新疆医科大学学报
新疆醫科大學學報
신강의과대학학보
JOURNAL OF XINJIANG MEDICAL UNIVERSITY
2015年
7期
879-883
,共5页
血清胱抑素 C%超敏 C 反应蛋白%冠心病介入%造影剂肾病
血清胱抑素 C%超敏 C 反應蛋白%冠心病介入%造影劑腎病
혈청광억소 C%초민 C 반응단백%관심병개입%조영제신병
serum cystatin C%high sensitivity C reactive protein%percutaneous coronary intervention%con-trast induced nephropathy
目的：评价胱抑素 C（Cys-C）、超敏 C 反应蛋白（Hs-CRP）在冠心病介入术后早期预测造影剂肾病（CIN）中的应用价值，为临床预防、早期发现及治疗造影剂诱导的急性肾损伤提供科学依据。方法纳入2014年7－12月300例冠心病并接受介入治疗的患者。按照48～72 h 血清肌酐（SCr）水平较使用造影剂前升高≥25％，将病例分为 CIN 组及对照组。测定术前各项生化指标，术后24、48、72 h 共3个时间点进行 SCr、CysC、尿素氮（BUN）、Hs-CRP 等检测。结果（1）CIN 组37例，发病率为12．3％。（2）CIN 组术后24 h Cys-C、Hs-CRP 较对照组明显升高，差异有统计学意义。（3）ROC 曲线分析24 h Cys-C 截断值为1．37 mg／L，敏感度为89．2％，特异度为73％，约登指数为0．622；24 h Hs-CRP 截断值为2．38 mg／dL，敏感度为75．7％，特异度为71．9％，约登指数为0．476。（4）24 h Cys-C、24 h Hs-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≥300 mL是 CIN 的危险因素。结论血浆 Cys-C 联合 Hs-CRP 对 CIN 的早期预测诊断具有较高价值。
目的：評價胱抑素 C（Cys-C）、超敏 C 反應蛋白（Hs-CRP）在冠心病介入術後早期預測造影劑腎病（CIN）中的應用價值，為臨床預防、早期髮現及治療造影劑誘導的急性腎損傷提供科學依據。方法納入2014年7－12月300例冠心病併接受介入治療的患者。按照48～72 h 血清肌酐（SCr）水平較使用造影劑前升高≥25％，將病例分為 CIN 組及對照組。測定術前各項生化指標，術後24、48、72 h 共3箇時間點進行 SCr、CysC、尿素氮（BUN）、Hs-CRP 等檢測。結果（1）CIN 組37例，髮病率為12．3％。（2）CIN 組術後24 h Cys-C、Hs-CRP 較對照組明顯升高，差異有統計學意義。（3）ROC 麯線分析24 h Cys-C 截斷值為1．37 mg／L，敏感度為89．2％，特異度為73％，約登指數為0．622；24 h Hs-CRP 截斷值為2．38 mg／dL，敏感度為75．7％，特異度為71．9％，約登指數為0．476。（4）24 h Cys-C、24 h Hs-CRP 併聯試驗提高瞭診斷敏感度，降低瞭特異度，而串聯試驗提高瞭診斷特異度，降低瞭敏感度。（5）多因素 Logistic 迴歸分析顯示，年齡≥75歲、糖尿病、慢性心衰、IABP 使用、造影劑用量≥300 mL是 CIN 的危險因素。結論血漿 Cys-C 聯閤 Hs-CRP 對 CIN 的早期預測診斷具有較高價值。
목적：평개광억소 C（Cys-C）、초민 C 반응단백（Hs-CRP）재관심병개입술후조기예측조영제신병（CIN）중적응용개치，위림상예방、조기발현급치료조영제유도적급성신손상제공과학의거。방법납입2014년7－12월300례관심병병접수개입치료적환자。안조48～72 h 혈청기항（SCr）수평교사용조영제전승고≥25％，장병례분위 CIN 조급대조조。측정술전각항생화지표，술후24、48、72 h 공3개시간점진행 SCr、CysC、뇨소담（BUN）、Hs-CRP 등검측。결과（1）CIN 조37례，발병솔위12．3％。（2）CIN 조술후24 h Cys-C、Hs-CRP 교대조조명현승고，차이유통계학의의。（3）ROC 곡선분석24 h Cys-C 절단치위1．37 mg／L，민감도위89．2％，특이도위73％，약등지수위0．622；24 h Hs-CRP 절단치위2．38 mg／dL，민감도위75．7％，특이도위71．9％，약등지수위0．476。（4）24 h Cys-C、24 h Hs-CRP 병련시험제고료진단민감도，강저료특이도，이천련시험제고료진단특이도，강저료민감도。（5）다인소 Logistic 회귀분석현시，년령≥75세、당뇨병、만성심쇠、IABP 사용、조영제용량≥300 mL시 CIN 적위험인소。결론혈장 Cys-C 연합 Hs-CRP 대 CIN 적조기예측진단구유교고개치。
Objective To evaluate the therapy of serum cystatin C combined with high sensitive C reactive protein in the early prediction for contrast induced nephropathy in patients with coronary heart disease after percutaneous coronary intervention.The paper aimed to provide a scientific basis for the clinical pre-vention,early diagnosis and the treatment for contrast induced nephropathy.Methods 300 patients with coronary heart disease undergoing percutaneous coronary intervention from 2014.7-12 hospitalized in Car-diovascular Department of Internal Medicine in Xinjiang Uygur Autonomous Region People′s Hospital were enrolled.Serum biochemical indexes were determined at baseline and 24,48,72 hours after PCI.300 patients were divided into CIN Group and non-CIN Group by the increasing of SCr above 25% to baseline. Results (1)The incidence of 12.3% of CIN was found in CIN group.(2)Compared with the non-CIN group,CysC and Hs-CRP at 24h increased significantly after PCI in CIN group,with statistically signifi-cant difference.(3)ROC curve analysis showed that at a cutoff of 1.37,CysC exhibited 89.2% sensitivity and 73% specificity,with Youden index of 0.622.ROC curve analysis showed that at a cutoff of 2.38,Hs-CRP exhibited 75.7% sensitivity and 71.9% specificity,with Youden index of 0.476.When CysC and Hs-CRP were combined,the sensitivity was improved by parallel testing,the specificity decreased meanwhile. The specificity was improved by serial testing,with the sensitivity decreasing.Multi variate logistic regres-sion analysis showed that with the old,diabetes mellitus,chronic heart failure,intra-aortic balloon pump, the use of contrast volume≥300 mL during procedure was an independent predictors of CIN.Conclusion It′s proved that the therapy of serum cystatin C combined with high sensitive C reactive protein had a high-er value in the early prediction and diagnosis in CIN.
