NLR联合胱抑素C对急性心肌梗死患者冠状动脉介入治疗术后发生对比剂急性肾损伤的预测价值  

Predictive value of neutrophil-to-lymphocyte ratio combined with cystatin C on contrast-induced acute kidney injury in patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：杨煜华 马晶茹[1] YANG Yuhua;MA Jingru(Department of Cardiovascular Medicine,Second Hospital Affiliated to Shenyang Medical College,Shenyang 110035,China)

机构地区：[1]沈阳医学院附属第二医院心血管内科,沈阳110035

出　　处：《中国医科大学学报》2023年第2期141-146,共6页Journal of China Medical University

基　　金：辽宁省科学技术计划(2018225063)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)、胱抑素C(CysC)及二者联合对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后发生对比剂急性肾损伤(CI-AKI)的预测价值。方法选取2015年1月至2020年12月在沈阳医学院附属第二医院心血管内科住院诊断为AMI并行PCI治疗的患者583例。采用2012年改善全球肾病预后组织制定的急性肾损伤诊断标准,将所有患者分为CI-AKI组(51例)和非CI-AKI组(532例),比较2组临床资料的差异,通过二分类logistic回归模型分析AMI患者PCI术后发生CI-AKI的危险因素,并绘制受试者操作特征(ROC)曲线以评估NLR、CysC及二者联合对CI-AKI的预测能效。结果583例患者中CI-AKI发病率为8.75%。将临床基线资料中有意义的变量进行单因素logistic回归分析后得出,高血压史、卒中史、急性ST段抬高型心肌梗死(STEMI)、Killip分级≥2级、多支血管病变、造影剂剂量、左心室射血分数(LVEF)、N末端B型利钠肽原(NT-proBNP)、NLR、血小板与淋巴细胞比值(PLR)、CysC、估算的肾小球滤过率(eGFR)等12项危险因素与CI-AKI密切相关,多因素logistic分析表明,NLR、CysC、eGFR、Killip分级≥2级、多支血管病变是AMI患者PCI术后发生CI-AKI的独立危险因素。ROC曲线分析提示,NLR、CysC及二者联合预测AMI患者PCI术后CI-AKI的曲线下面积分别为0.729、0.777和0.853。NLR、CysC对CI-AKI的发生具有较高的预测价值,且二者联合预测CI-AKI的能效性明显高于单一指标。结论术前较高的NLR和CysC水平对AMI患者PCI术后发生CI-AKI的预测价值较高,二者联合诊断CI-AKI具有更高的能效性。Objective To explore the predictive values of neutrophil-to-lymphocyte ratio(NLR),cystatin C(CysC),and combined NLR and CysC on contrast-induced acute kidney injury(CI-AKI)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods This study included 583 patients diagnosed with AMI who were treated with PCI between January,2015 and December,2020 in the Department of Cardiology of the Second Affiliated Hospital of Shenyang Medical College.All patients were divided into the CI-AKI(n=51)and non-CI-AKI groups(n=532)according to the diagnostic criteria of acute renal injury established by the Global Nephropathy prognosis Organization in 2012,and the differences in clinical data between the two groups were compared.The risk factors of CI-AKI after PCI in patients with AMI were analyzed using a binary logistic regression model,and the receiver operating characteristic(ROC)curve was drawn to evaluate the efficiency of NLR,CysC,and combined NLR and CysC on CI-AKI.Results The overall incidence of CI-AKI among all study participants was 8.75%.After a univariate logistic regression analysis was performed using significant variables from the clinical baseline data,12 risk factors,such as history of hypertension,history of stroke,ST-elevation myocardial infarction,Killip classification≥2,multivessel disease,contrast volume,left ventricular ejection fraction(LVEF),N-terminal pro-Btype natriuretic peptide(NT-proBNP),NLR,platelet-to-lymphocyte ratio(PLR),CysC,and estimated glomerular filtration rate(eGFR),were closely related to CI-AKI.Multivariate logistic analysis showed that NLR,PLR,CysC,eGFR,Killip classification≥2,and multivessel disease were independent risk factors for CI-AKI in patients with AMI after PCI.ROC curve analysis showed that the area under the curve of NLR,CysC,and combined NLR and CysC in predicting CI-AKI after PCI in patients with AMI were 0.729,0.777,and 0.853,respectively.Both NLR and CysC had a high predictive value for the occurrence of CI-AKI,and the effic

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 中性粒细胞与淋巴细胞比值 胱抑素C 对比剂急性肾损伤 

分 类 号：R541.4[医药卫生—心血管疾病]