中国医药
中國醫藥
중국의약
China Medicine
2015年
11期
1609-1613
,共5页
刘晓丽%周玉杰%韩红亚%杨清%聂斌
劉曉麗%週玉傑%韓紅亞%楊清%聶斌
류효려%주옥걸%한홍아%양청%섭빈
糖尿病%肾功能不全%胱蛋白酶抑制素C%急性肾损伤
糖尿病%腎功能不全%胱蛋白酶抑製素C%急性腎損傷
당뇨병%신공능불전%광단백매억제소C%급성신손상
Diabetes%Renal dysfunction%Cystatin C%Acute kidney injury
目的 探讨血浆胱蛋白酶抑制素C (CysC)对糖尿病合并肾功能不全患者对比剂诱导的急性肾损伤(CIAKI)的早期诊断价值.方法 连续选择2009年1月至2010年7月于首都医科大学附属北京安贞医院就诊的冠状动脉粥样硬化性心脏病(冠心病)合并糖尿病及肾功能不全,拟行冠状动脉造影及支架置入术的患者.检测术前血清肌酐、血糖、血脂、术后48 ～ 72 h血清肌酐水平,术前、术后24 h血浆CysC水平,评价CysC对糖尿病合并肾功能不全患者CIAKI的早期诊断价值.结果 入选患者122例,根据是否发生CIAKI分成CIAKI组(21例)和无CIAKI组(101例).CIAKI组与无CIAKI组年龄、尿素氮、肾小球滤过率、肾小球滤过率＜60 ml/(min· 1.73 m2)者占比、冠状动脉病变数以及对比剂使用量比较[(67±11)岁比(59±10)岁,(8.6 ±2.1) mmol/L比(7.4±0.9)mmol/L,(62±17) mL/(min·1.73 m2)比(71±14) ml/(min· 1.73 m2),61.9％ (13/21)比35.6％ (36/101),1支:19.0％ (4/21)比35.6％(36/101),2支:38.1％ (8/21)比49.5％ (50/101),≥3支:42.9％ (9/21)比14.9％ (15/101),(210 ±55) ml比(178±47)ml],差异均有统计学意义(均P＜0.05).术前,CIAKI组血清肌酐水平明显高于无CIAKI组[(108 ±21) μmol/L比(99 ±9) μmol/L,P＜0.05],而CysC水平2组比较差异无统计学意义(P＞0.05).术后,CIAKI组血清肌酐、CysC水平明显高于术前和无CIAKI组术后[(120±27) μmol/L比(108±21)、(102±12) μmol/L,(567±187) μg/L比(468±176)、(454±180)μg/L],差异有统计学意义(P＜0.05);无CIAKI组术后CysC水平明显高于术前[(454±180)μg/L比(413±158) μg/L,P＜0.05],但血清肌酐水平与术前比较差异无统计学意义(P =0.070).Pearson检验表明,基线时血清肌酐水平与CysC明显相关(r=0.554,P＜0.01).术前及术后24 h血浆CysC水平的受试者工作特征曲线下面积分别为0.605(95％置信区间:0.464～0.745,P=0.136)和0.663(95％置信区间:0.541～0.785,P=0.020).CysC相对升高≥25％诊断CIAKI的敏感度和特异度分别为0.905和0.782,阴性预测价值97.5％.结论 血浆CysC可以作为CIAKI的早期诊断标志物,阴性诊断价值更大.
