胱抑素C早期诊断对比剂肾病的研究  

Clinical Research of Cystatin C in Early Diagnosisof Contrast Induced Nephropathy

作　　者：许朝祥[1] 王耀国[1] 杜心清[1] 许有容[1] 

机构地区：[1]福建医科大学附属第二医院心内科,泉州362000

出　　处：《福建医科大学学报》2011年第2期130-133,共4页Journal of Fujian Medical University

摘　　要：目的探讨血浆胱抑素C(Cys C)在对比剂肾病(CIN)早期诊断的临床意义。方法选择使用非离子型低渗造影剂进行冠状动脉造影的260例患者为研究对象,分别于造影前后24,48 h检测Cys C、血清肌酐(Scr)水平,根据改良MDRD公式推算肾小球滤过率(eGFR),根据患者在造影后48 h内是否发生CIN,分为CIN组和非CIN组。分析不同基础肾功能状态CIN的发生情况;比较CIN组和非CIN组各个时间点Cys C和Scr水平的变化;应用受试者工作曲线(ROC)比较两种指标对CIN的早期诊断价值。结果 CIN的发生率为8.85%,但在基础肾功能中重度不全者CIN发生率明显增高(31.9%)。CIN组造影后24 h血浆Cys C浓度已明显升高,而Scr浓度于48 h升高。应用ROC比较发现,Cys C曲线下面积优于Scr(0.94vs0.79,P=0.018),以Cys C>1.52 mg/L作为诊断CIN的标准,其敏感性为91.3%,特异性为86.9%。结论造影后24 h的血浆Cys C浓度对CIN的早期诊断有一定的价值,较Scr更为理想。Objective To study clinical value of cystatin C（cys C）in early diagnosis of contrast induced nephropathy（CIN）.Methods Total 260 patients with angiography enrolled in the study were divided into CIN group and non-CIN group according to appearance of CIN in 48 hour after angiography.The serum creatinine（Scr） and cystatin C were measured in the patients immediately before and 24 hour,48 hour after the angiography.Estimated glomerular filtration rate（GFR） was calculated according to the modification of diet in renal disease（MDRD） equation in chinese.Comparison of variables were performed using chi-square test and analysis of variance（AVONA）.The receiver operating characteristics analysis（ROC）was used to compare the diagnosis value of CIN and to determin the cut-off points of cystatin C.Results The prevalence of CIN was 8.85% in all patients.But the incidence of CIN was 31.9% in patients with moderate and severe renal insufficiency.The serum cystatin C levels in CIN group significantly rose in 24 hour after the angiography.The serum creatinine levels in 24 hour after angiography were similar to those before contrast injection,until 48 hour later the levels of creatinine began to rise after angiography.Receiver operating characteristics analysis shows higher area under the curve for serum cystatin C than for serum creainine（0.94 vs 0.79,P=0.018）.At a cut-off level of 1.52 mg/L,serum cystatin C exhibited 91.3% sensitivity and 86.9% in specificity for detecting CIN.Conclusion The level of serum cystatin C in 24 hour after the angiography may be a better biomarker for early diagnosis of CIN than the level of serum creatinine.

关 键 词：西司他汀类 肌酸酐 冠状动脉疾病 肾功能衰竭 急性 放射摄影术 介入性 

分 类 号：R541.4[医药卫生—心血管疾病] R814.3[医药卫生—内科学]