血清中性粒细胞明胶酶相关脂质运载蛋白对对比剂肾病的早期预测价值
|
摘要
目的观察冠心病患者冠状动脉造影(CAG)及经皮冠状动脉介入(PCI)术前与术后血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平变化,探讨NGAL预测对比剂肾病(CIN)的价值。方法回顾性分析南京医科大学第二附属医院心血管内科和急诊中心2017年4月至2018年4月行CAG和PCI术的患者136例,根据术后是否发生CIN,将患者分为CIN组(10例)和非CIN组(126例),比较2组患者术前、术后24 h和48 h血肌酐(SCr)、尿素氮(BUN)以及NGAL水平并分析NGAL预测CIN的价值。采用SPSS 22.0统计软件对数据进行分析。组间比较采用t检验、方差分析或χ~2检验。绘制受试者工作特征曲线(ROC)分析血清NGAL水平对CIN的预测价值。结果 CIN组患者术后48 h SCr、24 h BUN、48 h BUN和24 h NGAL水平相比术前增高,差异有统计学意义(P<0.05)。相比非CIN组患者,CIN组患者术后48 h SCr[(174.95±15.77)vs(97.69±9.33)μmol/L]、24 h BUN[(7.75±1.75)vs(5.07±1.35)mmol/L]、48 h BUN[(8.92±2.03)vs(5.17±1.31)mmol/L]、术前NGAL[(341.08±205.69)vs(186.98±83.08)ng/ml]和术后24 h NGAL[(457.68±220.69)vs(185.82±51.41)ng/ml]水平增高,差异均具有统计学意义(P<0.05)。ROC曲线显示术后24 h NGAL水平预测CIN截断点为40.325 ng/ml,曲线下面积为0.852,灵敏度70%,特异度100%。结论冠心病患者PCI和CAG术后24 h血清NGAL水平明显升高,有早期预测CIN价值。
Objective To observe the change of serum neutrophil gelatinase-associated lipocalin(NGAL) level before and after coronary angiography(CAG) and percutaneous coronary intervention(PCI) in patients with coronary heart disease,and to investigate its predictive value of NGAL for contrast-induced nephropathy(CIN).Methods A total of 136 patients who underwent CAG and PCI in the Department of Cardiology and Emergency Center of our hospital from April 2017 to April 2018 were recruited,and their clinical data were collected and retrospectively analyzed.According to the occurrence of CIN,they were assigned into CIN group(n=10) and non-CIN group(n=126).The serum creatinine(SCr),blood urea nitrogen(BUN) and NGAL levels before and at 24 h and 48 h after operation were compared between 2 groups,and the predictive value of NGAL for CIN was analyzed by receiver operating characteristic(ROC) curve.The data were analyzed by SPSS statistics 22.0.Student′s t test,ANOVA or Chi-square test was used for comparison between 2 groups.Results The CIN group had significantly increased levels of 48 h SCr,24 h BUN,48 h BUN and 24 h NGAL than those indices before operation(P<0.05).Compared with the non-CIN group,the CIN group had obviously higher 48 h SCr [(174.95±15.77) vs(97.69±9.33)μmol/L],24 h BUN [(7.75±1.75) vs(5.07±1.35)mmol/L],48 h BUN [(8.92±2.03) vs(5.17±1.31)mmol/L],and 24 h NGAL [(457.68±220.69) vs(185.82±51.41)ng/ml](all P<0.05).ROC curve showed that the cut-off value of 24 h NGAL for predicting CIN was 40.325 ng/ml,and the area under the curve was 0.852,with a sensitivity of 70% and a specificity of 100%.Conclusion The serum level of NGAL is significantly increased in coronary heart disease patients at 24 h after PCI and CAG,and the index shows early predictive value for CIN.
Objective To observe the change of serum neutrophil gelatinase-associated lipocalin(NGAL) level before and after coronary angiography(CAG) and percutaneous coronary intervention(PCI) in patients with coronary heart disease,and to investigate its predictive value of NGAL for contrast-induced nephropathy(CIN).Methods A total of 136 patients who underwent CAG and PCI in the Department of Cardiology and Emergency Center of our hospital from April 2017 to April 2018 were recruited,and their clinical data were collected and retrospectively analyzed.According to the occurrence of CIN,they were assigned into CIN group(n=10) and non-CIN group(n=126).The serum creatinine(SCr),blood urea nitrogen(BUN) and NGAL levels before and at 24 h and 48 h after operation were compared between 2 groups,and the predictive value of NGAL for CIN was analyzed by receiver operating characteristic(ROC) curve.The data were analyzed by SPSS statistics 22.0.Student′s t test,ANOVA or Chi-square test was used for comparison between 2 groups.Results The CIN group had significantly increased levels of 48 h SCr,24 h BUN,48 h BUN and 24 h NGAL than those indices before operation(P<0.05).Compared with the non-CIN group,the CIN group had obviously higher 48 h SCr [(174.95±15.77) vs(97.69±9.33)μmol/L],24 h BUN [(7.75±1.75) vs(5.07±1.35)mmol/L],48 h BUN [(8.92±2.03) vs(5.17±1.31)mmol/L],and 24 h NGAL [(457.68±220.69) vs(185.82±51.41)ng/ml](all P<0.05).ROC curve showed that the cut-off value of 24 h NGAL for predicting CIN was 40.325 ng/ml,and the area under the curve was 0.852,with a sensitivity of 70% and a specificity of 100%.Conclusion The serum level of NGAL is significantly increased in coronary heart disease patients at 24 h after PCI and CAG,and the index shows early predictive value for CIN.
