尿ATF-3对老年经皮冠状动脉介入治疗术后患者对比剂肾病的预测价值  

The predictive value of urinary ATF-3 on contrast-induced nephropathy in elderly patients after percutaneous coronary intervention

作　　者：杨同肖 李永旺[1] 祝黎东 唐立丽 陈晶健 YANG Tong-xiao;LI Yong-wang;ZHU Li-dong(Dalian Friendship Hospital,Dalian 116001,China)

机构地区：[1]大连市友谊医院冠心病一病房,116001

出　　处：《中国现代药物应用》2024年第19期61-65,共5页Chinese Journal of Modern Drug Application

基　　金：大连市医学科学研究项目(项目编号:2111016)。

摘　　要：目的研究尿转录激活因子3(ATF-3)对老年经皮冠状动脉介入治疗(PCI)术后患者对比剂肾病(CIN)的预测价值。方法选取择期行PCI的老年冠心病患者300例,根据是否发生CIN将所有患者分成CIN组(n=21)及非CIN组(n=279)。比较两组患者的临床资料,包括性别、年龄、心率、合并症、不良生活习惯、血常规、生化指标、尿常规及服用药物史。比较不同时段的肾功能指标[术前血清肌酐、术前肾小球滤过率(GFR)、术前及术后2、8、12、24 h的尿ATF-3],绘制受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC),分析不同时段尿ATF-3水平对CIN的早期预测价值。结果CIN组年龄(80.57±3.64)岁、合并糖尿病14例(66.67%)、尿酸(308.00±42.74)μmol/L、服用阿司匹林肠溶片13例(61.90%);非CIN组年龄(74.84±6.69)岁、合并糖尿病119例(42.65%)、尿酸(334.35±49.51)μmol/L、服用阿司匹林肠溶片111例(39.78%)。两组患者年龄、糖尿病占比、尿酸、服用阿司匹林肠溶片占比比较,差异有统计学意义(P<0.05);两组患者性别、心率、高血压病占比、吸烟占比、白细胞计数、红细胞计数、血红蛋白、血小板计数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇以及服用他汀类、血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、钙通道拮抗剂占比比较,差异无统计学意义(P>0.05)。两组患者术前血清肌酐、术前GFR及术前尿ATF-3比较,差异均无统计学意义(P>0.05);CIN组术后2、8、12、24 h的尿ATF-3分别为(0.65±0.18)、(1.27±0.12)、(0.97±0.15)、(0.74±0.15)ng/ml,均高于非CIN组的(0.55±0.18)、(1.04±0.19)、(0.74±0.20)、(0.58±0.17)ng/ml,差异均有统计学意义(P<0.05)。通过对不同时段的尿ATF-3绘制ROC曲线发现,术后2 h尿ATF-3的AUC为0.660,最佳截点(cut-off)为0.600,敏感度0.667,特异度0.638;术后8 h尿ATF-3的AUC为0.851,最佳截点为1.105,敏感度Objective To study the predictive value of activating transcription factor 3(ATF-3)on contrast-induced nephropathy(CIN)in elderly patients after percutaneous coronary intervention(PCI).Methods There were 300 elderly patients with coronary atherosclerotic heart disease undergoing elective PCI were selected.All patients were divided into CIN group(n=21)and non CIN group(n=279)according to whether they had CIN or not.The clinical data of the two groups were compared,including gender,age,heart rate,comorbidities,bad habits,blood routine,biochemical index,urine routine and history of taking drugs.The renal function indexes(preoperative serum creatinine,preoperative glomerular filtration rate(GFR),and urinary ATF-3 preoperatively,at 2,8,12 and 24 h postoperatively)were compared at different time intervals,and the receiver operating characteristic(ROC)curves of the subjects were plotted to calculate the areas under the curves(AUC),and to analyze the early predictive value of the urinary ATF-3 level at different time intervals for CIN.Results In the CIN group,the age was(80.57±3.64)years,14 cases(66.67%)had diabetes mellitus,the uric acid was(308.00±42.74)μmol/L,13 cases(61.90%)took aspirin enteric-coated tablets;in the non-CIN group,the age was(74.84±6.69)years,119 cases(42.65%)had diabetes mellitus,the uric acid was(334.35±49.51)μmol/L,111 cases(39.78%)took aspirin enteric-coated tablets.Comparison of age,percentage of diabetes mellitus,uric acid,and percentage of taking aspirin enteric-coated tablets between the two groups showed a statistically significant difference(P<0.05).Comparison of gender,heart rate,percentage of hypertension,percentage of smoking,white blood cell count,red blood cell count,hemoglobin,platelet count,total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,and the percentage of taking statin,angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor antagonist(ARB),β-blocker,and calcium channel antagonist between the two groups showe

关 键 词：尿转录激活因子3 经皮冠状动脉介入治疗 对比剂肾病 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病] R692[医药卫生—内科学]