氨基末端脑钠肽前体与老年冠心病患者支架置入术后造影剂肾病的相关性  

Association between NT-proBNP and contrast-induced nephropathy in elderly CHD patients after PCI

作　　者：卢建刚[1] 田杰[1] 曾秋蓉[2] 胡凌云[1] 张科[1] 谭红霞[1] 王鹏[1] 欧阳[1] 覃于洪 

机构地区：[1]重庆市涪陵中心医院老年病科,408099 [2]重庆市涪陵中心医院内分泌科,408099

出　　处：《中华老年心脑血管病杂志》2015年第10期1036-1040,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨血浆氨基末端脑钠肽前体（NT-proBNP）水平与老年冠心病患者行PCI术后造影剂肾病（CIN）的相关性。方法选择行PCI的老年冠心病患者300例,按NT-proBNP水平的四分位分为4组：Q1组75例（NT-proBNP〈450ng/L）、Q2组75例（NT-proBNP 450~900ng/L）、Q3组75例（NT-proBNP 901~1800ng/L）、Q4组75例（NT-proBNP〉1800ng/L）。PCI手术前后分别测NT-proBNP等。采用ROC曲线及logistic分析NT-proBNP与CIN的关系。结果Q1、Q2、Q3及Q4组发生CIN分别为3例（4.0%）、8例（10.7%）、12例（16.0%）和19例（25.3%）,4组CIN发生率比较差异有统计学意义（P=0.000）;4组急性心力衰竭发生率比较,差异有统计学意义（1.3%vs 4.0%vs 6.7%vs 14.7%,P=0.000）。NT-proBNP预测CIN的ROC曲线下面积0.701,其界值为1277.5ng/L时,预测CIN的敏感性为73.8%,特异性为62.8%;logistic回归分析示,术前NT-proBNP是CIN的独立危险因素（OR=2.8,95%CI：1.2~6.4,P=0.008）。结论术前血浆NT-proBNP水平与老年冠心病行PCI后CIN密切相关,且是其独立危险因素。Objective To study the association between NT-proBNP and contrast-induced nephropathy（CIN）in elderly CHD patients after PCI.Methods Three hundred elderly CHD patients who underwent PCI in our hospital were divided into Q1 group with their NT-proBNP450ng/L（n=75）,Q2 group with their NT-proBNP 450-900 ng/L（n=75）,Q3 group with their NT-proBNP 901-1800ng/L（n=75）and Q4 group with their NT-proBNP1800ng/L（n=75）according to their quartile of NT-proBNP.Their serum NT-proBNP levels were measured at 12 h before PCI and on days 2and 3after PCI.Association between NT-proBNP and CIN was analyzed by multivariate logistic regression analysis according to the ROC curve.Results The incidence of CIN was 4.0%,10.7%,16.0%,25.3%in the 4groups（P=0.000）.The incidence of acute heart failure was significantly lower in Q1 group than in the other 3groups（1.3%vs 4.0%vs 6.7%vs14.7%,P=0.000）.The area under the ROC curve was 0.701.The NT-proBNP cutoff value was1277.5ng/L with a sensitivity of 73.8% and a specificity of 62.8% for the diagnosis of CIN.Multivariate logistic regression analysis showed that the preoperational serum NT-proBNP level was an independent factor for CIN（OR =2.8,95%CI：1.2-6.4,P =0.008）.ConclusionNT-proBNP is closely related with CIN in elderly CHD patients after PCI.The incidence of CIN increases with the increasing preoperational serum NT-proBNP level and is an independent risk factor for CIN in elderly CHD patients.

关 键 词：利钠肽 脑 冠心病 支架 ROC曲线 肾小球滤过率 肾病 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]