摘要
目的探讨联合检测补体C3、中性粒细胞与淋巴细胞比值(NLR)及Mehran评分对急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)治疗后发生对比剂诱导急性肾损伤(CI-AKI)的预测价值.方法182例AMI患者分为CI-AKI组(发生CI-AKI,30例)和非CI-AKI组(未发生CI-AKI,152例).比较两组临床特征及实验室指标.采用Spearman相关分析及多因素logistic回归分析补体C3、NLR及Mehran评分与CI-AKI的关系,绘制ROC曲线,分析其对CI-AKI的预测价值.结果CI-AKI组患者高龄和高血压病史比例、SCr、白细胞计数、中性粒细胞计数、NLR、血小板计数、补体C3、Mehran评分、超敏C反应蛋白水平高于非CI-AKI组,而血红蛋白、估计肾小球滤过率、术后6-h尿量低于非CI-AKI组(P<0.05).多因素logistic回归分析结果显示,NLR升高、血清补体C3升高、Mehran评分增加是AMI患者PCI治疗后发生CI-AKI的独立危险因素(P<0.05).ROC曲线显示,补体C3、NLR和Mehran评分单独预测AMI患者PCI治疗后发生CI-AKI的曲线下面积分别为0.786、0.840和0.873;三者联合检测时的曲线下面积增加至0.923.Spearman相关性分析结果显示,AMI患者血清补体C3与NLR、Mehran评分均呈正相关(r=0.503、0.261,P<0.01).结论血清补体C3、NLR及Mehran评分升高是AMI患者PCI治疗后发生CI-AKI的危险因素,三者联合检测对CI-AKI的预测价值最高.
Objective To investigate the value of combined use of complement C3,neutrophil-lymphocyte ratio(NLR)and Mehran score in predicting the contrast-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI)in the patients with acute myocardial infarction(AMI).Methods A total of 182 AMI patients after PCI were divided into two groups of A(with CI-AKI,30 cases)and B(without CI-AKI,152 cases).The clinical characteristics and laboratory indexes were compared between the two groups.Spearman correlation analysis and multivariate logistic regression were used to analyze the relationship between complement C3,NLR and Mehran score and CI-AKI,and ROC curve was drawn to analyze their predictive value for CI-AKI.Results The proportion of the patients with advanced age and history of hypertension,and increased levels of SCr,white blood cell count,neutrophil count,NLR,platelet count,complement C3,Mehran score,and hsCRP were higher in group A than those in group B,while hemoglobin,glomerular filtration rate,postoperative 6-h urine output were less in group A than those in group B(P<0.05).Multivariate logistic regression analysis showed that increased NLR,serum complement C3 and Mehran score were the independent risk factors for CI-AKI in the patients with AMI after PCI(P<0.05).The ROC curve showed that the values of the area under the ROC curves(AUC)of complement C3,NLR and Mehran scores for predicting CI-AKI in AMI patients after PCI were 0.786,0.840 and 0.873,respectively.The AUC value increased to 0.923 when combined use of the three indicators.Spearman correlation analysis showed that serum complement C3 was positively correlated with NLR and Mehran scores in AMI patients(r=0.503 and 0.261,P<0.01).Conclusion Increased serum complement C3,NLR and Mehran score are the risk factors for CI-AKI in the patients with AMI after PCI Combined use of the three indicators has the highest predictive value for CI-AKI.
作者
陆飞
袁卫东
孟海亮
范亚平
LU Fei;YUAN Weidong;MENG Hailiang(Department of Nephrology,Nantong Haimen People's Hospital,Nantong 226001,CHINA)
出处
《江苏医药》
CAS
2022年第4期389-393,共5页
Jiangsu Medical Journal
