PCI术中对比剂应用对老年患者肾功能的影响

目的探讨与血清肌酐（Cre）相比较，血清胱抑素C（Cys）是否为更灵敏和特异的早期预测对比剂肾病（CIN）的标记物。方法前瞻性分析172名接受经皮冠脉血管成形术（PCI）的老年患者，均应用碘海醇造影，测定术前及术后5d内Cys及Cre。结果Cre正常组（Cre〈1．2mg／dl），PCI前后Cre、Cys、估计的肾小球滤过率（eGFR）自身比较P〉0．05，轻度受损组（Cre1．2-1．5mg／dl）Cys、eGFR，P〈0．05，严重受损组（Cre〉1．5mg／dl）Cre、Cys、eGFR，P〈0．05。以eGFR较基础值上升25％为CIN的诊断标准，受试者工作特征曲线下面积（AUC），Cys=0．894，Cre=0．717，P〈0．05。结论Cys是反应肾功轻度受损的灵敏指标。与Cre相比，Cys是更灵敏、更特异的早期预测CIN的指标。

Study on Renal Function in Elderly Patients with Contrast Agent in the Application of PCI

Objective To investigate that whether serum cystatin C was more sensitive and reliable than serum creatinine as a marker of CIN. Methods A total of 172 elderly patients received PCI was prospective analysis. All patients used iohexol as radiographic conirast media. The serum cystatin C and serum ereatinine levels at baseline and for the following five days were measured. Results In the normal group（ Cre 〈 1.2 mg/dl）, there were no statistically significant between Cre, Cys, and eGFR（ P 〉 0. 05 ）before and after PCI;in the mildly impaired group （Cre 1.2-1.5 mg/dl）, there were statistically significant between Cys, and eGFR（ P 〈 0. 05 ）, and in the seriously impaired group（ Cre 〉 1.5 mg/dl ）, there were statistically significant between Cre, Cys,and eGFR（ P 〈 0. 05 ）. When CIN was defined as a 25% rise in eGFR, the receiver operating characteristic curve of serum cystatin C was 0. 894 vs creatinine 0.717 （ P 〈 0. 05 ）. Conclusion Cystatin C was an accurate marker of subtle early changes in renal function and it may be superior to ereatinine as an accurate marker of CIN.