摘要
目的探讨高敏c反应蛋白（hs—CRP）与急性sT段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗后对比剂肾病（CIN）的相关性。方法人选220例行急诊经皮冠状动脉介入治疗的sT段抬高型心肌梗死患者。按hs—CRP水平的四分位数间距，将患者分为4组：Q1组（hs—CRP〈6．26mg／L），Q2组（hs—CRP6．26～14．44mg／L），Q3组（hs—CRP14．45～33．08mg／L），Q4组（hs—CRP〉33．08mg／L）。比较4组之间的基线资料、CIN发生率及院内临床事件。对比剂肾病定义为使用对比剂后48～72h血肌酐值比基线值升高超过5mg／L。采用受试者工作特征（ROC）曲线及logistics回归分析评估hs—CtlP与CIN风险的相关性。结果220例患者中，21（9．8％）例患者发生C1N。Q1、Q2、Q3和Q4组的CIN发生率分别为1．8％（1／55）、1．8％（1／55）、14．5％（8／55）和20．0％（11／55）（趋势检验，P〈0．01）；院内病死率、需肾脏替代治疗的比例差异均无统计学意义（趋势检验，P均〉0．05）。ROE曲线显示：hs—CRP界值为16．85mg／L时，其预测CIN的敏感度为81．O％，特异度为61．8％，曲线下面积0．748。单因素logistics回归分析显示，hs—CRP水平与CIN发病率显著相关（OR=6．88，95％C1：2．23～21．21，P〈0．01）。多因素logistics回归分析显示，校正性别、贫血、使用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拈抗剂、应用主动脉内球囊反搏、左心室射血分数〈4（1％、年龄〉75岁、基线估算肾小球滤过率、糖尿病史后，hs—CRP〉16．85mg／L是CIN的独立危险因子（OR=15．91，95％“：3．43～73．85，P〈0．01）；年龄〉75岁（OR=7．27，95％叫：1．85～28．63，P〈0．01）及基线估算肾小球滤过率（OR=6．38，95％CI：1．48—27．41，P〈0．05）与CIN发生率显著相关。结论行急诊经皮冠状动脉介入治疗的急性sT段抬高型心肌梗�
Objective To explore the association between high-sensitivity C-reactive protein （hs- CRP）and contrast-induced nephropathy （CIN） in patients with ST-segment elevated myocardial infarction （STEMI） undergoing percutaneous coronary intervention （PCI）. Methods A total of 220 STEMI patients undergoing primary PCI from Guangdong general hospital were recruited. Patients were divided into four groups according to the quartile of hs-CRP（ Q1 group：hs-CRP 〈 6. 26 rag/L, Q2 group：6. 26 - 14.44 mg/L, Q3 group ： 14. 45 - 33.08 rag/L, Q4 group ：hs-CRP 〉 33.08 rag/L）. Baseline data, CIN incidence and other in-hospital outcomes were compared among groups. CIN was defined as an increase in serum creatinine of more than 5 mg/L from baseline within 48 - 72 hours after contrast media exposure. Receiver operator characteristics （ROC） curves and muhivariate logistic regression were used to assessed the correlation between hs-CRP and CIN. Results CIN occurred in 21 （9. 8% ）patients. CIN incidence of hs-CRP quartitles were 1.8% （ 1/55 ）, 1.8% （ 1/55 ）, 14.5% （ 8/55 ） and 20.0% （ 11/55 ） （ P-trend 〈 0.01 ）, respectively.In-hospital death （ P-trend 〉 0. 05 ）, required renal replace therapy （ P-trend 〉 0. 05 ） were similar among groups. ROC analysis revealed that the optimal cutoff value of hs-CRP to predict the onset of CIN was 16. 85 mg/L （ sensitivity ： 81.0% , specificity ： 61.8% , AUC ： 0. 748）, Univariate logistic analysis showed that hs- CRP was strongly related with CIN incidence（ OR = 6. 88,95% CI：2. 23 - 21.21, P 〈 0.01 ）. Multivariate logistic regression analysis showed that after adjusting other traditional risk factors including female gender, anemia, ACEI/ARB use, IABP support, LVEF 〈 40% , age 〉 75 years, baseline eGFR and diabetes, hs- CRP 〉 16.85 mg/L was still a significant independent predictor of CIN in patients with STEMI undergoing primary PCI. Additionally, age 〉75 years（ OR = 7.27,95% CI： 1.85 - 28.63, P 〈 0. 01
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第5期394-398,共5页
Chinese Journal of Cardiology
关键词
C反应蛋白
造影剂
肾病
血管成形术
经腔
经皮冠状动脉
C-reactive protein
Contrast media
Nephrosis
Angioplasty, transluminal,percutaneous coronary
