樊秀芳，靳团娥，王浩

(内蒙古医科大学附属医院，内蒙古 呼和浩特　010050)



胱抑素C及超敏C反应蛋白对经皮冠状动脉介入术后造影剂肾病的预测价值

樊秀芳，靳团娥，王浩

(内蒙古医科大学附属医院，内蒙古 呼和浩特010050)

目的：探讨经皮冠状动脉介入术前胱抑素C(Cys-C)及超敏C反应蛋白(high sensitivity C reactive protein，Hs-CRP)水平对术后发生造影剂肾病(contrast-induced nephropathy，CIN)的预测价值。方法：选择2015年1月至2015年10月本院心内科208例行经皮冠状动脉介入术的急性心肌梗死(acute myocardial infarction,AMI)患者，根据术后CIN的诊断标准将患者分为CIN组和非CIN组,并对CIN的相关危险因素进行多因素Logistic回归分析，利用ROC曲线分析相关指标的预测价值。结果：(1)208例患者中有36例发生CIN，发病率17.30%。(2)Pearson相关分析显示，术前Cys-C、Hs-CRP水平与术后血清肌酐(serum creatinine，Scr)呈正相关(P<0.01)。(3)单因素分析示，CIN和非CIN两组间术前Cys-C、Hs-CRP、对比剂(contrast medium，CM)剂量>200 mL及糖尿病病史差异有统计学意义(P<0.05)；多因素Logistic回归分析示，术前Cys-C、hs-CRP、CM剂量>200 mL及糖尿病病史是术后发生CIN的独立危险因素(P<0.05)。(4)ROC曲线示，Cys-C曲线下面积为0.810，最佳阈值为1.335 mg/L,敏感度为0.806，特异度为0.692；Hs-CRP曲线下面积为0.774，最佳阈值为7.750 mg/L,敏感度为0.722，特异度为0.860。结论：经皮冠状动脉介入术前联合Cys-C及Hs-CRP对术后CIN的诊断具有较高的预测价值。

胱抑素C；超敏C反应蛋白；经皮冠状动脉介入；造影剂肾病

【Abstract】Objective：To observe the predictive value of cystatin C(Cys-C)high sensitivity C reactive protein (Hs-CRP)to contrast-induced nephropathy (CIN)after percutaneous coronary intervention(PCI).Methods：208 cases of acute myocardial infarction(AMI)enrolled to our hospital with PCI from January 2015 to October 2015.Patients were divided into two groups according to the diagnostic criteria of CIN: CIN group and non CIN group.A multi-factor Logistic regression was performed to analyze the risk factors associated with the incidence of CIN,and the predictive value was verified on the risk factors by Receiver operating characteristic(ROC)curve.Results：(1)A total of 208 patients were enrolled,including 36 patients had CIN,the incidence of CIN was 17.30%.(2)Pearson correlation analysis indicated that postoperative serum creatinine(Scr)was positively correlated with preoperative Cys-C and Hs-CRP (P<0.01).(3)Univariate analysis showed that preoperative Cys-C,Hs-CRP,dose of contrast medium(CM)>200 mL and diabetes were significantly different between the two groups (P<0.05).(4)Multi-factor Logistic regression indicated that Cys-C,dose of CM>200 mL and diabetes were the independent risk factors for the onset of CIN (P<0.05).(4)ROC curve analysis revealed that the optimal cutoff of Cys-C to predict CIN is 1.335 mg/L (AUC=0.810,sensitivity 0.806,specificity 0.692),and the optimal cutoff of Hs-CRP to predict CIN is 7.750mg/L (AUC=0.774,sensitivity 0.722,specificity 0.860).Conclusion：It is proved that the therapy of Cys-C combined with Hs-CRP had a higher value in the early prediction in CIN before PCI.

目前，经皮冠脉支架介入治疗术(percutaneous coronary intervention，PCI)在各大型医院普遍开展，已作为治疗急性心肌梗死(acute myocardial infarction，AMI)患者的重要手段之一。同时，含碘对比剂(contrast medium，CM)在PCI术中使用也越来越广泛，但CM的肾毒性使得PCI术后患者易引起急性肾功能损害—造影剂肾病(contrast-induced nephropathy，CIN)的发生率增高。Jorgensen[1]对一般人群使用造影剂后，结果显示CIN的发病率高于2%。一旦出现CIN，将增加患者住院时间及医疗费用，且患者预后不佳，严重者需血液或腹膜透析治疗。故早期预防、早期预测CIN已成为临床医护人员关注的重点，尤其是合并有慢性肾病、心功能不全及高龄患者，其CIN的发病率可高达20%～50%[2]。……