血清高迁移率族蛋白B1对ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后造影剂肾病的预测价值  

Predictive value of serum high mobility group protein B1 for contrast-induced nephropathy in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作　　者：李勇 苏亚坤 李原 张宏博 李占虎 闫小菊 LI Yong;Su Ya-kun;Li Yuan;Zhang Hong-bo;LI Zhan-hu;YAN Xiao-ju(Department of Cardiology,Hengshui People’s Hospital,Hebei Province,Hengshui 053000,China)

机构地区：[1]衡水市人民医院心血管内科,河北省衡水市053000

出　　处：《中国心血管病研究》2024年第8期751-756,共6页Chinese Journal of Cardiovascular Research

基　　金：衡水市科技局科技计划项目(2020014081Z)。

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PPCI)前后血清高迁移率族蛋白B1(HMGB1)变化对造影剂肾病(CIN)发生的预测价值。方法对衡水市人民医院2022年1~12月首次行PPCI术治疗的235例STEMI患者进行观察,根据术后是否发生CIN将患者分为CIN组和非CIN组。比较两组患者一般临床资料以及术前、术后6 h、24 h、48~72 h的血清HMGB1、胱抑素C(Cys C)、肌酐(SCr)水平差异性。对术后CIN发生的相关因素进行多因素logistic回归分析。应用受试者工作特征(ROC)曲线分析各指标对PPCI术后CIN发生的预测价值。结果术后33例发生CIN,发生率14.04%。与非CIN组比较,CIN组患者入院时血糖(ABG)、糖化血红蛋白(HbA1C)、造影剂使用剂量均明显升高[(9.66±3.49)mmol/L比(7.85±2.35)mmol/L、(15.08±4.33)%比(13.10±5.12)%、(124.03±13.87)ml比(118.81±11.74)ml];中性粒细胞/淋巴细胞比值(NLR)、既往肾病及心力衰竭病史占比也较高(均P<0.05)。CIN组术前、术后各观察时间点的血清HMGB1、CysC水平均高于非CIN组。术后24 h和48~72 h的血清SCr水平也高于非CIN组(P<0.05),但两组术前和术后6 h血清肌酐水平差异无统计学意义(P>0.05)。Logistic回归分析显示,ABG、术前和术后6h较高水平的HMGB1、Cys C是PPCI术后CIN独立危险因素。ROC曲线显示,预测CIN的曲线下面积(AUC)较大的是术后6 h和术前血清HMGB1水平,分别为0.974(95%CI 0.947~1.000)、0.964(95%CI 0.934~0.995),术后6 h血清HMGB1特异度最高。结论STEMI患者PPCI术后6 h和术前HMGB1对预测术后CIN的发生均具有良好预测价值,术后6 h HMGB1水平变化预测价值更好。Objective To explore the predictive value of serum high mobility group protein B1(HMGB1)level before and after primary percutaneous coronary intervention(PPCI)on the occurrence of contrast-induced nephropathy(CIN)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The data of 235 STEMI patients who underwent primary PCI for the first time in Hengshui People’s Hospital from January to December 2022 were retrospectively analyzed.The patients were divided into the CIN group and non-CIN group according to whether CIN occurred after the operation.The general clinical data,serum HMGB1,cystatin C(CysC)and creatinine(SCr)levels were compared between the two groups before and 6 h,24 h and 48-72 h after the operation.Multivariate logistic regression analysis was used to analyze the related factors of CIN after the operation.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index for CIN after the primary PCI.Results CIN occurred in 33 cases after the operation,with an incidence of 14.04%.Compared with the non-CIN group,the blood glucose(ABG),glycosylated hemoglobin(HbA1C)and contrast agent dosage were significantly increased in the CIN group[(9.66±3.49)mmol/L vs.(7.85±2.35)mmol/L、(15.08±4.33)%vs.(13.10±5.12)%、(124.03±13.87)ml vs.(118.81±11.74)ml],and the neutrophil/lymphocyte ratio(NLR),previous history of kidney disease and heart failure were also higher(all P<0.05).The levels of serum HMGB1 and CysC in CIN group were higher than those in non-CIN group before and after operation.Serum SCr levels at 24 h and 48-72 h after operation were also higher than those in the non-CIN group(P<0.05),but there was no significant difference in serum creatinine levels between the two groups before and 6 h after operation(P>0.05).Logistic regression analysis showed that ABG,higher levels of HMGB1 and Cys C before and 6 hours after operation were the independent risk factors for CIN after the primary PCI.ROC curve showed that the area under the curve(AU

关 键 词：高迁移率族蛋白B1 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 造影剂肾病 

分 类 号：R542.22[医药卫生—心血管疾病]