术前血清胱抑素C、超敏C 反应蛋白对PCI 术后造影剂肾病的预测价值*

The predictive value of preoperative cystatin C and high-sensitivity C-reactive protein in the occurrence of contrast-induced nephropathy after percutaneous coronary intervention*

摘要:

目的 探讨术前24 h血清胱抑素C（CysC）及超敏C反应蛋白（hs-CRP）对经皮冠状动脉介入术 （PCI）后造影剂肾病的预测价值。方法 选取2019年6月—2020年3月在河北中石油中心医院行PCI治疗的128例 冠状动脉硬化性心脏病（以下简称冠心病） 患者为研究对象，根据术后造影剂肾病诊断结果，将其分为病例组 （23例）和对照组（105例）。采用全自动生化分析仪测定两组术前24 h血清CysC、hs-CRP水平。采用Logistic回 归分析患者PCI术后造影剂肾病的危险因素，通过绘制受试者工作特征（ROC） 曲线评价术前24 h血清CysC、 hs-CRP及两者联合对造影剂肾病的预测价值。结果 病例组造影剂用量、合并糖尿病患者比例、术前24 h血清 CysC及hs-CRP水平高于对照组（P <0.05）。多因素Logistic回归分析显示，造影剂用量高［O＾R=1.843（95% CI： 1.322，2.758）］、合并糖尿病［O＾R =0.645（95% CI：0.510，0.892）］、术前24 h血清CysC升高［O＾R=1.801 （95% CI：1.139，2.448）］、术前24 h血清hs-CRP升高［O＾R=0.633（95%CI：0.479，0.880）］是PCI术后发生 造影剂肾病的独立危险因素（P <0.05）。术前24 h血清CysC（>1.322 mg/L）联合hs-CRP（>5.290 mg/L）预测 造影剂肾病的AUC最高，为0.916 （95% CI：0.897，0.986），敏感性为91.3% （95% CI：0.883，0.936），特异性 为82.9% （95% CI：0.795，0.850）。结论 PCI术后造影剂肾病的发生与造影剂用量、合并糖尿病情况及术前 24 h血清CysC、hs-CRP水平有关。术前24 h血清CysC、hs-CRP对PCI术后造影剂肾病具有较高的预测价值。

Abstract:

Objective To investigate the predictive value of preoperative cystatin C (CysC) and highsensitivity C-reactive protein (hs-CRP) in the occurrence of contrast-induced nephropathy after percutaneous coronary intervention (PCI). Methods One hundred and twenty-eight patients with coronary heart disease who underwent PCI in our hospital from June 2019 to March 2020 were selected. According to whether the patients were diagnosed with contrast-induced nephropathy after the operation, they were divided into case group (n =23) and control group (n =105). The baseline data of the two groups were compared, and the serum CysC and hs-CRP levels were measured by automatic biochemical analyzer. Logistic regression was used to analyze the influencing factors for the occurrence of contrast-induced nephropathy after PCI. The predictive value of serum CysC, hs-CRP and their combination in the occurrence of contrast-induced nephropathy was evaluated via receiver operating characteristic (ROC) curve. Results In case group, the proportion of diabetic patients, the dosage of contrast medium, and the levels of CysC and hs-CRP 24 hours before operation were higher than those in control group (P < 0.05). Logistic regression analysis showed that high dosage of contrast medium [O＾R = 1.843 (95% CI: 1.322, 2.758)], complication with diabetes mellitus [O＾R = 0.645 (95% CI: 0.510, 0.892)], increased CysC 24 hours before operation [O＾R = 1.801 (95% CI: 1.139, 2.448)], and elevated hs-CRP 24 hours before operation [O＾R = 0.633 (95% CI: 0.479, 0.880)] were the influencing factors for the occurrence of contrast-induced nephropathy after PCI (P < 0.05). Area under the ROC curve (AUC) of the combination of CysC (> 1.322 mg/L) and hs-CRP (> 5.290 mg/L) 24 hours before operation was the highest in predicting contrast-induced nephropathy, which was 0.916 (95% CI: 0.897, 0.986). The sensitivity was 91.3% (95% CI: 0.883, 0.936), and the specificity was 82.9% (95% CI: 0.795, 0.850). Conclusions The incidence of contrast-induced nephropathy after PCI was correlated with dosage of contrast medium, combination with diabetes mellitus, and serum CysC and hs-CRP levels 24 hours before PCI. The serum CysC and hs-CRP before operation showed a high predictive value for the occurrence of contrast-induced nephropathy after PCI.