造影剂早期肾损伤的诊断及水化治疗对其防护作用
发布时间：2018-07-13 19:29
【摘要】：目的探讨尿中性粒细胞明胶酶载脂蛋白(NGAL)和肾损伤因子1(KIM-1)在造影剂早期肾损伤中的诊断价值,评估水化治疗对造影剂肾病(CIN)的预防作用。 方法选择经皮冠状动脉介入治疗(PCI)患者120例,随机分为水化治疗组(60例)和对照组(60例)。PCI术前6h始给予水化治疗组患者静脉补液至术后12h。采用自动生化仪分别检测定患者术前(TO)、术后12h (T1)、24h (T2)、48h (T3)、72h (T4)的血Scr、BUN、血浆胱抑素C (Cys-C)及尿微量白蛋白(mAlb)变化,ELISA法检测尿NGAL和尿KIM-1水平,检测尿al-微球蛋白(a1-MG)、尿N-Z酰一β-D氨基葡萄糖苷酶(NAG)。 结果(1)120例受试者中有87例患者PCI术后12h出现尿NGAL/Cr和KIM-1/Cr升高至基线值的两倍以上,发生CIN8例6.67%),其中水化治疗组l例(1.7%),对照组7例(11.7%),两组比较差异有统计学意义(P0.05)。(2)两组患者血BUN、Scr、mAlb/Cr、Cys-C、GFR的差异无统计学意义(均P0.05)。(3)两组患者尿a1-MG、NAG水平均于术后24h升高。水化治疗组术后72h基本回落至术前水平,与对照组比较差异有统计学意义(P0.01)。(4)两组患者尿NGAL、KIM-1水平均于术后12h升高。水化治疗组术后72h基本回落至术前水平,与对照组比较差异有统计学意义(P0.01)。(5)两组患者PCI术后12h NGAL/Cr、KIM-1/Cr的ROC曲线下面积(AUC)分别为0.931、0.811,组间比较差异有统计学意义(P0.05)。 结论NGAL和KIM-1是诊断造影剂早期肾损伤敏感和特异性的指标,水化治疗可预防造影剂肾病的发生。
[Abstract]:Objective to investigate the diagnostic value of urinary neutrophil gelatinase apolipoprotein (NGAL) and renal injury factor-1 (KIM-1) in early renal injury and evaluate the preventive effect of hydration on contrast agent nephropathy (cin). Methods 120 patients with percutaneous coronary intervention (PCI) were randomly divided into hydration group (n = 60) and control group (n = 60). The levels of urinary NGAL and urinary KIM-1 were detected by automatic biochemical instrument before operation (to), 12 h (T1), 48 h (T 3) and 72 h (T 4), plasma cystatin C (Cys-C) and urinary microalbumin (mAlb) were determined by Elisa. Urine al- microglobulin (a1-MG) and urine N-Z acyl-尾-D glucosaminidase (nag) were detected. Results (1) in 87 of 120 subjects, urinary NGAL-Cr and KIM-1 / Cr increased more than twice the baseline value 12 hours after PCI. The incidence of CIN8 was 6.67%, including 1 case (1.7%) in hydration treatment group and 7 cases (11.7%) in control group. There was a significant difference between the two groups (P0.05). (2). There was no significant difference between two groups (P0.05). (3) in urine a1-MGNAG level of two groups (P0.05). (3). The levels of urinary NGALL KIM-1 in hydration treatment group were significantly higher than those in control group (P0.01). (4) at 12 hours after operation. In the hydration treatment group, the area under the ROC curve was 0.931 卤0.811 at the 12th hour after PCI (P0.01). (5), and there was significant difference between the two groups (P0.05). Conclusion NGAL and KIM-1 are sensitive and specific indexes in the diagnosis of early renal injury in contrast medium. Hydration therapy can prevent the occurrence of contrast agent nephropathy.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5
本文编号：2120501
[Abstract]:Objective to investigate the diagnostic value of urinary neutrophil gelatinase apolipoprotein (NGAL) and renal injury factor-1 (KIM-1) in early renal injury and evaluate the preventive effect of hydration on contrast agent nephropathy (cin). Methods 120 patients with percutaneous coronary intervention (PCI) were randomly divided into hydration group (n = 60) and control group (n = 60). The levels of urinary NGAL and urinary KIM-1 were detected by automatic biochemical instrument before operation (to), 12 h (T1), 48 h (T 3) and 72 h (T 4), plasma cystatin C (Cys-C) and urinary microalbumin (mAlb) were determined by Elisa. Urine al- microglobulin (a1-MG) and urine N-Z acyl-尾-D glucosaminidase (nag) were detected. Results (1) in 87 of 120 subjects, urinary NGAL-Cr and KIM-1 / Cr increased more than twice the baseline value 12 hours after PCI. The incidence of CIN8 was 6.67%, including 1 case (1.7%) in hydration treatment group and 7 cases (11.7%) in control group. There was a significant difference between the two groups (P0.05). (2). There was no significant difference between two groups (P0.05). (3) in urine a1-MGNAG level of two groups (P0.05). (3). The levels of urinary NGALL KIM-1 in hydration treatment group were significantly higher than those in control group (P0.01). (4) at 12 hours after operation. In the hydration treatment group, the area under the ROC curve was 0.931 卤0.811 at the 12th hour after PCI (P0.01). (5), and there was significant difference between the two groups (P0.05). Conclusion NGAL and KIM-1 are sensitive and specific indexes in the diagnosis of early renal injury in contrast medium. Hydration therapy can prevent the occurrence of contrast agent nephropathy.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5
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