尿NGAL对ACS患者PCI术后对比剂肾病的早期诊断价值  

Early diagnostic value of urine NGAL for contrast-induced nephropathy in ACS patients after PCI

作　　者：卓杨[1] 王丽[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院肾脏内科,上海市200011

出　　处：《心血管康复医学杂志》2016年第3期271-276,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨尿液中性粒细胞明胶酶脂质载脂蛋白(NGAL)对急性冠脉综合征(ACS)患者PCI术后对比剂肾病(CIN)的早期诊断价值。方法:选择在我院住院的ACS并行择期冠脉介入术患者104例为ACS组,与之相匹配的稳定型冠心病择期行冠脉介入术患者110例为稳定型冠心病组。根据是否患有CIN,每组被进一步分为CIN亚组和非CIN亚组。收集术前、术后6h及术后24h患者尿液标本,测定各组尿NGAL水平,比较术前、术后肾功能及尿NGAL水平的变化。结果:在ACS组内,与非CIN组比较,CIN组术后72h肾小球滤过率[(81.59±27.46)ml·min^(-1)·1.73m^(-2)比(45.29±28.34)ml·min^(-1)·1.73m^(-2)]明显降低,血清肌酐(Scr)水平[(96.80±21.98)μmol/L比(132.69±43.03)μmol/L]明显升高(P均<0.01);而CIN组尿NGAL水平在术后6h即明显高于非CIN组[(1.57±0.43)μg/L比(0.94±0.31)μg/L,P<0.01]。ACS组和稳定型冠心病组的两CIN亚组比较,NGAL水平无显著差异(P均>0.05)。结论:尿NGAL水平对于经皮冠状动脉介入术后对比剂急性肾损伤诊断比血清肌酐更为敏感,是一个比血清肌酐更早的对比剂肾病诊断标志物。Objective： To explore early diagnostic value of urine neutrophil gelatinase associated lipocalin （NGAL） for contrast - induced nephropathy （CIN） in patients with acute coronary syndrome （ACS） after PCI. Methods： A total of 104 ACS patients hospitalized in our hospital undergoing selective percutaneous coronary intervention （PCI） were enrolled as ACS group, another 110 corresponding patients with stable coronary heart disease （CHlective PCI were regarded as stable CHD group. According to presence of CIN or not, eached into CIN subgroup and non - CIN subgroup. Urine samples of patients were collected before,6h aPCI,and urineNGAL levelwas measured inall groups. Renal function and urine NGAL level wermong all groups before and after PCI. Results： In ACS group,compared with non - CIN group on 72h after PCI, there was significant reduction in glomerular filtration rate [ （81. 59 ± 27. 46） ml · min^-1 · 1. 73m^-2 vs. （45. 29 ± 28. 34） ml · min^-1 · 1. 73m^-2] and sgnificant rise in serumcreatinine level [ （96. 80 ± 21. 9 8 ）μ mol/L vs. （132. 69 ± 43. 03） μmol/L] in CIN group,P〈0. 01 both; but compared with non-CIN group on 6h after PCI, there was immediate significant rise in urine NGAL level [ （0. 94 ± 0. 31） μ g /L v s （1. 57 ± 0. 43） μ g /L,P 〈 0 . 01] There was no significant difference in NGAL level between CIN subgroups of ACS group and stable CHD group, P 〉0. 05 all. Conclusion： Compared with erum creatinine, urine NGAL is more sensitive reflecting acute renal injury caused by contrast after PCI,which a earlier diagnostic marker for CIN than serum creatinine .

关 键 词：急性冠状动脉综合征 血管成形术 气囊 冠状动脉 肾病 

分 类 号：R541.4[医药卫生—心血管疾病]