王小明　　彭四萍　廖洁

[摘要] 目的 探讨血中性粒细胞明胶酶相关性载脂蛋白（NGAL）、肝型脂肪酸结合蛋白（L-FABP）、胱抑素C（CysC）早期预测绝经期妇女经皮冠脉介入（PCI）术后对比剂肾病（CIN）。 方法 选择2018年6月至2020年9月我院收治的绝经期妇女PCI术后CIN患者80例为试验组，同期在我院行PCI术治疗且术后无CIN发生的绝经期妇女80例为对照组。对比两组NGAL、L-FABP、CysC差异，分析NGAL、L-FABP、CysC早期预测绝经期妇女PCI术后CIN价值。 结果 试验组NGAL、L-FABP、CysC水平高于对照组，差异有统计学意义（P<0.05）;NGAL早期预测绝经期妇女PCI术后CIN的曲线下面积（AUC）为0.919，敏感度和特异度分别为88.96%、87.01%;L-FABP早期预测绝经期妇女PCI术后CIN的AUC为0.851，敏感度和特异度分别为85.95%、88.11%;CysC早期预测绝经期妇女PCI术后CIN的AUC为0.922，敏感度和特异度分别为83.24%、94.68%。 结论 血NGAL、L-FABP、CysC均是早期预测绝经期妇女PCI术后CIN的有效指标，可作为诊断CIN的“肌钙蛋白”。

[关键词] 绝经期妇女;对比剂肾病;经皮冠脉介入;中性粒细胞明胶酶相关性载脂蛋白;胱抑素C;肝型脂肪酸结合蛋白

[中图分类号] R587.2          [文献标识码] A          [文章編号] 1673-9701（2021）13-0021-04

Value of serum NGAL， L-FABP and CysC in early prediction of CIN of menopausal women after PCI

WANG Xiaoming1   PENG Siping2   LIAO  Jie1

1.Medical Laboratory， Pingxiang People′s Hospital in Jiangxi Province， Pingxiang   337000， China; 2.Department of Cardiovascular Internal Medicine， Pingxiang People′s Hospital in Jiangxi Province， Pingxiang   337000， China

[Abstract] Objective To explore the value of serum neutrophil gelatinase-associated apolipoprotein （NGAL）， liver fatty acid binding protein （L-FABP） and cystatin C （CysC） in the early prediction of contrast-induced nephropathy （CIN） for menopausal women after percutaneous coronary intervention（PCI）. Methods A total of 80 menopausal women with CIN after PCI in our hospital from June 2018 to September 2020 were selected as the experimental group， while 80 menopausal women without CIN after PCI in our hospital at the same time were selected as the control group. The differences of NGAL， L-FABP and CysC between the two groups were compared， and the value of NGAL， L-FABP and CysC in the early prediction of CIN of menopausal women after PCI was analyzed. Results The levels of NGAL， L-FABP and CysC were higher in the experimental group than those in the control group， and the differences were statistically significant （P<0.05）. The area under curve （AUC） of NGAL for early prediction of CIN in menopausal women after PCI was 0.919， and the sensitivity and specificity were 88.96% and 87.01%，respectively. The AUC of L-FABP for early prediction of CIN in menopausal women after PCI was 0.851， and the sensitivity and specificity were 85.95% and 88.11%，respectively. The AUC of CysC for early prediction of CIN in menopausal women after PCI was 0.922， and the sensitivity and specificity of 83.24% and 94.68%， respectively. Conclusion Serum NGAL， L-FABP and CysC are all effective indicators for early prediction of CIN in menopausal women after PCI， and can be used as “troponin” for diagnosis of CIN.

[Key words] Menopausal women; Contrast agent nephropathy; Percutaneous coronary intervention; Neutrophil gelatinase-associated apolipoprotein; Cystatin C; Liver fatty acid binding protein

经皮冠脉介入（Percutaneous coronary intervention，PCI）是临床常用治疗手段，因血管内对比剂的使用增加会增加对比剂肾病（Contrast induced nephropathy，CIN）发生的风险[1]。CIN多由大剂量高渗性含碘造影剂所致，临床症状为尿中出现尿酸盐结晶、肾小管上皮细胞等，能够损害患者消化、循环系统，严重时可诱发肾衰竭、呼吸衰竭等并发症，甚至危及生命安全[2]。因此，早期准确预测CIN，尽早给予患者相应的治疗措施，对改善患者预后至关重要。因受蛋白摄入量、药物等因素影响，临床常用的血清肌酐（Serum creatinine，Scr）诊断滞后于实际肾小球滤过率的改变，一般在术后24 h出现水平升高，难以早期反映肾损伤[3]。血中性粒细胞明胶酶相关性载脂蛋白（Neutrophil gelatinase-associated lipocalin，NGAL）、肝型脂肪酸结合蛋白（Liver fatty acid binding protein，L-FABP）、胱抑素C（Cystatin C，CysC）等腎标志物指标逐渐受到临床关注。本研究分析血NGAL、L-FABP、CysC早期预测绝经期妇女PCI术后CIN，为临床早期诊断和治疗提供参考，现报道如下。……