引文
[1] Inokuchi R, Hara Y, Yasuda H, et al. Differences in characteristics and outcomes between community- and hospital-acquired acute kidney injury: a systematic review and meta-analysis[J]. Clin Nephrol, 2017, 88(10): 167-182. DOI: 10.5414/CN109011.
[2] Ali-Hassan-Saegh S, Mirhosseini SJ, Ghodratipour Z, et al. Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review[J]. Kardiol Pol, 2016, 74(7): 610-626. DOI: 10.5603/KP.a2016.0007.
[3] Atzori L, Mussap M, Noto A, et al. Clinical metabolomics and urinary NGAL for the early prediction of chronic kidney disease in healthy adults born ELBW[J]. J Matern Fetal Neonatal Med, 2011, 24(Suppl 2): 40-43. DOI: 10.3109/14767058.2011.606678.
[4] de Bruyn M, Arijs I, De Hertogh G, et al. Serum neutrophil gelatinase B-associated lipocalin and matrix metalloproteinase-9 (NGAL-MMP-9) complex as a surrogate marker for mucosal healing in patients with Crohn′s disease[J]. J Crohns Colitis, 2015, 9(12): 1079-1087. DOI: 10.1093/ecco-jcc/jjv148.
[5] Tziaka D, Chalikias G, Stakos D, et al. Development of an easily applicable risk score model for contrast-induced nephropathy prediction after percutaneous coronary intervention: a novel approach tailored to current practice[J]. Int J Cardiol, 2013, 163(1): 46-55. DOI: 10.1016/j.ijcard.2011.05.079.
[6] Stacul F, van der Molen AJ, Reimer P, et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines[J]. Eur Radiol, 2011, 21(12): 2527-2541. DOI: 10.10 07/s00330-011-2225-0.
[7] Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group[J]. Ann Intern Med, 1999, 130(6): 461-470.
[8] Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation[J]. J Am Coll Cardiol, 2004, 44(7): 1393-1399. DOI: 10.1016/j.jacc.2004.06.068.
[9] Silver SA, Shah PM, Chertow GM, et al. Risk prediction models for contrast induced nephropathy: systematic review[J]. BMJ, 2015, 351: h4395. DOI: 10.1136/bmj.h4395.
[10] 郭敏, 邹阳春. 造影剂肾病研究进展[J]. 中华老年多器官疾病杂志, 2010, 9(3): 286-288. Guo M, Zou YC. Research progress of contrast-induced nephro-pathy[J]. Chin J Mult Organ Dis Elderly, 2010, 9(3): 286-288.
[11] Chao FC, Lin CC. Current concepts of contrast-induced nephro-pathy: a brief review[J]. J Chin Med Assoc, 2013, 76(12): 673-681. DOI: 10.1016/j.jcma.2013.08.011.
[12] Pisani A, Riccio E, Andreucci M, et al. Role of reactive oxygen species in pathogenesis of radiocontrast-induced nephropathy[J]. Biomed Res Int, 2013, 2013: 868321. DOI: 10.1155/2013/868321.
[13] 高聪普, 陈宝平, 时军, 等. 对比剂肾病患者尿胱抑素C及血尿酸水平变化的临床意义[J].山东医药, 2014, 54(1): 82-84. DOI: 10.3969/j.issn.1002-266X.2014.01.036. Gao CP, Chen BP, Shi J, et al. Clinical significance of urinary cystatin C and serum uric acid level in patients with contrast-agent nephropathy[J]. Shandong Med J, 2014, 54(1): 82-84. DOI: 10.3969/j.issn.1002-266X.2014.01.036.
[14] McMahon BA, Koyner JL, Murray PT. Urinary glutathione S-transferases in the pathogenesis and diagnostic evaluation of acute kidney injury following cardiac surgery: a critical review[J]. Curr Opin Crit Care, 2010, 16(6): 550-555. DOI: 10.1097/MCC.0b013e32833fdd9a.
