CAJ | 학술논문

目的：探讨冠状动脉造影或冠状动脉介入术后联合应用血清胱抑素C （ Cys C ）与脑利钠肽（ BNP）水平在更早期、更准确诊断对比剂肾病（ CIN）中的临床意义。方法收集358例行冠状动脉造影或冠状动脉介入术的住院患者相关临床资料。检测术前血肌酐（ Scr）、Cys C与BNP水平，术后8 h、16 h、24 h各点Cys C与BNP水平，术后24 h、48 h、72 h各点Scr水平。依据Scr水平诊断CIN并分组，将CIN组与对照组进行比较分析，并分析Cys C与BNP各单指标及联合转换指标的诊断性能。结果358例患者中，术后16例发生了CIN，发生率为4．47％。与对照组比较，CIN组的Scr水平在术后24 h后升高。两组术后8 h的血清Cys C、BNP水平与术前比较，差异无统计学意义（P＞0．05）；CIN组中术后16 h、24 h的血清Cys C、BNP水平较术前升高，[16 h Cys C：（1．63±0．49） mg/L比（0．91±0．33） mg/L；24 h Cys C：（3．45±0．83） mg/L比（0．91±0.33）mg/L；16 h BNP：（215．96±55．72）ng/L比（102．40±32．23）ng/L；24 h BNP：（352．41±61．08）ng/L比（102．40±32．23）ng/L；均P＜0．01]。 CIN组与对照组比较，术前、术后8 h的血清Cys C、BNP水平差异无统计学意义（P＞0．05）；术后16 h、24 h的血清Cys C、BNP水平升高[16 h Cys C：（1．63±0．49）mg/L比（0．93±0．38） mg/L；24 h Cys C：（3．45±0．83） mg/L比（0．92±0．34） mg/L；16 h BNP：（215．96±55．72） ng/L比（149.32±43．74）ng/L；24 h BNP：（352．41±61．08）ng/L比（164．82±49．62）ng/L；均 P＜0．01]。术后16 h的Cys C与BNP联合转换指标的诊断性能即有高度的准确性。结论血清Cys C、BNP均是较好的CIN早期诊断指标，时间早于Scr。两指标的联合应用能更早期、更准确的诊断CIN。
목적：탐토관상동맥조영혹관상동맥개입술후연합응용혈청광억소C （ Cys C ）여뇌리납태（ BNP）수평재경조기、경준학진단대비제신병（ CIN）중적림상의의。방법수집358례행관상동맥조영혹관상동맥개입술적주원환자상관림상자료。검측술전혈기항（ Scr）、Cys C여BNP수평，술후8 h、16 h、24 h각점Cys C여BNP수평，술후24 h、48 h、72 h각점Scr수평。의거Scr수평진단CIN병분조，장CIN조여대조조진행비교분석，병분석Cys C여BNP각단지표급연합전환지표적진단성능。결과358례환자중，술후16례발생료CIN，발생솔위4．47％。여대조조비교，CIN조적Scr수평재술후24 h후승고。량조술후8 h적혈청Cys C、BNP수평여술전비교，차이무통계학의의（P＞0．05）；CIN조중술후16 h、24 h적혈청Cys C、BNP수평교술전승고，[16 h Cys C：（1．63±0．49） mg/L비（0．91±0．33） mg/L；24 h Cys C：（3．45±0．83） mg/L비（0．91±0.33）mg/L；16 h BNP：（215．96±55．72）ng/L비（102．40±32．23）ng/L；24 h BNP：（352．41±61．08）ng/L비（102．40±32．23）ng/L；균P＜0．01]。 CIN조여대조조비교，술전、술후8 h적혈청Cys C、BNP수평차이무통계학의의（P＞0．05）；술후16 h、24 h적혈청Cys C、BNP수평승고[16 h Cys C：（1．63±0．49）mg/L비（0．93±0．38） mg/L；24 h Cys C：（3．45±0．83） mg/L비（0．92±0．34） mg/L；16 h BNP：（215．96±55．72） ng/L비（149.32±43．74）ng/L；24 h BNP：（352．41±61．08）ng/L비（164．82±49．62）ng/L；균 P＜0．01]。술후16 h적Cys C여BNP연합전환지표적진단성능즉유고도적준학성。결론혈청Cys C、BNP균시교호적CIN조기진단지표，시간조우Scr。량지표적연합응용능경조기、경준학적진단CIN。
Objective To explore the clinical significance of serum cystatin C (Cys C) combined with brain natriuretic peptide(BNP)in more earlier,more accurate diagnosis of contrast-induced nephropathy(CIN)after coro-nary angiography or percutaneous coronary intervention .Methods 358 patients undergone coronary angiography or percutaneous coronary intervention were enrolled in this study , and the data were collected .The serum creatinine (Scr),Cys C and BNP were tested before operation .The serum Cys C and BNP were tested 8h,16h,24h after opera-tion.The serum Scr was tested 24h,48h,72h after operation.All patients were diagnosed and grouped with CIN by ser-um Scr.The results were compared between the CIN group and control group ,diagnosis efficiency of Cys C ,BNP and combine with them was analyzed .Results CIN occurred in 16 cases of 358 enrolled patients , the incidence was 4.47%.The levels of Scr increased beyond 24h after operation in the CIN group .The levels of serum Cys C and BNP had no significant difference at 8h after operation compared to preoperation (P>0.05),and significantly rosed at 16h and 24h after operation(P<0.01)than before in the two group,[16h Cys C:(1.63 ±0.49)mg/L vs(0.91 ±0.33) mg/L,24h Cys C:(3.45 ±0.83)mg/L vs(0.91 ±0.33)mg/L,16h BNP:(215.96 ±55.72)ng/L vs(102.40 ± 32.23)ng/L,24h BNP:(352.41 ±61.08)ng/L vs(102.40 ±32.23)ng/L,all P<0.01].The levels of serum Cys C and BNP had no significant difference at 8h after operation in CIN(P>0.05),and significantly rosed at 16h and 24h after operation in CIN( P<0.01)than the corresponding levels in the control group [16h Cys C:(1.63 ±0.49)mg/L vs(0.93 ±0.38)mg/L,24h Cys C:(3.45 ±0.83)mg/L vs(0.92 ±0.34)mg/L,16h BNP:(215.96 ±55.72)ng/L vs(149.32 ±43.74)ng/L,24h BNP:(352.41 ±61.08)ng/L vs(164.82 ±49.62)ng/L,all P<0.01].The diagno-sis efficiency of serum Cys C combined with BNP at 16h after operation had high degree of accuracy .Conclusion In this study,the serum Cys C and BNP are better biomarker for early diagnose of CIN ,witch can diagnose CIN earlier than Scr .Combine of the two biomarker can more earlier ,more accurate diagnose CIN .