目的 探討血漿胱蛋白酶抑製素C (CysC)對糖尿病閤併腎功能不全患者對比劑誘導的急性腎損傷(CIAKI)的早期診斷價值.方法 連續選擇2009年1月至2010年7月于首都醫科大學附屬北京安貞醫院就診的冠狀動脈粥樣硬化性心髒病(冠心病)閤併糖尿病及腎功能不全,擬行冠狀動脈造影及支架置入術的患者.檢測術前血清肌酐、血糖、血脂、術後48 ～ 72 h血清肌酐水平,術前、術後24 h血漿CysC水平,評價CysC對糖尿病閤併腎功能不全患者CIAKI的早期診斷價值.結果 入選患者122例,根據是否髮生CIAKI分成CIAKI組(21例)和無CIAKI組(101例).CIAKI組與無CIAKI組年齡、尿素氮、腎小毬濾過率、腎小毬濾過率＜60 ml/(min· 1.73 m2)者佔比、冠狀動脈病變數以及對比劑使用量比較[(67±11)歲比(59±10)歲,(8.6 ±2.1) mmol/L比(7.4±0.9)mmol/L,(62±17) mL/(min·1.73 m2)比(71±14) ml/(min· 1.73 m2),61.9％ (13/21)比35.6％ (36/101),1支:19.0％ (4/21)比35.6％(36/101),2支:38.1％ (8/21)比49.5％ (50/101),≥3支:42.9％ (9/21)比14.9％ (15/101),(210 ±55) ml比(178±47)ml],差異均有統計學意義(均P＜0.05).術前,CIAKI組血清肌酐水平明顯高于無CIAKI組[(108 ±21) μmol/L比(99 ±9) μmol/L,P＜0.05],而CysC水平2組比較差異無統計學意義(P＞0.05).術後,CIAKI組血清肌酐、CysC水平明顯高于術前和無CIAKI組術後[(120±27) μmol/L比(108±21)、(102±12) μmol/L,(567±187) μg/L比(468±176)、(454±180)μg/L],差異有統計學意義(P＜0.05);無CIAKI組術後CysC水平明顯高于術前[(454±180)μg/L比(413±158) μg/L,P＜0.05],但血清肌酐水平與術前比較差異無統計學意義(P =0.070).Pearson檢驗錶明,基線時血清肌酐水平與CysC明顯相關(r=0.554,P＜0.01).術前及術後24 h血漿CysC水平的受試者工作特徵麯線下麵積分彆為0.605(95％置信區間:0.464～0.745,P=0.136)和0.663(95％置信區間:0.541～0.785,P=0.020).CysC相對升高≥25％診斷CIAKI的敏感度和特異度分彆為0.905和0.782,陰性預測價值97.5％.結論 血漿CysC可以作為CIAKI的早期診斷標誌物,陰性診斷價值更大.
목적 탐토혈장광단백매억제소C (CysC)대당뇨병합병신공능불전환자대비제유도적급성신손상(CIAKI)적조기진단개치.방법 련속선택2009년1월지2010년7월우수도의과대학부속북경안정의원취진적관상동맥죽양경화성심장병(관심병)합병당뇨병급신공능불전,의행관상동맥조영급지가치입술적환자.검측술전혈청기항、혈당、혈지、술후48 ～ 72 h혈청기항수평,술전、술후24 h혈장CysC수평,평개CysC대당뇨병합병신공능불전환자CIAKI적조기진단개치.결과 입선환자122례,근거시부발생CIAKI분성CIAKI조(21례)화무CIAKI조(101례).CIAKI조여무CIAKI조년령、뇨소담、신소구려과솔、신소구려과솔＜60 ml/(min· 1.73 m2)자점비、관상동맥병변수이급대비제사용량비교[(67±11)세비(59±10)세,(8.6 ±2.1) mmol/L비(7.4±0.9)mmol/L,(62±17) mL/(min·1.73 m2)비(71±14) ml/(min· 1.73 m2),61.9％ (13/21)비35.6％ (36/101),1지:19.0％ (4/21)비35.6％(36/101),2지:38.1％ (8/21)비49.5％ (50/101),≥3지:42.9％ (9/21)비14.9％ (15/101),(210 ±55) ml비(178±47)ml],차이균유통계학의의(균P＜0.05).술전,CIAKI조혈청기항수평명현고우무CIAKI조[(108 ±21) μmol/L비(99 ±9) μmol/L,P＜0.05],이CysC수평2조비교차이무통계학의의(P＞0.05).술후,CIAKI조혈청기항、CysC수평명현고우술전화무CIAKI조술후[(120±27) μmol/L비(108±21)、(102±12) μmol/L,(567±187) μg/L비(468±176)、(454±180)μg/L],차이유통계학의의(P＜0.05);무CIAKI조술후CysC수평명현고우술전[(454±180)μg/L비(413±158) μg/L,P＜0.05],단혈청기항수평여술전비교차이무통계학의의(P =0.070).Pearson검험표명,기선시혈청기항수평여CysC명현상관(r=0.554,P＜0.01).술전급술후24 h혈장CysC수평적수시자공작특정곡선하면적분별위0.605(95％치신구간:0.464～0.745,P=0.136)화0.663(95％치신구간:0.541～0.785,P=0.020).CysC상대승고≥25％진단CIAKI적민감도화특이도분별위0.905화0.782,음성예측개치97.5％.결론 혈장CysC가이작위CIAKI적조기진단표지물,음성진단개치경대.
