1 南京医科大学附属江宁医院心血管内科，南京 211100
目的：血清肌酐(serum creatinine，Scr)、胱抑素C(cystatin C，CysC)及同型半胱氨酸(homocysteine，Hcy)水平预测急性冠脉综合征(acute coronary syndrome，ACS)经皮冠状动脉介入术(percutaneous coronary intervention，PCI)术后造影剂肾病(contrast-induced nephropathy，CIN)发生的价值。方法：连续收集2018年1月至2020年3月南京医科大学附属江宁医院收治的择期行PCI手术治疗的87例ACS患者。根据患者术后是否发生CIN分为CIN组(发生CIN)和非CIN组(未发生CIN)。比较两组血清Scr、CysC及Hcy水平，并通过多因素logistic回归分析CIN发生的相关的危险因素。此外，绘制受试者工作特征(receiver operating characteristic curve，ROC)曲线分析血清CysC、Hcy对CIN的预测价值。结果：87例ACS患者经PCI治疗病情均得到缓解，术后30例发生CIN，发生率为34.5%；CIN组吸烟、高血压、糖尿病占比均明显高于非CIN组(均P<0.05)；CIN组术后血清Scr、CysC、Hcy水平均明显高于术前水平(均P<0.05)，且高于同期非CIN组水平(均P<0.05)。两组术前血清Scr、CysC、Hcy比较差异均无统计学意义均(P>0.05)；logistic回归分析结果显示血清CysC、Hcy为CIN发生的独立危险因素；ROC曲线显示术后48 h血清CysC、Hcy预测CIN发生的价值均较高，其中CysC预测CIN发生的最佳临界值为1.4 mg/L，AUC为0.764(95%CI：0.664~0.863)，Hcy预测CIN发生的最佳临界值为10.2 μmol/L，AUC为0.813(95%CI：0.720~0.907)。结论：血清CysC、Hcy为ACS患者PCI术后并发CIN的独立影响因素，该类患者体内上述指标水平明显异常，术后48 h对其进行检测可有效预测CIN发生。
Value of serum SCR, CysC, and Hcy levels in predicting the occurrence of contrast nephropathy after PCI in acute coronary syndrome
CorrespondingAuthor: CAI Jie
This work was supported by the Research Project of Nantong Municipal Health Committee, China (MB2019038).
Objective: To analyze the value of serum creatinine (SCR), cystatin C (CysC) and homocysteine (Hcy) levels in predicting the occurrence of contrast-induced nephropathy (CIN) in acute coronary syndrome (ACS) after Percutaneous coronary intervention (PCI). Methods: A total of 87 ACS patients admitted to our hospital for PCI from January 2018 to March 2020 were collected continuously. According to whether CIN occurred after the surgery, they were divided into a CIN group (with CIN) and a non-CIN group (without CIN). Serum Scr, CysC and Hcy levels were compared between the 2 groups, and risk factors related to CIN were analyzed by multivariate logistic regression. In addition, ROC curve was drawn to analyze the predictive value of serum CysC and Hcy to CIN. Results: A total of 87 patients with ACS were relieved after PCI, but 30 cases developed CIN after PCI, the incidence rate was 34.5%. Smoking, hypertension, and diabetes in the CIN group were significantly higher than those in the non-CIN group (all P<0.05). The serum levels of SCR, CysC and Hcy in the CIN group were significantly higher than those before the operation (all P<0.05), and higher than those in the non-CIN group in the same period (all P<0.05). There was no significant difference in serum SCR, CysC and Hcy between the 2 groups before the operation (P>0.05). Logistic regression analysis showed that serum CysC and Hcy were independent risk factors for CIN. ROC curve showed that the value of serum CysC and Hcy in predicting the occurrence of CIN after 48 h was relatively high, and the optimal critical value of CysC was 1.4 mg/L, AUC was 0.764 (95%CI: 0.664~0.863), while Hcy was 10.2 mol/L, and AUC was 0.813 (95%CI: 0.720~0.907). Conclusion: Serum CysC and Hcy are independent influencing factors for CIN complications in ACS patients after PCI, and these indicators are significantly abnormal in these patients. Detection of these indicators 48 h after the surgery can effectively predict the occurrence of CIN.
serum creatinine; cystatin C; homocysteine; acute coronary syndrome; percutaneous coronary intervention; contrast-induced nephropathy