CAJ | 학술논문

目的前瞻性研究冠状动脉介入诊疗术后,尿N-乙酰-β-D氨基葡萄糖酐酶(UNAG)和尿视黄醇结合蛋白(URBP)在造影剂所致急性肾损伤发生前后的差异.方法收集150例接受冠状动脉造影及介入治疗患者的临床资料.留取患者术前、术后24 h、术后48～72 h尿液和血液.用酶法测血清肌酐(SCr)和尿肌酐(UCr)值;用ELISA法检测UNAG和URBP水平.手术后48～72 h SCr上升基础值的25%或绝对值上升44 μmol/L以上诊断为造影剂肾病(CIN)13例,选择性别、年龄、冠状动脉造影结果等基础资料匹配的27例为对照组.结果接受冠状动脉造影及介入治疗患者的CIN发病率为8.7%(13/150).CIN组术前UNAG/UCr水平明显高于对照组[1.97(1.06,2.64)U/mmol与1.07(0.68,1.88)U/mmol,Z=2.076,P=0.039];术后24 h CIN组患者UNAG/UCr值较术前显著上升[2.82(1.88,4.26)U/mmol与1.97(1.06,2.64)U/mmol,Z=2.607,P=0.009];ROC分析显示术前基础UNAG值可用于CIN预测,曲线下面积达0.776(P=0.023);截断值为8.08 U/L时,诊断的敏感性和特异性分别为0.771和0.713.基线UNAG高于8.08 U/L的比例在CIN组中明显高于对照组[77.1%(10/13)与29.6%(8/27),Z=2.564,P=0.011],与发病的相对危险度为5.58,95%GI为1.24～25.08.结论 UNAG检测可用于CIN患病危险度的预测,并且术后24 h水平可用于CIN的早期诊断.
목적 전첨성연구관상동맥개입진료술후,뇨N-을선-β-D안기포도당항매(UNAG)화뇨시황순결합단백(URBP)재조영제소치급성신손상발생전후적차이.방법 수집150례접수관상동맥조영급개입치료환자적림상자료.류취환자술전、술후24 h、술후48～72 h뇨액화혈액.용매법측혈청기항(SCr)화뇨기항(UCr)치;용ELISA법검측UNAG화URBP수평.수술후48～72 h SCr상승기출치적25%혹절대치상승44 μmol/L이상진단위조영제신병(CIN)13례,선택성별、년령、관상동맥조영결과 등기출자료필배적27례위대조조.결과 접수관상동맥조영급개입치료환자적CIN발병솔위8.7%(13/150).CIN조술전UNAG/UCr수평명현고우대조조[1.97(1.06,2.64)U/mmol여1.07(0.68,1.88)U/mmol,Z=2.076,P=0.039];술후24 h CIN조환자UNAG/UCr치교술전현저상승[2.82(1.88,4.26)U/mmol여1.97(1.06,2.64)U/mmol,Z=2.607,P=0.009];ROC분석현시술전기출UNAG치가용우CIN예측,곡선하면적체0.776(P=0.023);절단치위8.08 U/L시,진단적민감성화특이성분별위0.771화0.713.기선UNAG고우8.08 U/L적비례재CIN조중명현고우대조조[77.1%(10/13)여29.6%(8/27),Z=2.564,P=0.011],여발병적상대위험도위5.58,95%GI위1.24～25.08.결론 UNAG검측가용우CIN환병위험도적예측,병차술후24 h수평가용우CIN적조기진단.
Objective To prospectively study the difference of urinary N-acetyl-β-D-glucosaminidase( UN-AG) and retinol binding protein(URBP) in contrast-induced nephropathy (CIN). Methods The clinical data of 150 patients undergoing coronary angiography were documented. The urine and blood samples before,24 hours after and 48～72 hours after the procedure were collected;Serum creatinine (SCr) and urinary ereatinine (UCr)were tested by enzymic method. UNAG and URBP were tested by ELISA in CIN and control group. CIN was defined as an increase in SCr of ≥44 μmol/L or >25% from baseline 48 ～72 h after the procedure. 27 age- , sex- , results of coro-nary angiography-matched cases were taken as control group. Results CIN was diagnosed in 13 of 150 patients (8.7%). In CIN group, UNAG/UCr were significantly higher than that in control group[ 1.97 (1.06,2.64) U/mmol vs 1.07 (0, 68,1.88 ) U/mmol, Z = 2.076, P = 0.039 ] before ;24 hours after the procedure, UNAG/UCr was signifi-cantly up-regulated in CIN group from baseline level [ 2.82 ( 1.88 ,4.26) U/mmol vs 1.97 (1.06,2.64) U/mmol, Z =2.607,P =0. 009]. ROC curve analysis showed that baseline UNAG could be used as an early predictor for CIN, the AUC =0. 776 ,P =0.023 ;when cut off value = 8.08 U/L,the sensitivity and specificity of UNAG were 0. 771 and 0. 713 respectively. The percentage of patients of UNAG over 8.08 U/L in CIN group was significantly higher than that in control group[77.1% (10/13) vs 29.6% (8/27) ,Z =2. 564,P =0. 011 ] ,the related risk factor is 5.58,95% CI was 1.24 ～ 25.08. Conclusion UNAG could be used as a predictor of CIN before the procedure and its postprocedure 24 h level maybe useful in early diagnosis after the procedure.