肾动脉阻力指数联合胱抑素C对冠状动脉CT血管造影后对比剂肾病的预测价值  

The predictive value of renal artery resistance index combined with cystatin C in contrast-induced nephropathy after coronary artery CT

作　　者：陈曦 麦李明 吴楠 Chen Xi;Mai Liming;Wu Nan(Department of Nephrology,Hebei Petro China Central Hospital,Langfang 065000,China)

机构地区：[1]河北中石油中心医院肾内科,廊坊065000

出　　处：《中国医师进修杂志》2023年第8期711-715,共5页Chinese Journal of Postgraduates of Medicine

基　　金：廊坊市科技支撑计划项目(2019013013)。

摘　　要：目的分析冠状动脉CT血管造影(CTA)检查前24 h血清胱抑素C(Cys-C)及肾动脉阻力指数(RRI)对冠状动脉CTA后对比剂肾病的预测价值。方法回顾性选取2020年1月至2021年3月在河北中石油中心医院接受冠状动脉CTA检查的冠心病患者64例作为研究对象,根据冠状动脉CTA检查后对比剂肾病的发生情况分为病例组(25例)和正常组(39例)。CTA检查前24 h应用全自动生化分析仪测定血清Cys-C水平,应用彩色多普勒超声测定RRI值。CTA检查后对比剂肾病的危险因素分析采用Logistic回归,通过绘制受试者工作特征(ROC)曲线,评价CTA检查前24 h血清Cys-C、RRI和两种指标联合检测预测对比剂肾病的价值。结果病例组对比剂用量、高血压比例、检查前Cys-C水平、检查前RRI值高于对照组[(85.53±16.27)ml比(64.37±15.08)ml、80.00%(20/25)比56.41%(22/39)、(1.36±0.18)mg/L比(1.02±0.21)mg/L、0.743±0.093比0.632±0.081],差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,对比剂用量高(OR=1.892,95%CI 1.298~2.805)、合并高血压(OR=0.682,95%CI 0.557~0.921)、检查前血清Cys-C水平升高(OR=1.796,95%CI 1.147~2.483)、检查前RRI值升高(OR=0.648,95%CI 0.489~0.992)是CTA检查后发生对比剂肾病的独立危险因素(P<0.05)。ROC曲线分析结果显示,CTA检查前24 h血清Cys-C(>1.318 mg/L)联合RRI值(>0.653)预测对比剂肾病的曲线下面积为0.922,灵敏度为92.5%,特异度为81.6%。结论冠状动脉CTA后对比剂肾病的发生与对比剂用量、合并高血压、CTA前24 h血清Cys-C水平及RRI值有关,Cys-C水平及RRI值两者联合检测对冠状动脉CTA后对比剂肾病的发生有较高的预测价值。Objective To investigate the predictive value of serum cystatin C(Cys-C)and renal artery resistance index(RRI)24 h before coronary CT angiography(CTA)examination in contrast-induced nephropathy(CIN).Methods Sixty-four patients with coronary heart disease who received coronary CTA examination in Hebei Petro China Central Hospital from January 2020 to March 2021 were selected as the research subjects.According to the incidence of CIN after coronary CTA examination,they were divided into the case group(25 patients)and the normal group(39 patients).Serum Cys-C level was measured by automatic biochemical analyzer at 24 h before CTA examination,and RRI value was measured by color Doppler ultrasound.Risk factors of CIN after CTA examination were analyzed by Logistic regression.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum Cys-C,RRI and the combination of the two indexes in CIN.Results Compared with the control group,the dosage of contrast agent,patients with hypertension,serum Cys-C level at 24 h before CTA examination and RRI value in the case group were higher than those in the normal group:(85.53±16.27)ml vs.(64.37±15.08)ml,80.00%(20/25)vs.56.41%(22/39),(1.36±0.18)mg/L vs.(1.02±0.21)mg/L,0.743±0.093 vs.0.632±0.081,there were statistical differences(P<0.05).Multivariate Logistic regression analysis showed that the amount of contrast agent,hypertension,serum Cys-C level at 24 h before CTA examination and RRI value were independent risk factor for CIN after CTA examination(P<0.05).The results of ROC curve analysis showed that serum Cys-C(>1.318 mg/L)combined with RRI value(>0.653)at 24 h before CTA examination predicted CIN with the highest area under the curve was 0.922,sensitivity was 92.5%and specificity was 81.6%.Conclusions The incidence of CIN after CTA is related to the dosage of contrastant,hypertension,serum Cys-C level and RRI value at 24 h before CTA.The combination of Cys-C level and RRI value has a high predictive value for the occurrence of CIN.

关 键 词：心血管造影术 肾病 造影剂 肾动脉阻力指数 胱抑素C 预测 

分 类 号：R692[医药卫生—泌尿科学] R541.4[医药卫生—外科学]