联合检测血清GDF-15、Cys-C水平对经皮冠状动脉介入治疗后发生造影剂肾病的预测价值

Predictive value of combined detection of growth differentiation factor-15 and cystatin C to contrastinduced nephropathy in CHD patients after PCI

目的探讨联合检测血清生长分化因子15(GDF-15)、胱抑素C(Cys-C)水平对经皮冠状动脉介入治疗(PCI)后发生造影剂肾病(CIN)的预测价值。方法选取承德市中心医院心内科于2017年1月至2019年12月收治的301例住院行PCI患者,根据是否发生CIN分为2组,CIN组48例,NCIN组253例,测定所有患者的血清肌酐(Scr)、GDF-15、Cys-C水平,计算肾小球滤过率(GFR);对比两组患者血清Scr、GDF-15、Cys-C水平和GFR,Pearson相关性分析血清GDF-15、Cys-C水平与Scr、GFR的相关性,多因素Logistic回归分析PCI后CIN发生因素,绘制受试者工作特征(ROC)曲线,评价GDF-15联合Cys-C对PCI后CIN的预测价值。结果CIN组血清Scr、GDF-15、Cys-C水平明显高于NCIN组,GFR明显低于NCIN组(P<0.05);Pearson相关性分析显示,血清GDF-15、Cys-C水平与Scr水平呈正相关性,与GFR呈负相关(P<0.05);多因素Logistic回归分析显示,Scr、GDF-15、Cys-C为PCI后CIN发生独立影响因素;ROC曲线显示,GDF-15联合Cys-C对PCI后CIN的灵敏度、特异度及曲线下面积(AUC)均高于Cys-C、GDF-15单独检测。结论CHD患者PCI后CIN者血清GDF-15、Cys-C水平明显提升,为其独立影响因素,联合检测灵敏度和特异度高,可作为CHD患者PCI后CIN预测指标。

Objective To investigate the predictive value of combined detection of growth differentiation factor-15(GDF-15)and cystatin C(Cys C)to contrast-induced nephropathy(CIN)in patients with coronary heart disease(CHD)after PCI.Methods CHD patients(n=301)undergone PCI were chosen from Department of Cardiology in Central Hospital of Chengde City from Jan.2017 to Dec.2019,and divided,according to whether CIN incidence or not,into CIN group(n=48)and non-CIN group(NCIN group,n=253).The levels of serum creatinine(SCr),GDF-15 and Cys-C were detected,and glomerular filtration rate(GFR)was calculated in 2 groups.Scr,GDF-15,Cys-C and GFR were compared between 2 groups.The correlation among GDF-15,Cys-C,Scr and GFR were analyzed by using Pearson correlation analysis.The risk factors of CIN after PCI were analyzed by using multi-factor Logistic regression analysis,and predictive value of combined detection of GDF-15 and Cys-C to CIN after PCI was reviewed after drawing ROC curve.Results The levels of Scr,GDF-15 and Cys-C were significantly higher,and GFR was significantly lower in CIN group than those in NCIN group(P<0.05).The results of Pearson correlation analysis showed that GDF-15 and Cys-C were positively correlated to Scr,and negatively correlated to GFR(P<0.05).The results of multi-factor Logistic regression analysis showed that Scr,GDF-15 and Cys-C were independent influence factors of CIN after PCI.The results of ROC curve analysis showed that combined detection of GDF-15 and Cys-C had higher sensitivity,specificity and AUC in predicting CIN after PCI than single detection of Cys-C or single detection of GDF-15.Conclusion The levels of GDF-15 and Cys-C increase significantly in CHD patients with CIN after PCI,and they are independent influence factors of CIN.The combined detection of GDF-15 and Cys-C has higher sensitivity and specificity,which can be taken as predictive indexes for CHD patients with CIN after PCI.