[15] Benzer M, Alpay H, Baykan ?, et al. Serum NGAL, cystatin C and urinary NAG measurements for early diagnosis of contrast-induced nephropathy in children[J]. Ren Fail, 2016, 38(1): 27-34. DOI: 10.3109/0886022X.2015.1106846.
[16] Liebetrau C, Gaede L, Doerr O, et al. Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of contrast-induced nephropathy after percutaneous coronary intervention[J]. Scand J Clin Lab Invest, 2014, 74(2): 81-88. DOI: 10.3109/00365513.2013.860615.
[2] Ali-Hassan-Saegh S, Mirhosseini SJ, Ghodratipour Z, et al. Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review[J]. Kardiol Pol, 2016, 74(7): 610-626. DOI: 10.5603/KP.a2016.0007.
[3] Atzori L, Mussap M, Noto A, et al. Clinical metabolomics and urinary NGAL for the early prediction of chronic kidney disease in healthy adults born ELBW[J]. J Matern Fetal Neonatal Med, 2011, 24(Suppl 2): 40-43. DOI: 10.3109/14767058.2011.606678.
[4] de Bruyn M, Arijs I, De Hertogh G, et al. Serum neutrophil gelatinase B-associated lipocalin and matrix metalloproteinase-9 (NGAL-MMP-9) complex as a surrogate marker for mucosal healing in patients with Crohn′s disease[J]. J Crohns Colitis, 2015, 9(12): 1079-1087. DOI: 10.1093/ecco-jcc/jjv148.
[5] Tziaka D, Chalikias G, Stakos D, et al. Development of an easily applicable risk score model for contrast-induced nephropathy prediction after percutaneous coronary intervention: a novel approach tailored to current practice[J]. Int J Cardiol, 2013, 163(1): 46-55. DOI: 10.1016/j.ijcard.2011.05.079.
[6] Stacul F, van der Molen AJ, Reimer P, et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines[J]. Eur Radiol, 2011, 21(12): 2527-2541. DOI: 10.10 07/s00330-011-2225-0.
[7] Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group[J]. Ann Intern Med, 1999, 130(6): 461-470.
[8] Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation[J]. J Am Coll Cardiol, 2004, 44(7): 1393-1399. DOI: 10.1016/j.jacc.2004.06.068.
[9] Silver SA, Shah PM, Chertow GM, et al. Risk prediction models for contrast induced nephropathy: systematic review[J]. BMJ, 2015, 351: h4395. DOI: 10.1136/bmj.h4395.
[10] 郭敏, 邹阳春. 造影剂肾病研究进展[J]. 中华老年多器官疾病杂志, 2010, 9(3): 286-288. Guo M, Zou YC. Research progress of contrast-induced nephro-pathy[J]. Chin J Mult Organ Dis Elderly, 2010, 9(3): 286-288.
[11] Chao FC, Lin CC. Current concepts of contrast-induced nephro-pathy: a brief review[J]. J Chin Med Assoc, 2013, 76(12): 673-681. DOI: 10.1016/j.jcma.2013.08.011.
[12] Pisani A, Riccio E, Andreucci M, et al. Role of reactive oxygen species in pathogenesis of radiocontrast-induced nephropathy[J]. Biomed Res Int, 2013, 2013: 868321. DOI: 10.1155/2013/868321.
[13] 高聪普, 陈宝平, 时军, 等. 对比剂肾病患者尿胱抑素C及血尿酸水平变化的临床意义[J].山东医药, 2014, 54(1): 82-84. DOI: 10.3969/j.issn.1002-266X.2014.01.036. Gao CP, Chen BP, Shi J, et al. Clinical significance of urinary cystatin C and serum uric acid level in patients with contrast-agent nephropathy[J]. Shandong Med J, 2014, 54(1): 82-84. DOI: 10.3969/j.issn.1002-266X.2014.01.036.
[14] McMahon BA, Koyner JL, Murray PT. Urinary glutathione S-transferases in the pathogenesis and diagnostic evaluation of acute kidney injury following cardiac surgery: a critical review[J]. Curr Opin Crit Care, 2010, 16(6): 550-555. DOI: 10.1097/MCC.0b013e32833fdd9a.
[15] Benzer M, Alpay H, Baykan ?, et al. Serum NGAL, cystatin C and urinary NAG measurements for early diagnosis of contrast-induced nephropathy in children[J]. Ren Fail, 2016, 38(1): 27-34. DOI: 10.3109/0886022X.2015.1106846.
[16] Liebetrau C, Gaede L, Doerr O, et al. Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of contrast-induced nephropathy after percutaneous coronary intervention[J]. Scand J Clin Lab Invest, 2014, 74(2): 81-88. DOI: 10.3109/00365513.2013.860615.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |