尿中性粒细胞明胶酶相关脂质运载蛋白对对比剂肾病的早期诊断价值  

The value of urinary neutrophil gelatinase-associated lipocalin for early diagnosis of contrast-induced nephropathy

作　　者：尤威[1] 戚晨良 叶飞[1] 黄胜兰[1] 谢渡江[1] 吴志明[1] 黄凯[1] 陈凯伦[1] 黄天熠[1] 陈绍良[1] You Wei Qi Chenliang Ye Fei Huang Shenglan Xie Dujiang Wu Zhiming Huang Kai Chen Kailun Huang Tianyi Chen(Shaoliang. Department of Cardiology, Nanfing First Hospital, Nanjing Medical University, Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心内科,210006

出　　处：《中华心血管病杂志》2016年第12期1024-1029,共6页Chinese Journal of Cardiology

基　　金：南京市医学科技发展资金（YKK13108）;南京市科技发展计划项目（2015sc511008）

摘　　要：目的探讨冠状动脉介入诊疗术后患者尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对对比剂肾病（CIN）的早期诊断价值。方法采用前瞻性研究方法，连续入选2015年5月至2016年1月在南京医科大学附属南京医院接受冠状动脉造影或经皮冠状动脉介入治疗的患者506例。按照术后是否发生CIN，将患者分为CIN组（47例）和非CIN组（459例）。比较两组患者的临床资料；尿NGAL与CIN的相关性分析采用Spearman相关分析；CIN的危险因素分析采用多因素logistic回归分析；描绘受试者工作特征（ROC）曲线，计算曲线下面积（AUC），分析尿NGAL诊断CIN的敏感度和特异度。结果（1）两组患者的临床基本资料和介入诊疗相关资料，包括年龄、合并糖尿病、高血压、慢性心力衰竭、收缩压、术前血清肌酐、使用等渗对比剂、对比剂用量、Mehran评分、手术时间、处理冠状动脉支数、水化治疗和用药情况等，差异均无统计学意义（P均〉0．05）。（2）CIN组患者术后24和48h尿NGAL水平、术后24h与术前的尿NAGL差值（ANGAL24-0h）、术后48h血清肌酐水平均高于非CIN组（P均〈0．01），两组患者的术前尿NGAL水平、术后48h与术后24h的尿NAGL差值（ANGAL448-24h）、术后24h血清肌酐水平差异均无统计学意义（P均〉0．05）。（3）Spearman相关分析显示，ANGAL24—0h与CIN呈正相关（r=0．478，P〈0．001）。（4）多因素logistic回归分析显示，估算的肾小球滤过率（OR=1．020，95％CI1．005～1．035，P=0．007）和ANGAL24—0h（OR=1．020，95％CI1．014～1．027，P〈0．001）均是CIN的独立危险因素。（5）ANGAL24-0h诊断CIN的ROC曲线显示，曲线下面积为0．899（0．854，0．944），切点值为4．65μg／L，敏感度和特异度分别为93．6％和80．4％。结论冠状动脉介入诊疗术后24h尿NGAL水平升高可以早期诊断CIN。Objective To explore the value of urinary neutrophil gelatinase-associated lipocalin （NGAL） for early diagnosis of contrast-induced nephropathy （CIN） in patients who underwent percutaneous coronary angiography （CAG） or percutaneous coronary intervention （PCI）. Methods From May 2015 to January 2016,506 consecutive patients who underwent CAG or PCI in our hospital were enrolled in this prospective study. Patients were divided into CIN group （n = 47） and non-CIN group （n = 459）. Clinical and interventional data were compared between the two groups. Spearman ranking correlation coefficient was used to define the relation between NGAL and CIN, and multivariable logistic regression analysis was performed to identif independent predictors of CIN. Receiver-operator characteristic （ROC）： curve was generated, and area under the curve （AUC） was calculated and sensitivity and specificity for CIN diagnosis were analyzed. Results （ 1 ） Basic clinical and interventional data including age, incidence of diabetes, hypertension and chronic heart failure, level of systolic blood pressure, serum creatine before procedure, use of isotonic contrast agent, contrast volume, Mehran score, operation time, treatment number of coronary artery, hydration and medication were all similar between two groups （ all P 〉 0. 05 ）. （2） Urinary NAGL level at 24 and 48 h after procedure, serum creatinine （Scr） level at 48 h after procedure, and ANGAL24 -0 h were significantly higher in CIN group than in non-CIN group （ all P 〈 0.01 ）, but the differences of urinary NGAL level before procedure, Scr level 24 h after procedure, and ANGAL48-24 h were similar between two groups （ all P 〉 0.05 ）. （ 3 ） The positive correlation was found by Spearman ranking correlation between ANGAL24-0 h and CIN （ r = 0. 478, P 〈 0. 001 ）. （4） Multivariable logistic regression analysis showed that estimated glomerular filtration rate（ OR = 1. 020,95% CI 1. 005 - 1. 035, P = 0. 007 ） and ANGAL24

关 键 词：造影剂 肾病 尿中性粒细胞明胶酶相关脂质运载蛋白 

分 类 号：R541.4[医药卫生—心血管疾病] R692[医药卫生—内科学]