabetes history,higher Merhan score,more implanted stents and higher doses of contrast agent.In the elderly patients,the Scr levels of CIN group and non-CIN group 24 hours after the surgery showed significant difference(P<0.05).And the levels of uNGAL in two groups 4 hours after the surgery and 24 hours after the surgery were statistically significant(P<0.05).In the young and middle-aged patients,there was significant difference in uNGAL levels between CIN group and non-CIN group 24 hours after the surgery(P<0.05).The area under the curve of uNGAL in the diagnosis of CIN 4 hours after the surgery was 0.658,and the cutoff value,sensitivity and specificity were 47.50(ng/ml),0.661 and 0.686,respectively.Conclusion The increase of uNGAL level in early stage of percutaneous coronary intervention has high sensitivity and specificity for the diagnosis of early CIN in elderly CHD patients,and it can be used as a reference index for early diagnosis of the disease.