胱抑素C对冠状动脉介入治疗术后对比剂肾病的预测价值  

The predictive value of cystatin C in contrast-induced nephropathy after percutaneous coronary intervention

作　　者：潘力健[1] 潘娟娟[1] 刘磊[1] 史益军[1] 龚辉[1] 

机构地区：[1]复旦大学附属金山医院心内科,上海201508

出　　处：《临床内科杂志》2013年第12期816-819,共4页Journal of Clinical Internal Medicine

摘　　要：目的 评价血清胱抑素C（Cys C）对冠状动脉介入治疗（PCI）术后对比剂肾病的预测价值.方法 将我院2011年6月～2012年12月行PCI术的患者428例,按是否发生对比剂肾病分为对比剂肾病组和非对比剂肾病组,比较两组术前、术后48小时Cys C和血肌酐（Scr）水平变化;应用ROC曲线评价Cys C对对比剂肾病的早期诊断价值;运用KaPlan-Meier法分析高Cys C水平组的主要不良事件累计发生率;采用多因素Logistic回归分析法评估PCI术后对比剂肾病的相关影响因素.结果 对比剂肾病发生率为4.9％,对比剂肾病组术后48小时Cys C较术前明显升高,且与Scr呈现明显的正相关.ROC分析结果显示,术后48小时Cys C较Scr存在更好的ROC曲线下面积,根据Youden评价指数得出其最佳诊断阈值点为1.36 mg/L. KaPlan-Meier法分析显示,术后48小时Cys C＞1.36 mg/L的患者6个月主要不良事件累计发生率明显高于Cys C＜1.36mg/L的患者;多因素Logistic回归分析相关影响因素发现,年龄、糖尿病、基础Cys C水平、对比剂用量等4因素为PCI术后对比剂肾病的临床危险因素.结论 造影后48小时的血清Cys C浓度对对比剂肾病的早期诊断价值优于Scr,且对预后的预测价值较好;年龄、糖尿病、基础Cys C水平和对比剂用量为PCI术后发生对比剂肾病的临床危险因素.Objective To evaluate the predictive Value of cystatin C in early diagnosis of con- trast-induced nephropathy（CIN） after percutaneous coronary intervention （PCI）. Methods A total of 428 patients undergoing PCI from June 2011 to December 2012 were enrolled in this study. According to the occurrence of CIN,the cases were divided into two groups （ no CIN group and CIN group）. We detected creatinine（Scr） and Cys C in serum between two groups before and 48 hours after the operation. Search for the cut off point of CIN by work characteristic curve（ROC） and used KaPlan-Meier method to analysis survival of CIN;Multivariate analysis about effect factors of CIN was performed with multivariate logistic regression analysis. Results CIN occurred in 21 of 428 enrolled patients, the incidence was 4.9%. There was a significant increased（P 〈 0.05 ）between Cystatin C level of 48h after operation and before operation in CIN group. Through working characteristic curve（ROC） ,Cys C has better ROC curve area than Ser 48h after operation,the cut off point of Cys C level were 1.36 mg/L. The cases of Cys C 〉 1.36 mg/L have significantly higher than the cases of Cys C 〈 1.36 mg/L in the cumulative incidence of major adverse e- vents. In multivariate Logistic regression, ages, diabetes, base line of Cys C, contrast dose, were remained as the significant predictors of contrast-induced nephropathy after percutaneous coronary intervention, a- mong ten possible faeors. Conclusion Cystatin C level of 48h after pereutaneous coronary intervention has the better early diagnostic and predictive value of CIN than Ser. Age, diabetes, base line of Cys C and contrast load were the significant predictors of contrast-induced nephropathy after percutaneous coronary intervention.

关 键 词：胱抑素C 对比剂肾病 冠状动脉介入治疗术 预后 

分 类 号：R654.2[医药卫生—外科学]