血清GDF-11、S100A4对冠状动脉造影术后对比剂肾病的预测效能

Predictive efficacy of serum GDF-11 and S100A4 for contrast-induced nephropathy after coronary angiography

目的探讨血清生长分化因子11(GDF-11)、钙卫蛋白A4(S100A4)对冠状动脉造影(CAG)术后对比剂肾病(CIN)的预测效能。方法选取2020年12月至2023年11月于西安交通大学第一附属医院行CAG术的528例患者为研究对象,根据患者是否发生CIN将其分为非肾病组(472例)与肾病组(56例)。采用酶联免疫吸附试验检测血清GDF-11、S100A4水平,采用多因素Logistic回归分析探讨CAG术后CIN的影响因素,采用受试者工作特征(ROC)曲线评估血清GDF-11、S100A4对CAG术后CIN的预测价值。结果肾病组血清GDF-11、S100A4水平高于非肾病组(P<0.05)。肾病组对比剂剂量、术后血肌酐水平高于非肾病组(P<0.05)。多因素Logistic回归分析显示,对比剂剂量≥131.84 mL(OR=2.158,95%CI 1.284~3.627)、术后血肌酐≥87.57μmol/L(OR=2.445,95%CI 1.533~3.898)、GDF-11≥450.84 ng/mL(OR=3.043,95%CI 1.789~5.177)是CAG术后发生CIN的影响因素(P<0.05)。血清GDF-11、S100A4预测CAG术后CIN的曲线下面积(95%CI)分别为0.861(95%CI 0.810~0.912)、0.798(95%CI 0.747~0.849),最佳临界值分别为450.84 ng/mL、86.98 pg/mL,特异度分别为65.89%、57.62%,灵敏度分别为94.74%、94.74%,二者联合诊断的曲线下面积为0.906(95%CI 0.856~0.957),特异度为87.09%,灵敏度为84.26%。结论血清GDF-11、S100A4水平升高与CAG术患者术后发生CIN密切相关,可作为评估CAG术患者术后发生CIN的生物学指标,且二者联合预测的效能更高。

Objective To investigate the predictive value of serum growth differentiation factor 11(GDF-11)and calprotectin A4(S100A4)for contrast-induced nephropathy(CIN)after coronary angiography(CAG).Methods A total of 528 patients who underwent CAG in the First Affiliated Hospital of Xi′an Jiaotong University from December 2020 to November 2023 were selected as the research objects.According to whether the patients had CIN,they were divided into non-nephropathy group(472 cases)and nephropathy group(56 cases).Enzyme-linked immunosorbent assay was used to detect serum levels of GDF-11 and S100A4.Multivariate Logistic regression analysis was used to explore the influencing factors of CIN after CAG.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum GDF-11 and S100A4 for CIN after CAG.Results The serum levels of GDF-11 and S100A4 in nephropathy group were higher than those in non-nephropathy group(P<0.05).The contrast agent dose and postoperative serum creatinine level in the nephropathy group were higher than those in the non-nephropathy group(P<0.05).Multivariate Logistic regression analysis showed that contrast agent dose≥131.84 mL(OR=2.158,95%CI 1.284—3.627),postoperative serum creatinine≥87.57μmol/L(OR=2.445,95%CI 1.533—3.898),GDF-11≥450.84 ng/mL(OR=2.445,95%CI 1.533—3.898)were the influencing factors of CIN after CAG(P<0.05).The area under the curve(95%CI)of serum GDF-11 and S100A4 for predicting CIN after CAG was 0.861(95%CI 0.810—0.912)and 0.798(95%CI 0.747—0.849),respectively.The optimal cut-off values were 450.84 ng/mL and 86.98 pg/mL,the specificity were 65.89%and 57.62%,and the sensitivity were 94.74%and 94.74%,respectively.The area under the curve of the combination of the two was 0.906(95%CI 0.856—0.957),the specificity was 87.09%,and the sensitivity was 84.26%.Conclusion The elevated levels of serum GDF-11 and S100A4 are closely related to the occurrence of CIN in patients after CAG surgery,which can be used as biological indicators to evaluate the occurrence of CIN in patients after CAG surgery,and the combined prediction efficiency of GDF-11 and S100A4 is higher.