冠心病合并糖尿病和(或)高血压患者经皮冠状动脉介入治疗前后胱抑素C水平临床观察  

Clinical observation of CysC levels before and after PCI in patients with coronary heart disease complicating diabetes or/and hypertension

作　　者：赵瑜 黄贤胜[1] 王虹[1] 严露 胡娜[1] 梁浩[1] 高海超[1] 赵乐[1] ZHAO Yu;HUANG Xiansheng;WANG Hong;YAN Lu;HU Na;LIANG Hao;GAO Haichao;ZHAO Le(Department of Cardiology,Southern Area, Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院南区心脏内科,河北承德067000

出　　处：《现代医药卫生》2019年第7期999-1002,共4页Journal of Modern Medicine & Health

摘　　要：目的评价冠心病合并糖尿病和(或)高血压患者经皮冠状动脉介入治疗(PCI)前后胱抑素C(CysC)水平变化情况,分析CysC在冠心病合并糖尿病,高血压诊断造影剂肾病(CIN)的临界值及评价CysC与肌酐诊断CIN的一致性。方法选取2016年10月至2018年5月该院收治的冠心病合并糖尿病和(或)高血压患者227例,分为单纯冠心病组(52例)、冠心病合并高血压组(74例)、冠心病合并糖尿病组(51例)和冠心病合并糖尿病及高血压组(50例),记录各组患者PCI前及PCI后72h血清CysC、肌酐等,统计分析PCI前后各组患者CysC水平变化情况,计算并评价比较各组患者CIN发生率,计算CysC在冠心病合并糖尿病及高血压诊断CIN的临界值,并评价CysC与肌酐诊断CIN的一致性。结果冠心病合并糖尿病及高血压病组患者PCI前后CysC水平均最高,然后依次为冠心病合并糖尿病组、冠心病合并高血压组、单纯冠心病组,各组患者PCI前后CysC水平比较,差异均有统计学意义(P<0.05);各组患者PCI后CysC水平与同组PCI前比较,差异均有统计学意义(P<0.05)。4组患者CIN发生率比较,差异有统计学意义(P<0.05);CysC和肌酐在冠心病合并糖尿病及高血压诊断CIN的一致性一般(κ=0.592,P=0.001),PCI后CysC水平较PCI前升高28.59%可诊断CIN,受试者工作特征曲线下面积最大为92.50%,灵敏度为90.00%,特异性为82.50%。结论冠心病合并糖尿病和(或)高血压患者PCI前后CysC水平均不同,冠心病合并糖尿病及高血压患者CysC水平最高。冠心病合并糖尿病和(或)高血压患者CIN发生率不同,冠心病合并糖尿病及高血压患者最高(达20.00%)。CysC对CIN具有较高的诊断价值。Objective To evaluate the changes of cystatin C(CysC) levels before and after percutaneous coronary intervention(PCI) in the patients with coronary heart disease(CHD) complicating diabetes and/or hypertension,to analyze the critical value of CysC for diagnosing contrast- induced nephropathy(CIN) in CHD complicating diabetic and hypertension and to evaluate the consistency of CysC and creatinine for diagnosing CIN. Methods A total of 227 patients with CHD complicating diabetes and / or hypertension in this hospital from October 2016 to May 2018 were selected and divided into the simple CHD group(52 cases),CHD complicating hypertension group(74 cases),CHD complicating diabetes group(51 cases) and CHD complicating diabetes and hypertension group(50 cases).The serum CysC level and creatinine level before PCI and at 72 h after PCI were recorded in each group.Then the changes of CysC level before and after PCI were statistically analyzed in each group.The incidences of CIN was calculated and evaluated in each group.The critical value of CysC for diagnosing CIN in the patients with CHD complicating diabetic and hypertension was calculated.The consistency between CysC and creatinine for diagnosing CIN was evaluated. Results The CysC level in the CHD complicating diabetes and hypertension group was the highest before and after PCI,then followed in turn by the CHD complicating diabetes group,CHD complicating hypertension group and simple CHD group( P <0.05),the CysC level in each group had statistical difference between before and after PCI( P < 0.05 );the CysC level after PCI in each group had statistical difference compared with that before PCI in the same group ( P <0.05). The CIN occurrence rate had statistical difference among 4 groups( P < 0.05 ).The consistency between CysC and creatinine for diagnosing CIN in CHD complicating diabetes and hypertension was general(κ= 0.592, P =0.001),the CysC level after PCI was increased by 28.59% compared with before PCI,which could diagnose CIN,the maximal area under ROC curve w

关 键 词：冠心病 糖尿病 高血压 经皮冠状动脉 肾疾病 造影剂 

分 类 号：R541.4[医药卫生—心血管疾病]