C反应蛋白与白蛋白及其比值对冠状动脉造影术后造影剂肾病的预测价值

Predictive value of C-reactive protein,albumin and their ratio on contrast-induced nephropathy after coronary angiography

目的探究C反应蛋白(CRP)、白蛋白(ALB)以及两者间比值(CAR)对急性冠状动脉综合征(ACS)患者行冠状动脉造影(CAG)术后发生的造影剂肾病(CIN)的早期预测价值。方法选取2019-12-01-2022-03-30在泰安市中心医院心内科住院行CAG手术的ACS患者为研究对象。入院后完善相关检查,收集患者的一般资料,以及CRP、ALB血清浓度。分别抽取患者CAG术前及术后48和72h肘静脉血并检测血肌酐值,根据CIN诊断标准,将患者分为CIN组(n=50)和非CIN组(n=591)。比较2组患者相关检测指标是否有统计学意义,分析各项指标与CIN发生的相关性,绘制受试者工作特征(ROC)曲线,并评估CAR对CIN发生的早期预测价值。结果CIN发病率为7.8%(50/641),CIN组CRP(Z=0.007,P<0.001)、ALB(Z=0.003,P<0.001)、CAR(Z=0.005,P<0.001)水平高于非CIN组,差异有统计学意义。Spearman相关分析结果显示,CAG术后CIN的发生与CRP(r=0.493,P<0.001)、CAR(r=0.279,P<0.001)的水平呈正相关,与ALB(r=-0.335,P<0.001)的水平呈负相关。logistic回归分析结果显示,CRP(OR=1.288,P<0.001,95%CI:1.170~1.417)、CAR(OR=0.234,P=0.026,95%CI:0.065~0.839)和ALB(OR=0.634,P<0.001,95%CI:0.539~0.747)是预测CAG术后CIN发生的独立危险因素。ROC曲线结果显示,CRP曲线下面积为0.934,截断点为6.15,灵敏度为96.0%,特异度为74.5%;ALB曲线下面积0.930,截断点为39.45,灵敏度为88.3%,特异度为86.0%;CAR曲线下面积为0.968,截断点为0.21,灵敏度为94.0%,特异度88.5%。结论CAR可作为早期预测CAG术后CIN发生的血清标志物,且具有较高的灵敏度及特异度。

Objective To explore the predictive value of C-reactive protein(CRP),albumin(ALB),and their ratio(CAR)for contrast-enhanced nephropathy(CIN)after coronary angiography(CAG)in patients with acute coronary syndrome(ACS).Methods ACS patients who underwent CAG surgery in the Cardiology Department of Taian Central Hospital from December 1,2019to March 30,2022were selected as the research subjects.After admission,relevant examinations were completed and general information,CRP and ALB serum concentrations of patients were collected.Venous blood samples were taken from the patients 48and 72hours before and after CAG,and serum creatinine levels were measured.Patients were randomly divided into CIN group(n=50)and non CIN group(n=591)based on the diagnostic criteria of CIN.Finally,the statistical significance of the relevant detection indicators in the two patient groups was compared,and correlation between various indicators and CIN occurrence was analysed.The receiver operating characteristic(ROC)curve was drawn and the early evaluative value of the CAR for CIN occurrence was assessed.Results The incidence rate of CIN was 7.8%(50/641).The levels of CRP(Z=0.007,P<0.001),ALB(Z=0.003,P<0.001)and CAR(Z=0.005,P<0.001)in CIN group were higher than those in non CIN group,with statistical significance.The Spearman correlation analysis results showed that the occurrence of CIN after CAG was positively correlated with the levels of CRP(r=0.493,P<0.001)and CAR(r=0.279,P<0.001),and negatively correlated with the levels of ALB(r=-0.335,P<0.001).The results of logistic regression analysis showed that CRP(OR=1.288,P<0.001,95%CI:1.170-1.417),CAR(OR=0.234,P=0.026,95%CI:0.065-0.839),and ALB(OR=0.634,P<0.001,95%CI:0.539-0.747)were independent risk factors for predicting the occurrence of CIN after CAG surgery.According to the ROC curve,the area under the CRP curve was 0.934,with a cutoff point of 6.15,the susceptibility of 96.0%,and specificity of 74.5%;the area under,the ALB curve was 0.930,with a cutoff point of 39.45,the susceptibility of 88.3%,and the specificity of 86.0%;the area under the CAR curve was 0.968,with a cutoff point of 0.21,the susceptibility of 94.0%,and the specificity of 88.5%.Conclusion CAR can serve as a serum marker for early prediction of CIN occurrence after CAG surgery,and has high sensitivity and specificity.