Objective To evaluate the value of plasma cystatin C (CysC) in early diagnosis of contrast induced acute kidney injury (CIAKI) in diabetic patients complicated with renal dysfunction.Methods Coronary heart disease patients with diabetes and renal dysfunction who underwent coronary angiography or stent implantation from January 2009 to July 2010 were enrolled.The baseline serum creatinine (SCr) , glucose and lipids were measured, the SCr was measured again at 48-72 hours after procedure;the plasma CysC levels before and 24 h after procedure were detected and the value of CysC in early diagnosis of CIAKI was evaluated.Results Totally 122 patients were enrolled and divided into CIAKI group (21 cases) and non-CIAKI group (101 cases).The age, urea, glomerular filtration rate, proportion of patients with glomerular filtration rate ＜60 ml/(min · 1.73 m2), the number of coronary artery lesions and contrast material usage in CIAK group were significantly different from those in non-CIAKI group [(67 ± 11) years vs (59 ± 10) years;(8.6 ±2.1) mmol/L vs (7.4 ±0.9) mmol/L;(62 ± 17) ml/(min · 1.73 m2) vs (71 ± 14) ml/(min · 1.73 m2);61.9％ (13/21) vs 35.6％ (36/101);single vessel disease: 19.0％ (4/21) vs 35.6％ (36/101), double vessels disease: 2 branchs lesion: 38.1％ (8/21) vs 49.5％ (50/101), ≥ 3 vessels disease: 42.9％ (9/21) vs 14.9％ (15/101);(210 ±55) ml vs (178±47) ml] (P＜0.05).The baseline SCrin CIAKI group was significantly higher than that in non-CIAKI group [(108 ± 21) μmol/L vs (99 ± 9) μmol/L] (P ＜0.05) , while the CysC level had no significant difference between the two groups (P ＞ 0.05).The levels of Scr and CysC in CIAKI group after operation were significantly higher than those before operation and those in non-CIAKI group after operation [(120 ±27) μmol/L vs (108 ±21), (102 ± 12) μmol/L, (567 ± 187) μg/L vs (468 ± 176), (454 ± 180) μg/L] (P ＜ 0.05);the post-operative CysC level was significantly higher than preoperative level in non-CIAKI group [(454 ± 180) μg/L vs (413 ± 158) μg/L], but Scr showed no statistical difference after operation (P =0.070).The Pearson analysis showed that the baseline Scr was positively correlated with post-operative CysC level (r =0.554, P ＜ 0.01).The area under receiver operating characteristic curve of plasma CysC at baseline and after procedure was 0.605 (95％ confidence interval: 0.464-0.745, P =0.136) and 0.663 (95％ confidence interval: 0.541-0.785, P =0.020).The sensitivity, specificity and negative predictive value of CysC in diagnosing CIAKI were 0.905, 0.782 and 97.5％ with increasing by ≥ 25％ than baseline as cut off value.Conclusion Plasma CysC might be an early biomarker for diagnosis of CIAKI with high negative predictive value.
