冠心病患者冠脉介入治疗术后对比剂肾病的相关因素和尿NGAL对对比剂肾病的早期诊断价值

许小进; 张清; 王丙剑; 刘海浪; 张喜文

doi:10.12125/j.chj.201712057

冠心病患者冠脉介入治疗术后对比剂肾病的相关因素和尿NGAL对对比剂肾病的早期诊断价值

Correlation factors of contrast induced nephropathy after percutaneous coronary intervention therapy in patients with coronary heart disease and the value of urinary NGAL in early diagnosis of contrast induced nephropathy

摘要

摘要:
目的探讨尿中性粒细胞明胶酶相关载脂蛋白（NGAL）对冠心病患者经皮冠脉介入（PCI）治疗术后对比剂肾病（CIN）的早期诊断意义以及CIN的相关因素。

方法选取入院后行PCI的冠心病患者208例，其中并发高血压病118例、并发糖尿病106例、并发慢性心力衰竭28例、慢性肾功能不全24例，检测术前及术后4、24、48和72 h血清肌酐（SCr）、尿NGAL的含量，对CIN进行诊断性评价。观察CIN的发生率，同时观察住院至出院1个月内的主要心血管不良事件（MACE）。

结果 208例患者中术后发生CIN31例，CIN发生率为14.9%；CIN组糖尿病和慢性心力衰竭的患病率以及MACE发生率显著高于非CIN组（P<0.05）。CIN组和非CIN组术前尿NGAL含量水平相似，两组比较无统计学意义，CIN组术后4 h尿NGAL开始升高，且逐渐升高至72 h，与术前比较有统计学意义（P<0.05）；非CIN组术后尿NGAL较术前升高不明显；两组术后同时段尿NGAL的含量比较具有统计学意义（P<0.05）。ROC曲线分析发现，术后尿NGAL各时段4、24、48和72 h的曲线下面积（AUC）分别为0.932、0.946、0.957和0.975，诊断的敏感性为94%，特异性为100%；术后SCr各时段相应的AUC分别为0.588、0.562、0.842和0.879，诊断CIN的敏感性、特异性明显低于尿NGAL。Logistic多因素回归分析显示：糖尿病、SCr、肾小球滤过率估算值（eGFR）<60 ml/(min·1.73 m²)、NGAL、慢性心力衰竭左室射血分数（LVEF）<35%、糖化血红蛋白(>9.5%)是CIN的危险因素。

结论尿NGAL对PCI治疗术后CIN具有一定的早期诊断价值。并发糖尿病、慢性肾功能不全、慢性心力衰竭等为CIN的相关因素。发生CIN后MACE明显增高。

Abstract:
AIM AIM To investigate the significance of urinary neutrophil gelatinase associated apolipoprotein (NGAL) in the early diagnosis of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) and related factors of CIN.

METHODS 208 patients with coronary heart disease underwent PCI after admission were selected, including 118 with hypertension, 106 with diabetes mellitus, 28 with chronic heart failure and 24 with chronic renal insufficiency. Serum creatinine and urinary NGAL content were measured before and at 4, 24, 48 and 72 hours after PCI and diagnostic evaluation of CIN was carried out. The incidence of contrast induced nephropathy was observed and major cardiovascular adverse events were also observed within one month after hospital discharge.

RESULTS After PCI, there were 31 CIN cases out of 208 and the postoperative incidence rate was 14.9%. The prevalence of diabetes mellitus and chronic heart failure and the incidence of MACE in the CIN group were significantly higher than those in the non-CIN group (P<0.05). Preoperative urinary NGAL levels in the CIN group and the non CIN group were similar and there was no significant difference between the two groups (P>0.05). Urinary NGAL levels in the CIN group began to increase from 4 hours after the operation and the levels were still rising at 72 hours, with statistical significance compared with that before operation (P<0.05). The urinary NGAL in the non CIN group was not significantly higher than that before operation. There was statistical difference in the content of urinary NGAL at the same time between the two groups (P<0.05). ROC curve analysis revealed that the area under the curve of 4 h, 24 h, 48 h and 72 h in each period of urinary NGAL(AUC) was respectively, 0.932, 0.946, 0.957 and 0.975, the sensitivity of diagnosis was 94% and the specificity was 100%. The area under the curve of postoperative SCr was 0.588, 0.562, 0.842, and 0.879, respectively. The sensitivity and specificity of the diagnosis of CIN were significantly lower than that of urinary NGAL Logistic multivariate regression analysis showed that diabetes mellitus, SCr, eGFR <60 ml/(min 1.73 m2),chronic heart failure(LVEF<35%)and glycosylated hemoglobin (>9.5%) were risk factors of CIN.

CONCLUSION Urinary NGAL has early diagnostic value for CIN after percutaneous coronary intervention. Diabetes mellitus, chronic renal insufficiency, and chronic heart failure are related factors of CIN. After the occurrence of CIN, adverse cardiovascular events were increased significantly.

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