血浆胱抑素C与β痕迹蛋白在早期预测造影剂肾病中的价值

目的探讨胱抑素C(CysC)、β痕迹蛋白(BTP)在预测造影剂肾病(CIN)发生中的价值。方法选择2011年6月—2012年4月入院行冠状动脉造影(CAG)或经皮冠状动脉介入(PCI)治疗的100例患者为研究对象。造影术前抽血检测血浆肌酐(Scr)、CysC、BTP及依据MDRD估算肾小球滤过率(eGFR)。并于冠脉造影术后24 h、48 h检测Scr,依据造影后48 h内CIN发生情况,将其分为CIN组与非CIN组。分析CysC、BTP等指标对造影剂肾病的预测价值。结果 (1)CIN发病率为12.0%;(2)CIN组与非CIN组相比,两组间Scr、CysC、BTP及eGFR有差异(P0.05);(3)Spearman相关分析提示CysC、BTP、Scr与造影剂肾病呈正相关(r=0.357,P0.01;r=0.309,P0.01;r=0.238,P=0.017),eGFR与造影剂肾病呈负相关(r=-0.246,P=0.014);(4)通过ROC曲线找到CysC、BTP的最佳截断点分别为1.29 mg.L-1(敏感度83.3%;特异度83%)、3.91μg.L-1(敏感度75%;特异度78.4%);(5)以是否发生造影剂肾病作为因变量,采用二项Logistic回归分析显示纳入回归方程的指标仅为血浆CysC(OR=5.192,P=0.045)。结论血浆CysC可作为预测造影剂肾病发生的指标,而血浆BTP浓度对造影剂肾病无明显预测价值。

Significance of serum cystatin C and beta-trace protein in early indicators of contrast induced nephropathy

Objective To study clinical value of cystatin C（Cys C） and beta-trace protein（BTP） in early indicators of contrast induced nephropathy（CIN）.Methods Totally 100 patients after coronary arteriography（CAG） or percutaneous coronary intervention（PCI） were enrolled in this study from June 2011 to April 2012.BTP,Cys C,serum creatinine（Scr）,and estimated glomerular filtration rate（eGFR） were measured in 24 h before angiography.Scr was measured 24 h,48 h after the angiography,respectively.The selected patients were assigned into CIN group and non-CIN group according to changes in serum creatinine levels with 48 h after CAG or PCI,and then we analyzed the value of serum cystatin C and beta-trace protein in early indicators of contrast induced nephropathy.Results The prevalence of CIN was 12.0%.There was significant difference between CIN group and non-CIN group in BTP,Cys C,Scr and eGFR（P 0.05）.Spearman correlation was used to analyze the association of CIN with all the variables.CIN was positively correlated with CysC（r = 0.357,P 0.01）,BTP（r = 0.309,P 0.01）,Scr（r = 0.238,P = 0.017）,and negatively correlated with eGFR（r =-0.246,P = 0.014）.To set a cutoff level of serum CysC,BTP at the occurrence of CIN,a receiver operating characteristic（ROC） curve,the sensitivity and specificity were calculated.When the cutoff levels of serum CysC and BTP were set at 1.29 mg.L-1 and 3.91μg.L-1,the sensitivities were 83.3% and 75%,and the specificities were 83% and 78.4%,respectively.With whether contrast nephropathy deuelops as dependent variable,binary logistic regression analysis demonstrated that baseline serum cystatin C independently predicted CIN（odds ratioOR],5.192;95% confidence intervalCI]1.045 ～25.897;P =045）.Conclusion There is no significant clinical value of β-trace protein in early indicators of CIN.Cystatin C is useful for predicting the occurrence of CIN.