冠心病患者经皮冠状动脉介入术相关造影剂急性肾损害的影响因素分析及KIM-1、NGAL、NHE3的预测价值

Factors affecting the occurrence of contrast-induced acute kidney injury related to PCI in patients with coronary heart disease and predictive values of KIM-1, NGAL and NHE3

摘要:

目的 探究冠状动脉粥样硬化性心脏病（以下简称冠心病）患者经皮冠状动脉介入术（PCI）相关造影剂急性肾损害（CIAKI）的影响因素，并分析尿液中肾损伤分子-1（KIM-1）、中性粒细胞明胶酶相关脂质结合蛋白（NGAL）、钠/氢交换蛋白3（NHE3）预测CIAKI发生的价值。方法 回顾性分析2021年7月—2022年6月在齐齐哈尔医学院附属第一医院行PCI的142例冠心病患者的病历资料，根据患者术后是否发生CIAKI，分为CIAKI组和非CIAKI组。分析影响PCI术后发生CIAKI的因素，评估PCI前后KIM-1差值、NGAL差值及NHE3差值对PCI术后发生CIAKI的预测价值。结果 142例行PCI的冠心病患者中发生CIAKI 25例（17.61%）。CIAKI组糖尿病占比及造影剂使用剂量高于非CIAKI组（P <0.05），术前GFR水平低于非CIAKI组（P <0.05）。CIAKI组手术前后尿KIM-1、NGAL及NHE3的差值均高于非CIAKI组（P <0.05）。多因素逐步Logistic回归分析结果显示：糖尿病［O^R=3.350（95% CI：1.145，9.802）］、造影剂使用剂量［O^R=3.377（95% CI：1.154，9.880）］、KIM-1差值［O^R=4.958（95% CI：1.695，14.506）］、NGAL差值［O^R=4.446（95% CI：1.519，13.008）］、NHE3差值［O^R=4.446（95% CI：1.519，3.008）］是冠心病患者PCI术后发生CIAKI的危险因素（P <0.05）；GFR［O^R=0.262（95% CI：0.089，0.765）］是冠心病患者PCI术后发生CIAKI的保护因素（P <0.05）。受试者工作特征曲线分析结果表明，KIM-1差值、NGAL差值、NHE3差值单一及联合预测冠心病患者PCI术后发生CIAKI的敏感性为75.32%（95% CI：0.594，0.831）、68.59%（95% CI：0.537，0.762）、62.77%（95% CI：0.514，0.735）、80.93%（95% CI：0.629，0.924），特异性为74.01%（95%CI：0.583，0.826）、83.16%（95% CI：0.652，0.941）、78.92%（95% CI：0.603，0.875）、81.15%（95% CI：0.638，0.945），曲线下面积为0.743、0.748、0.762和0.837，联合诊断效能最高。结论 糖尿病、GFR、造影剂使用剂量和PCI前后KIM-1、NGAL、NHE3的变化影响CIAKI的发生，PCI前后KIM-1差值、NGAL差值及NHE3差值联合预测CIAKI的效能较好。

Abstract:

Objective To explore the factors affecting the occurrence of contrast-induced acute kidney injury (CIAKI) related to percutaneous coronary intervention (PCI) in patients with coronary heart disease, and to analyze the predictive values of kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and sodium-hydrogen exchanger 3 (NHE3) in the urine for the occurrence of CIAKI.Methods A retrospective analysis was conducted on medical records of 142 patients with coronary heart disease who underwent PCI in the First Affiliated Hospital of Qiqihar Medical University from July 2021 to June 2022. The patients were divided into the CIAKI group and the non-CIAKI group based on whether they developed CIAKI after PCI. The factors influencing the occurrence of CIAKI after PCI were analyzed, and the predictive values of the differences of the levels of KIM-1, NGAL and NHE3 before and after PCI for the development of CIAKI following PCI were assessed.Results Among the 142 patients with coronary heart disease who underwent PCI, 25 cases (17.61%) developed CIAKI. The proportion of patients with concomitant diabetes mellitus and the dosage of contrast agents were higher in the CIAKI group compared to the non-CIAKI group (P < 0.05). The preoperative GFR in the CIAKI group was lower than that in the non-CIAKI group (P < 0.05). The differences of urine levels of KIM-1, NGAL and NHE3 before and after PCI in the CIAKI group were greater than those in the non-CIAKI group (P < 0.05). The multivariable stepwise Logistic regression analysis (inclusion of variables with P-value < 0.05 and exclusion of variables with P-value > 0.10) revealed that presence of concomitant diabetes mellitus [O^R = 3.350 (95% CI: 1.145, 9.802) ], high dosage of contrast agents [O^R = 3.377 (95% CI: 1.154, 9.880) ], and great differences of levels of KIM-1 [O^R = 4.958 (95% CI: 1.695, 14.506) ], NGAL [O^R = 4.446 (95% CI: 1.519, 13.008) ], and NHE3 [O^R = 4.446 (95% CI: 1.519, 3.008) ] were identified as risk factors (P < 0.05), and that low preoperative GFR [O^R = 0.262 (95% CI: 0.089, 0.765) ] was identified as a protective factor for CIAKI after PCI in patients with coronary heart disease (P < 0.05). The receiver operating characteristic (ROC) curve analysis indicated that the sensitivities of the differences of levels of KIM-1, NGAL, and NHE3 alone and their combination for predicting CIAKI after PCI were 75.32% (95% CI: 0.594, 0.831), 68.59% (95% CI: 0.537, 0.762), 62.77% (95% CI: 0.514, 0.735), and 80.93% (95% CI: 0.629, 0.924), with the specificities being 74.01% (95% CI: 0.583, 0.826), 83.16% (95% CI: 0.652, 0.941), 78.92% (95% CI: 0.603, 0.875), and 81.15% (95% CI: 0.638, 0.945), and the areas under the ROC curves (AUC) being 0.743, 0.748, 0.762, and 0.837. The diagnostic efficacy of the combined detection was the highest.Conclusions Presence of diabetes mellitus, GFR, dosage of contrast agents, and changes in levels of KIM-1, NGAL and NHE3 before and after PCI affect the occurrence of CIAKI. The combination of the differences of levels of KIM-1, NGAL and NHE3 before and after PCI exhibits great predictive efficacy for CIAKI.