冠心病介入治疗患者血尿肾损伤标志物与对比剂肾病关系及不良事件预测价值

The relationship between blood and urine kidney injury markers and contrast medium nephropathy in patients with coronary heart disease interventional therapy and the predictive value for adverse events

目的探讨冠心病介入治疗患者血、尿肾损伤标志物与对比剂肾病(CIN)关系及不良事件预测价值。方法选取2017年7月至2019年12月新疆医科大学第二附属医院冠心病介入治疗患者200例,根据是否发生CIN分为CIN组(34例)和非CIN组(166例),比较两组患者的一般资料、尿微量白蛋白(MA)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、血NGAL及胱抑素C(CysC)水平,采用logistic回归分析CIN发生相关因素,采用Cox回归模型分析预后不良事件相关因素,采用受试者工作特征(ROC)曲线分析尿MA、NGAL、血NGAL、Cys-C水平对预后不良事件的预测价值。结果CIN组对比剂剂量(139.41±36.09)ml及术后1 d、术后2 d尿MA[(28.56±3.58)mg/L、(29.35±4.37)mg/L]、NGAL[(3.08±1.32)mg/L、(2.75±1.41)mg/L]、血NGAL[(162.15±39.68)μg/L、(171.56±44.37)μg/L]、Cys-C[(4.36±1.58)mg/L、(5.31±1.76)mg/L]水平高于非CIN组(117.05±32.38)ml、[(26.08±3.16)mg/L、(26.37±3.25)mg/L]、[(1.95±0.89)mg/L、(1.89±0.92)mg/L]、[(105.26±19.74)μg/L、(96.09±15.28)μg/L]、[(2.94±0.79)mg/L、(2.67±1.06)mg/L](t/P值=3.597/<0.001,4.074/<0.001,4.573/<0.001,6.157/<0.001,4.487/<0.001,12.472/<0.001,17.536/<0.001,7.796/<0.001,11.636/<0.001);Logistic回归分析显示,高剂量对比剂及术后1 d、术后2 d尿MA均为冠心病介入治疗患者发生CIN的独立危险因素(P<0.05);Cox回归分析显示,校正年龄、支架数、对比剂剂量后,术后1 d、术后2 d尿MA、NGAL、血NGAL、Cys-C高表达均为预后不良事件发生的独立危险因素(P<0.05);ROC曲线显示,术后1 d尿MA、NGAL、血NGAL、Cys-C联合预测及术后2 d尿MA、NGAL、血NGAL、Cys-C联合预测预后不良的AUC值分别为0.920、0.946。结论冠心病介入治疗患者术后1 d、2 d尿MA、NGAL、血NGAL、Cys-C高表达均为CIN发生有关,且是预后不良事件的独立危险因素,在预测不良预后中具有较高价值,临床可动态观察上述指标变化,以及时发现异常,制定措施。

Objective To investigate the relationship between blood and urine kidney injury markers and contrast-induced nephropathy(CIN)and the predictive value of adverse events in patients with coronary heart disease who underwent interventional therapy.Methods A total of 200 patients with coronary heart disease undergone interventional therapy in the Second Affiliated Hospital of Xinjiang Medical University from July 2017 to December 2019 were selected and divided into CIN group(n=34)and the non-CIN group(n=166)according to whether CIN occurred.The general data,urine MA,NGAL,blood NGAL and Cys-C levels were compared between the two groups.Logistic regression was used to analyze the related factors of CIN.Cox regression model was used to analyze the prognostic factors related to adverse events.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of urine MA,NGAL,blood NGAL and Cys-C levels for prognostic adverse events.Results The contrast agent dose(139.41±36.09)ml,urine MA[(28.56±3.58)mg/L,(29.35±4.37)mg/L],NGAL[(3.08±1.32)mg/L,(2.75±1.41)mg/L],blood NGAL[(162.15±39.68)μg/L,(171.56±44.37)μg/L]and Cys-C[(4.36±1.58)mg/L,(5.31±1.76)mg/L]levels in the CIN group 1 d and 2 d after the operation were higher than those in the control group(117.05±32.38)ml,[(26.08±3.16)mg/L,(26.37±3.25)mg/L],[(1.95±0.89)mg/L,(1.89±0.92)mg/L],[(105.26±19.74)μg/L,(96.09±15.28)μg/L],[(2.94±0.79)mg/L,(2.67±1.06)mg/L](t/P=3.597/<0.001,4.074/<0.001,4.573/<0.001,6.157/<0.001,4.487/<0.001,12.472/<0.001,17.536/<0.001,7.796/<0.001,11.636/<0.001).Logistic regression analysis showed that high-dose contrast media,urine MA,NGAL,blood NGAL and Cys-C at 1 and 2 days after the operation were independent risk factors for CIN in the patients(P<0.05).Cox regression analysis showed that adjusted age,number of stents,and contrast agent dose,high expressions of urinary MA,NGAL,blood NGAL and Cys-C were all the independent risk factors for the adverse prognosis(P<0.05).The ROC curve showed that the combined prediction of urine MA,NGAL,blood NGAL and Cys-C at 1 day after operation and the combined prediction of poor prognosis by urine MA,NGAL,blood NGAL and Cys-C at 2 days after operation were respectively 0.920 and 0.946.Conclusion The high expressions of urine MA,NGAL blood NGAL and Cys-C in the patients with coronary heart disease undergone interventional therapy are related to the occurrence of CIN and it is the independent risk factors for the adverse prognostic events.