半胱氨酸蛋白酶抑制剂C对老年患者造影剂肾病的诊断价值

目的探讨非离子型造影剂对老年患者肾功能的影响,以及血清半胱氨酸蛋白酶抑制剂C(CysC)在早期诊断造影剂肾病的临床价值。方法选择年龄70岁、肾功能正常并行冠状动脉介入治疗的老年患者50例(PCI组)和健康体检者50例(对照组),于术前及术后第1、2、3、5天采用苦味酸法检测血肌酐,采用颗粒增强透射免疫比浊法检测血清CysC,并计算内生肌酐清除率(Ccr)。采用工作特征曲线下面积评价比较CysC和肌酐对造影剂肾病的诊断效率。结果与术前比较,PCI组患者术后第2、3天Ccr明显下降,术后第1、2天CysC明显升高(P0.05),而血肌酐与术前比较无明显变化;以CysC为标准诊断,造影剂肾病的诊断效率明显优于血肌酐。结论在老年患者中,监测血肌酐预测造影剂肾病发生可能造成漏诊,血清CysC可更敏感地反映造影剂肾毒性的程度,有利于早期准确识别造影剂肾损害。

The value of serum cystatin C in diagnosis of contrast-induced nephropathy in very old people

Objectives To investigate the effect of iopromide,a kind of low osmolar and nonionic contrast medium,on renal function in people over 70 years old,and to study the value of serum cystatin C(CysC) in diagnosis of contrast-induced nephropathy(CIN).Methods Fifty old patients who accepted PCI operations were selected.Their Scr,Ccr and serum CysC were monitored on the first,second,third and fifth days after operation as well as before.Results In these patients,after receiving iopromide,Ccr decreased and CysC increased (P < 0.05 ),there was no significant change of Scr.The AUC of ROC of CysC was significantly higher than the AUC of ROC of Scr. Conclusion In people over 70 years old,serum CysC is a more sensitive and specific indicator for monitoring early changes in CIN.