N氨基末端脑钠肽前体与冠状动脉造影后对比剂肾病相关性研究  

Correlation between N-terminal pro-brain natriuretic peptide levels and contrast-induced nephropathy in patients after receiving coronary angiography: a clinical study

作　　者：卢海燕[1] 吕玲春[2] 沈珈谊 徐剑[2] 吴小燕[2] 韦铁民[2] 纪建松[3] LU Haiyan;LU Lingchun;SHEN Jiayi;XU Jian;WU Xiaoyan;WEI Tiemin;JI Jiansong(Electrocardiography Room,Lishui Municipal Central Hospital,Lishui,Zhejiang Province 323000,China)

机构地区：[1]浙江丽水市中心医院心电图室,323000 [2]浙江丽水市中心医院心血管内科,323000 [3]浙江丽水市中心医院放射影像科,323000

出　　处：《介入放射学杂志》2018年第9期817-821,共5页Journal of Interventional Radiology

基　　金：浙江省丽水市科技局公益性技术应用项目(2012JYZB17)

摘　　要：目的探讨冠状动脉造影(CAG)前血清N氨基末端脑钠肽前体(NT-proBNP)水平是否是一独立预测CAG后发展为对比剂肾病(CIN)的可靠有用的生物标志物。方法纳入2014年6月至12月收治的228例急性胸痛患者为研究对象,CAG前24 h内检测血清NT-proBNP、血清肌酐(SCr)、胱抑素(Cys)C、血尿素氮(BUN)、尿酸(UA),CAG后24、48、72 h检测NT-proBNP、SCr、BUN、UA。根据肾脏疾病膳食改良(MDRD)公式计算肾小球滤过率估计值(e GFR)。根据CAG后72 h内是否发生CIN,分为CIN组(n=36)和非CIN组(n=192)。采用受试者特征曲线(ROC)及Logistic回归分析,评价CAG前NTproBNP对CIN预测价值。结果 CIN组、非CIN组CAG前NT-proBNP分别为(1 065.41±275.08)pg/m L、(533.02±489.32)pg/m L(P<0.001),NT-proBNP曲线下面积(AUC)为0.821(95%CI=0.768~0.875),CIN发生预测灵敏度为77.8%,特异度为78.0%。Logistic回归分析显示CAG前NT-proBNP是CIN发病危险因素,NT-proBNP升高患者CIN发病率比正常患者高2.42倍。Pearson相关性分析显示CAG前NT-proBNP与CAG后SCr升高绝对值呈正相关(OR=0.17,P=0.01)。结论 CAG前NT-proBNP是独立预测急性胸痛患者CAG后发生CIN的简便、可靠有用的生物学标志物。Objective To clarify whether the N-terminal pro-brain natriuretic peptide（NT-pro BNP）levels before coronary angiography（CAG） is a useful and reliable biological marker that can independently predict the development of contrast-induced nephropathy（CIN）. Methods A total of 228 patients with acute chest pain, who admitted to authors＇ hospital during the period from June 2014 to December 2014, were enrolled in this study. Within 24 hours before CAG, the serum NT-pro BNP, serum creatinine（SCr）, cystatin（Cys） C, blood urea nitrogen（BUN） and uric acid（UA） were tested; and at 24, 48 and 72 hours after CAG, NT-pro BNP, SCr, BUN and UA were checked. According to modified dietary for renal diseases（MDRD） formula, the estimated glomerular filtration rate（e GFR） was calculated. Based on the occurrence of CIN or not, the patients were divided into CIN group（n =36） and non-CIN group（n =192）. The subject characteristic curve and Logistic regression analysis were used to evaluate the predictive value of NT-pro BNP for CIN before CAG. Results NT-pro BNP levels determined before CAG in CIN group and non-CIN group were（1 065.41±275.08） pg/m L and（533.02±489.32） pg/m L respectively（P〈0.05）. The area under curve（AUC） of NT-pro BNP was 0.821（95% CI =0.768-0.875）, the predictive sensitivity and specificity for the occurrence of CIN were 77.8% and 78.0% respectively. Logistic regression analysis indicated that NT-pro BNP level before CAG was a risk factor of CIN. The incidence of CIN in patients with higher NT-pro BNP level was2.42 times than that in patients with normal NT-pro BNP level. Pearson correlation analysis showed that a positive correlation existed between pre-CAG NT-pro BNP level and post-CAG elevated absolute value of SCr（OR=0.17, P=0.01）. Conclusion Pre-CAG NT-pro BNP level is a simple, convenient, reliable and useful biological marker for prediction of CIN in patients with acute chest pain after CAG.

关 键 词：N氨基末端脑钠肽前体 冠状动脉造影 对比剂肾病 

分 类 号：R528.1[医药卫生—内科学]