多种生物标记物在PCI术后对比剂急性肾损害早期诊断中的临床意义

发布时间：2018-01-29 18:12

本文关键词： 对比剂急性肾损害中性粒细胞明胶酶相关载脂蛋白半胱氨酸蛋白酶抑制剂C 肾脏损伤因子-1 血清肌酐　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的：探讨多种生物标记物在PCI术后对比剂急性肾损害(CIAKI)早期诊断中的临床意义。研究方法：选择2013年4月至2013年8月间,天津市泰达国际心血管病医院心内科收治的接受择期PCI且术前肌酐正常的稳定性心绞痛及非ST段抬高型急性冠脉综合征患者200例。所有患者均使用低渗造影剂优维显370(碘普罗胺注射液),并记录患者年龄、体重指数、吸烟、高血压病、糖尿病、高脂血症、陈旧心肌梗死、左心室射血分数(LVEF)、造影剂用量、入院肌酐水平、参照血管直径、靶病变植入支架总长度以及支架植入后最小支架内径等。于术前及术后不同时间分别测定血浆中性粒细胞明胶酶相关载脂蛋白(NGAL)、血浆半胱氨酸蛋白酶抑制剂C(Cystatin C)、尿中性粒细胞明胶酶相关载脂蛋白(NGAL)、尿肾脏损伤因子-1(Kidney injury molecule-1, Kim-1)及术后48h肌酐(Scr),并根据对比剂肾病诊断标准,分为CIAKI组及正常组。1.对CIAKI发生的危险因素进行Logistic回归分析,明确CIAKI发生的主要危险因素。2.观察两组多种生物标记物的变化情况,并以受试者工作特征曲线(ROC)及曲线下面积(AUC)评价各项标志物诊断CIAKI的临床意义。NGAL. Cystatin C、 Kim-1测定均采用ELISA方法,血肌酐采用比浊法检测。研究结果： 1.所有患者术后发生CIAKI的共有16例,发生率为8%。Logistic回归分析发现,高血压,造影剂用量均可能是肌酐正常患者经PCI治疗后发生CIAKI的危险因素。 2.①两组患者术前血浆NGAL、血浆Cystatin C、尿NGAL及尿Kim-1没有明显差异(P0.05)。②与术前相比,CIAKI组术后各种生物标记物水平均比术前升高,且差异显著(P0.05)；其中CIAKI组血浆NGAL于术后2小时开始逐渐升高,至4小时达到最高值,与正常组比较,差异显著(P0.05)；CIAKI组术后患者血浆Cystatin C于术后4小时明显升高,与正常组比较,差异显著(P0.05); CIAKI组尿NGAL水平均于术后8小时明显升高,与正常组比较,差异显著(P0.05); CIAKI组尿Kim-1于术后8小时升高,并持续升高24小时,与正常组相比,差异显著(P0.05)。③通过各种生物标记物对于CIAKI的诊断作用ROC曲线的比较可以看出,各种生物标记物均能反映早期肾功能的变化,其中血浆NGAL诊断CIAKI的敏感性和特异性比其他三种指标高。研究结论： 1.高血压和造影剂用量可能是肌酐正常患者经PCI治疗后发生CIAKI的危险因素。 2.PCI后CIAKI患者各项生物标志物在术后不同的时间点显著升高,为早期诊断PCI后CIAKI提供新的诊断方法。
[Abstract]:Objectives of the study: To investigate the clinical significance of multiple biomarkers in early diagnosis of acute renal injury after PCI. Research methods: Choose between April 2013 and August 2013. Two hundred patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome (ACS) receiving selective PCI and normal creatinine before operation were admitted to Tianjin Teda International Cardiovascular Disease Hospital. All patients were treated with low level. Osmotic contrast agent you Wei Xian 370 (. Iopramide injection. Age, body mass index (BMI), smoking, hypertension, diabetes, hyperlipidemia, old myocardial infarction, left ventricular ejection fraction (LVEF), contrast agent dosage, and admission creatinine level were recorded. The plasma neutrophil gelatinase-associated apolipoprotein (apolipoprotein NGALs) was measured before and after stent implantation according to the diameter of blood vessel the total length of stent and the minimum stent diameter after stent implantation. Cystatin, a plasma cysteine protease inhibitor, and urinary neutrophil gelatinase-associated apolipoprotein (NGALs). Urinary kidney injury factor-1 Kidney injury molecule-1 (Kim-1) and creatinine creatinine (SCR) at 48h after operation. The risk factors of CIAKI were analyzed by Logistic regression analysis. To identify the main risk factors for the occurrence of CIAKI. 2. To observe the changes of two groups of multiple biomarkers. The clinical significance of each marker in the diagnosis of CIAKI was evaluated by the operating characteristic curve (ROC) and the area under the curve. Kim-1 was determined by ELISA and serum creatinine by turbidimetry. Results of the study: 1. There were 16 cases of CIAKI in all the patients, the incidence rate was 8. Logistic regression analysis found that hypertension. The dosage of contrast agent may be the risk factor of CIAKI in patients with normal creatinine after PCI treatment. 2.1 there was no significant difference between the two groups in preoperative plasma NGALs, plasma Cystatin C, urinary NGAL and urinary Kim-1. The levels of various biomarkers in CIAKI group were higher than those before operation, and the difference was significant (P 0.05). The plasma NGAL in CIAKI group increased gradually at 2 hours after operation and reached the highest value at 4 hours. The difference was significant compared with the normal group (P 0.05). The level of plasma Cystatin C in CIAKI group was significantly higher than that in normal group at 4 hours postoperatively (P 0.05). The level of urinary NGAL in CIAKI group was significantly higher than that in normal group at 8 hours postoperatively (P 0.05). Urinary Kim-1 in the CIAKI group increased 8 hours after operation and continued to rise 24 hours, compared with the normal group. The difference was significant (P 0.05). By comparing the ROC curves of various biomarkers for the diagnosis of CIAKI, we can see that all kinds of biomarkers can reflect the changes of early renal function. The sensitivity and specificity of plasma NGAL in the diagnosis of CIAKI were higher than those of the other three indexes. The study concluded that: 1. Hypertension and dosage of contrast agent may be the risk factors of CIAKI in patients with normal creatinine after PCI treatment. 2. The biomarkers of CIAKI patients increased significantly at different time points after PCI, which provided a new diagnostic method for early diagnosis of CIAKI after PCI.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.4;R692.5

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