UACR联合血清KIM-1、NGAL对冠心病病人术后并发造影剂肾病的预测分析

Predictive analysis of UACR combined with serum KIM-1 and NGAL on postoperative contrast-induced nephropathy in patients with coronary heart disease

目的:探讨尿微量白蛋白/尿肌酐比值水平(urine micro-albumin/urinary creatinine ratio,UACR)联合血清肾损伤分子-1(kidney injury molecule-1,KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)对冠心病病人术后并发造影剂肾病(contrast-induced nephropathy,CIN)的评估价值。方法:选取162例冠心病病人,均行冠状动脉造影、经皮冠状动脉介入术,根据术后是否发生CIN分为CIN组(22例)、非CIN组(140例)。比较2组病人临床基线资料以及术后24 h的UACR、血清KIM-1、NGAL水平,采用多因素logistic回归分析CIN发生的危险因素,采用受试者工作特征曲线(ROC曲线)分析UACR、KIM-1、NGAL预测CIN的诊断价值。结果:CIN病人术后24 h的NGAL、血清KIM-1、UACR水平以及术前尿肌酐均高于非CIN组,而术前肾小球滤过率低于对照组,差异有统计学意义(P<0.05~P<0.01)。多因素logistic回归分析显示,UACR、KIM-1、NGAL升高均是CIN发生的危险因素(P<0.01)。ROC曲线分析显示,NGAL、KIM-1、UACR以及联合诊断预测CIN的曲线下面积分别为0.826、0.801、0.790、0.886,联合诊断的曲线下面积明显高于单独诊断,差异有统计学意义(P<0.05)。结论:UACR以及血清KIM-1、NGAL是冠心病病人术后发生CIN的独立危险因素,发生CIN的高风险病人各指标均处于较高水平,三种指标联合检测可提高CIN的预测价值。

Objective:To investigate the evaluation value of urine micro-albumin/urinary creatinine ratio(UACR)combined with serum kidney injury molecule-1(KIM-1)and neutrophil gelatinase-associated lipocalin(NGAL)on postoperative contrast-induced nephropathy(CIN)in patients with coronary heart disease.Methods:One hundred and sixty-two patients with coronary heart disease were selected.All patients underwent coronary angiography and percutaneous coronary intervention.According to the occurrence of CIN after operation,they were divided into CIN group(22 cases)and non-CIN group(140 cases).The baseline data,UACR,serum KIM-1 and NGAL levels at 24 h after operation were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors of CIN.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of UACR,KIM-1 and NGAL in predicting CIN.Results:The levels of NGAL,serum KIM-1,UACR and preoperative UCr of CIN patients 24 h after operation were significantly higher than those in non-CIN group,while preoperative eGFR was significantly lower than that in control group(P<0.05 to P<0.01).Multivariate logistic regression analysis showed that the increased levels of UACR,KIM-1,NGAL were the risk factor for CIN(P<0.01).ROC curve analysis showed that the area under the curve for NGAL,KIM-1,UACR and the combined diagnosis to predict CIN were 0.826,0.801,0.790,0.886,the area under the curve of the combined diagnosis to predict CIN was significantly higher than that in the single diagnosis(P<0.05).Conclusions:UACR,serum KIM-1 and NGAL are the independent risk factors for CIN in patients with coronary heart disease after surgery.High-risk patients with CIN are all at a high level in UACR,serum KIM-1 and NGAL.The combined prediction of the three indicators can improve the predictive value of CIN.