胱抑素C对对比剂肾病的预测价值  

Predictive value of serum cystatin C in early evaluation of contrast induced nephropathy

作　　者：张瑶[1] 田祥[2] 耿巍[2] 张旗 甄利波[2] 刘倩梅 杨颖[2] 宋达[2] 

机构地区：[1]承德医学院,河北承德067000 [2]保定市第一中心医院心内科,河北保定071000

出　　处：《临床荟萃》2016年第7期770-773,778,共5页Clinical Focus

摘　　要：目的探讨冠状动脉内应用对比剂后肌酐（SCr）及胱抑素C（Cystatin C,CysC）水平的变化,评价CysC对对比剂肾病（contrast induced nephropathy,CIN）的预测价值。方法选择于我院进行冠状动脉造影和（或）介入治疗的冠心病患者,监测介入术前、术后1天、2天、3天SCr和CysC水平,采用MDRD公式计算肾小球滤过率（（eGFR））。主要终点事件是CIN的发生。结果共纳入384例患者,以SCr作为诊断标准,16例（4.17%）患者发生CIN。介入术后第1天、第2天、第3天CysC浓度较术前升高（均P〈0.05）。CysC与SCr呈正相关（r=0.313,P〈0.01）,CysC与eGFR呈负相关（r=-0.325,P〈0.01）。术后第2天CysC诊断CIN的ROC曲线下面积为0.833（95%CI=0.744~0.992,P〈0.01）,优于术后第1天和术后第3天,最佳分界点为1.115mg/L。对术后第2天CysC水平不同升高程度做ROC曲线,得出ROC曲线下面积为0.812（95%CI=0.802~0.822,P〈0.01）,最佳分界点为12.5%。结论 CysC能够较早的评估肾功能状态,是一个能够反应CIN的敏感指标;术后第2天CysC水平诊断CIN的准确性优于术后第1天和第3天,其升高≥12.5%可以作为诊断CIN的切点。Objective To evaluate of cystatin C （CysC） on the predictive value of contrast induced nephropathy （CIN） by comparing the changes of creatinine（SCr） and CysC after coronary arteriography （CAG）. Methods Patients who underwent coronary angiography and/or percutaneous coronary intervention were enrolled. Serum creatinine and CysC were monitored before angiography, 1 day, 2 days, 3 days after angiography. Glomerular filtration rate was estimated by MDRD. The primary end point was the incidence of CIN. Results A total of 384 patients were enrolled in this study, and 16 （4.17%） patients developed CIN according to the SCr criteria. Serum CysC was significantly higher at 1 day, 2 days,3 days after angiography （ P 〈0.05）. The level of serum CysC was positively correlated with SCr level （ r =0. 313, P 〈0.01）, but negatively correlated with eGFR （ r = -0. 325, P〈0.01）. The area under ROC curve at 2 days after angiography was 0. 833（95% CI =0. 744-0. 992, P 〈0.01）, better than 1 day and 3 days after angiography. The best cutoff point was 1. 115 mg/L. The area under ROC curve of varying degrees at 2 days after angiography was 0. 812（95% CI =0. 802-0. 822, P 〈0.01） and the best cutoff point was 12.5%. Conclusion As serum CysC could evaluate the renal function at early period,it could be a sensitive biomarker to evaluate induced CIN. The accuracy of diagnosis CIN in CysC level 2 days after CAG was higher than that 1 day and 3 days after CAG. Moreover, ~12.5% increase can be used as a cutoff point in CIN diagnosis.

关 键 词：急性肾损伤 造影剂 胱抑素C 

分 类 号：R692[医药卫生—泌尿科学]