CysC联合Hs-CRP预测PCI术后CIN中的应用

发布时间：2018-04-08 09:44

  本文选题：血清胱抑素C　切入点：超敏C反应蛋白　出处：《新疆医科大学》2015年硕士论文

【摘要】：目的:评价血清胱抑素C联合超敏C反应蛋白早期预测冠心病介入术后造影剂肾病中的应用价值,旨在为临床预防、早期发现及治疗造影剂诱导的造影剂肾病提供科学依据。方法:纳入新疆维吾尔自治区人民医院2014年7月至2014年12月300例行冠心病并接收介入治疗的患者。入选患者均符合ACC/AHA和WHO制定的诊断标准。采集患者年龄、性别、身高、体重、血压(含收缩压、舒张压及平均压)、合并高血压或糖尿病、应用ACEI/ARB类药物等基本信息,并于术前检查肾功能、血脂、血糖、心功能(EF值)等。术前按照适合中国人的肾脏疾病饮食调整公式(MDRD)计算估测的肾小球滤过率(eGFR)评价肾功能:eGFR(ml·min-1·1.73 m-2)=175×SCr(mg/dl)-1.234×年龄-0.179×(0.79女性)。CIN被定义为血管内使用造影剂48-72h后血清肌酐值较基础值升高25%或增加44μmol/l。在PCI术前及在PCI术前、以及术后12、24、48-72小时采集血标本。所有病例依照是否出现造影剂肾病组(CIN组)和非造影剂肾病组(No-CIN组)。结果:1、入组病例300例中,CIN组37例,发病率12.3%。2、CIN组术后24hCysC、Hs-CRP较对照组明显升高,存在显著差异。3、PCI术后CIN与高龄(年龄≥75岁)、糖尿病、高血压、以往心梗、PCI病史、冠脉慢性闭塞病变、LVD≥55mm、造影剂≥300ml显著正相关。4、通过ROC曲线分析,最大曲线下面积0.899,95%置信区间(0.850-0.947),根据约登指数,24hCysC取界值为1.37mg/l,24hCysC对CIN的早期预测诊断敏感度为89.2%(95%CI:83.0-95.4),特异度73%(95%CI:64.2-81.9),约登指数:0.622;最大曲线下面积0.744,95%置信区间(0.658-0.830),根据约登指数,24hHs-CRP取界值为2.38mg/l,对CIN的早期预测诊断敏感度为75.7%(95%CI:67.2-84.3),特异度71.9%(95%CI:62.2-80.2),约登指数:0.476。24hCysC、24hHs-CRP并联试验提高了诊断敏感度,降低了特异度,而串联试验提高了诊断特异度,降低了敏感度。5、多因素logistic回归分析显示,年龄≥75岁、糖尿病、慢性心衰、IABP使用、造影剂用量≥300ml均是CIN的危险因素(P0.05)。结论:血浆CysC联合Hs-CRP对CIN的早期预测诊断具有较高价值。
[Abstract]:Objective: to evaluate the value of serum cystatin C combined with hypersensitive C-reactive protein in early prediction of contrast agent nephropathy after coronary intervention in order to provide scientific basis for clinical prevention, early detection and treatment of contrast agent nephropathy induced by contrast medium.Methods: 300 patients with coronary heart disease received interventional therapy from July 2014 to December 2014 in Xinjiang Uygur Autonomous region people's Hospital.All the selected patients met the diagnostic criteria established by ACC/AHA and WHO.Age, sex, height, weight, blood pressure (including systolic blood pressure, diastolic blood pressure and mean pressure), hypertension or diabetes mellitus, ACEI/ARB drugs and so on were collected. Renal function, blood lipid, blood sugar were examined before operation.Cardiac function (EF), et al.Preoperative estimation of glomerular filtration rate (GFR) according to the dietary adjustment formula for renal diseases in Chinese was used to evaluate the renal function: min-1 1.73 m ~ (-2) and 175 脳 SCr(mg/dl)-1.234 脳 age = -0.179 脳 0.79 female. Cin was defined as serum creatinine level increased by 25% or 44 渭 mol / L after intravascular contrast agent 48-72 h.Blood samples were collected before PCI and before PCI, and at 24 ~ 72 hours postoperatively.All cases were divided into two groups according to the presence of contrast agent nephropathy (cin group) and non contrast agent nephropathy group (No-CIN group).Results among 300 cases, 37 cases were in cin group. The incidence rate of CysCn Hs-CRP in the cin group was significantly higher than that in the control group at 24 h after operation. There was significant difference between CIN and the elderly (age 鈮，

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