胱抑素C在经皮冠状动脉介入治疗术后造影剂肾病诊断中的价值  

Diagnostic value of cystatin C in contrast-induced acute kidney injury after percutaneous coronary intervention

作　　者：彭莉[1] 黄嘉南 赵崇亮[1] 谭冠昶[1] 禤伟振 陶涛[1] 萧浤 

机构地区：[1]澳门镜湖医院,999078 [2] 澳门仁伯爵医院

出　　处：《中华内科杂志》2015年第3期188-192,共5页Chinese Journal of Internal Medicine

基　　金：澳门科技发展基金（027/2011/A）

摘　　要：目的 探讨胱抑素C在经皮冠状动脉介入治疗（PCI）术后造影剂肾病（CIAKI）诊断中的价值.方法 选择2012年1月1日至12月31日澳门镜湖医院行PCI的患者为研究对象,分别于术前、术后24 h和48 h检测患者血肌酐和胱抑素C水平,比较胱抑素C在术后24 h和48 h检测值分别升高10％、15％以及25％的诊断CIAKI效能.结果 共入选PCI患者196例,男性134例,女性62例,年龄（70.4±11.3）岁.以血肌酐作为诊断标准,29例（14.8％）发生CIAKI.术后24 h和48 h胱抑素C水平诊断CIAKI的AUCROC为0.661（95％CI 0.548 ～ 0.774,P=0.006）和0.783 （95％ CI0.701～0.865,P＜0.001）.术后24 h和48 h胱抑素C水平诊断CIAKI的敏感性为6.90％～48.28％,特异性为85.03％ ～97.60％,阴性预测值为85.79％～90.45％.48 h胱抑素C的约登指数普遍优于24h胱抑素C.48 h胱抑素C水平升高≥15％时诊断CIAKI的敏感性为41.38％,特异性为92.86％,阴性预测值为90.17％,正确率85.28％,约登指数为0.342 4.结论 胱抑素C在诊断CIAKI中的特异性和阴性预测值高,可用于CIAKI的排除诊断.术后48 h胱抑素C水平诊断效能优于24 h胱抑素C水平,48 h胱抑素C水平升高≥15％的综合诊断效能相对最好.Objective To prospectively evaluate the value of cystatin C （CysC） in diagnosis of contrast-induced acute kidney injury （CIAKI） among patients undergoing Percutaneous Cardiovascular Intervention （PCI）.Methods Patients who underwent PCI procedures in our hospital were enrolled.Serum creatinine（SCr） and CysC were measured at baseline before,24 h and 48 h after PCI,respectively.CysC were examined by particle-enhanced turbidimetric immunoassay （PETIA）.CIAKI was defined as a relative increase in SCr concentration of at least 25% or an absolute increase more than 44.8 mmol/L （0.5 mg/dl） within 48 h in the absence of other related causes.Results Among 196 patients,135 were male and 61 female with a mean age of（70.4 ± 11.3）years old.Twenty-nine （14.8%）patients developed CIAKI according to the SCr criteria.The area under the ROC curve （AUC） at 24 h and 48 h post PCI were 0.661 （95% CI 0.548-0.774,P =0.006） and 0.783 （95% CI 0.701-0.865,P 〈 0.001）,respectively.The diagnostic sensitivities of CysC at 24 h and 48 h were between 6.9% and 48.28%,while,the diagnostic specificities and negative predictive values of CysC were between 85.03%-97.60% and 85.79%-90.45%,respectively.The 15% elevation of 48 h CysC yielded the diagnostic sensitivity of 41.38%,specificity of 92.86%,negative predictive value of 90.17%,corrective rate of 85.28% with Youden Index of 0.342 4.Conclusions In this study,CysC presented an excellent diagnostic specificity and negative predictive value in diagnosis of CIAKI.It might be used as a tool for excluding CIAKI in clinical practice.48 h CysC performed better than 24 h CysC in CIAKI diagnosis,among which a 15% increment achieved relatively the best diagnostic value.

关 键 词：造影剂肾病 半胱氨酸蛋白酶抑制剂C 诊断 

分 类 号：R692[医药卫生—泌尿科学]