CAJ | 학술논문

目的探讨高敏C反应蛋白(hs-CRP)与急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗后对比剂肾病(CIN)的相关性.方法入选220例行急诊经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者.按hs-CRP水平的四分位数间距,将患者分为4组:Q1组(hs-CRP＜6.26mg/L),Q2组(hs-CRP 6.26 ～ 14.44 mg/L),Q3组(hs-CRP 14.45 ～ 33.08 mg/L),Q4组(hs-CRP＞33.08 mg/L).比较4组之间的基线资料、CIN发生率及院内临床事件.对比剂肾病定义为使用对比剂后48 ～72 h血肌酐值比基线值升高超过5mg/L.采用受试者工作特征(ROC)曲线及logistics回归分析评估hs-CRP与CIN风险的相关性.结果 220例患者中,21(9.8％)例患者发生CIN.Q1、Q2、Q3和Q4组的CIN发生率分别为1.8％ (1/55)、1.8％(1/55)、14.5％(8/55)和20.0％(11/55)(趋势检验,P＜0.01)；院内病死率、需肾脏替代治疗的比例差异均无统计学意义(趋势检验,P均＞0.05).ROC曲线显示:hs-CRP界值为16.85 mg/L时,其预测CIN的敏感度为81.0％,特异度为61.8％,曲线下面积0.748.单因素logistics回归分析显示,hs-CRP水平与CIN发病率显著相关(OR=6.88,95％ CI:2.23 ～21.21,P ＜0.01).多因素logistics回归分析显示,校正性别、贫血、使用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、应用主动脉内球囊反搏、左心室射血分数＜40％、年龄＞75岁、基线估算肾小球滤过率、糖尿病史后,hs-CRP＞ 16.85 mg/L是CIN的独立危险因子(OR=15.91,95％CI:3.43 ～73.85,P＜0.01)；年龄＞75岁(OR=7.27,95％CI:1.85 ～ 28.63,P＜0.01)及基线估算肾小球滤过率(OR =6.38,95％CI:1.48～ 27.41,P ＜0.05)与CIN发生率显著相关.结论行急诊经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者的hs-CRP水平与CIN相关,hs-CRP升高的患者发生CIN的风险增高.
목적 탐토고민C반응단백(hs-CRP)여급성ST단태고형심기경사환자행급진경피관상동맥개입치료후대비제신병(CIN)적상관성.방법 입선220례행급진경피관상동맥개입치료적ST단태고형심기경사환자.안hs-CRP수평적사분위수간거,장환자분위4조:Q1조(hs-CRP＜6.26mg/L),Q2조(hs-CRP 6.26 ～ 14.44 mg/L),Q3조(hs-CRP 14.45 ～ 33.08 mg/L),Q4조(hs-CRP＞33.08 mg/L).비교4조지간적기선자료、CIN발생솔급원내림상사건.대비제신병정의위사용대비제후48 ～72 h혈기항치비기선치승고초과5mg/L.채용수시자공작특정(ROC)곡선급logistics회귀분석평고hs-CRP여CIN풍험적상관성.결과 220례환자중,21(9.8％)례환자발생CIN.Q1、Q2、Q3화Q4조적CIN발생솔분별위1.8％ (1/55)、1.8％(1/55)、14.5％(8/55)화20.0％(11/55)(추세검험,P＜0.01)；원내병사솔、수신장체대치료적비례차이균무통계학의의(추세검험,P균＞0.05).ROC곡선현시:hs-CRP계치위16.85 mg/L시,기예측CIN적민감도위81.0％,특이도위61.8％,곡선하면적0.748.단인소logistics회귀분석현시,hs-CRP수평여CIN발병솔현저상관(OR=6.88,95％ CI:2.23 ～21.21,P ＜0.01).다인소logistics회귀분석현시,교정성별、빈혈、사용혈관긴장소전환매억제제혹혈관긴장소Ⅱ수체길항제、응용주동맥내구낭반박、좌심실사혈분수＜40％、년령＞75세、기선고산신소구려과솔、당뇨병사후,hs-CRP＞ 16.85 mg/L시CIN적독립위험인자(OR=15.91,95％CI:3.43 ～73.85,P＜0.01)；년령＞75세(OR=7.27,95％CI:1.85 ～ 28.63,P＜0.01)급기선고산신소구려과솔(OR =6.38,95％CI:1.48～ 27.41,P ＜0.05)여CIN발생솔현저상관.결론 행급진경피관상동맥개입치료적급성ST단태고형심기경사환자적hs-CRP수평여CIN상관,hs-CRP승고적환자발생CIN적풍험증고.
Objective To explore the association between high-sensitivity C-reactive protein (hs-CRP) and contrast-induced nephropathy (CIN) in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).Methods A total of 220 STEMI patients undergoing primary PCI from Guangdong general hospital were recruited.Patients were divided into four groups according to the quartile of hs-CRP(Q1 group:hs-CRP ＜ 6.26 mg/L,Q2 group:6.26-14.44 mg/L,Q3 group:14.45-33.08 mg/L,Q4 group:hs-CRP ＞ 33.08 mg/L).Baseline data,CIN incidence and other in-hospital outcomes were compared among groups.CIN was defined as an increase in serum creatinine of more than 5 mg/L from baseline within 48-72 hours after contrast media exposure.Receiver operator characteristics (ROC) curves and multivariate logistic regression were used to assessed the correlation between hs-CRP and CIN.Results CIN occurred in 21 (9.8％) patients.CIN incidence of hs-CRP quartitles were 1.8％(1/55),1.8％ (1/55),14.5％ (8/55) and 20.0％ (11/55) (P-trend ＜0.01),respectively.In-hospital death (P-trend ＞ 0.05),required renal replace therapy (P-trend ＞ 0.05) were similar among groups.ROC analysis revealed that the optimal cutoff value of hs-CRP to predict the onset of CIN was 16.85mg/L (sensitivity:81.0％,specificity:61.8％,AUC:0.748).Univariate logistic analysis showed that hs-CRP was strongly related with CIN incidence(OR =6.88,95％ CI:2.23-21.21,P ＜ 0.01).Multivariate logistic regression analysis showed that after adjusting other traditional risk factors including female gender,anemia,ACEI/ARB use,IABP support,LVEF ＜ 40％,age ＞ 75 years,baseline eGFR and diabetes,hs-CRP ＞ 16.85 mg/L was still a significant independent predictor of CIN in patients with STEMI undergoing primary PCI.Additionally,age ＞ 75 years (OR =7.27,95％ CI:1.85-28.63,P ＜ 0.01),eGFR (OR =6.38,95％ CI:1.48-27.41,P ＜0.05)were also independent risk factors of CIN.Conclusions hs-CRP is positively correlated with CIN incidence.STEMI patients with higher hs-CRP level post PCI is at higher risk of developing CIN.