本文關鍵詞： 對比劑急性腎損害 中性粒細胞明膠酶相關載脂蛋白 半胱氨酸蛋白酶抑制劑C 腎臟損傷因子-1 血清肌酐　出處：《天津醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：研究目的： 探討多種生物標記物在PCI術后對比劑急性腎損害(CIAKI)早期診斷中的臨床意義。 研究方法： 選擇2013年4月至2013年8月間,天津市泰達國際心血管病醫(yī)院心內科收治的接受擇期PCI且術前肌酐正常的穩(wěn)定性心絞痛及非ST段抬高型急性冠脈綜合征患者200例。所有患者均使用低滲造影劑優(yōu)維顯370(碘普羅胺注射液),并記錄患者年齡、體重指數、吸煙、高血壓病、糖尿病、高脂血癥、陳舊心肌梗死、左心室射血分數(LVEF)、造影劑用量、入院肌酐水平、參照血管直徑、靶病變植入支架總長度以及支架植入后最小支架內徑等。于術前及術后不同時間分別測定血漿中性粒細胞明膠酶相關載脂蛋白(NGAL)、血漿半胱氨酸蛋白酶抑制劑C(Cystatin C)、尿中性粒細胞明膠酶相關載脂蛋白(NGAL)、尿腎臟損傷因子-1(Kidney injury molecule-1, Kim-1)及術后48h肌酐(Scr),并根據對比劑腎病診斷標準,分為CIAKI組及正常組。1.對CIAKI發(fā)生的危險因素進行Logistic回歸分析,明確CIAKI發(fā)生的主要危險因素。2.觀察兩組多種生物標記物的變化情況,并以受試者工作特征曲線(ROC)及曲線下面積(AUC)評價各項標志物診斷CIAKI的臨床意義。NGAL. Cystatin C、 Kim-1測定均采用ELISA方法,血肌酐采用比濁法檢測。 研究結果： 1.所有患者術后發(fā)生CIAKI的共有16例,發(fā)生率為8%。Logistic回歸分析發(fā)現(xiàn),高血壓,造影劑用量均可能是肌酐正常患者經PCI治療后發(fā)生CIAKI的危險因素。 2.①兩組患者術前血漿NGAL、血漿Cystatin C、尿NGAL及尿Kim-1沒有明顯差異(P0.05)。②與術前相比,CIAKI組術后各種生物標記物水平均比術前升高,且差異顯著(P0.05)；其中CIAKI組血漿NGAL于術后2小時開始逐漸升高,至4小時達到最高值,與正常組比較,差異顯著(P0.05)；CIAKI組術后患者血漿Cystatin C于術后4小時明顯升高,與正常組比較,差異顯著(P0.05); CIAKI組尿NGAL水平均于術后8小時明顯升高,與正常組比較,差異顯著(P0.05); CIAKI組尿Kim-1于術后8小時升高,并持續(xù)升高24小時,與正常組相比,差異顯著(P0.05)。③通過各種生物標記物對于CIAKI的診斷作用ROC曲線的比較可以看出,各種生物標記物均能反映早期腎功能的變化,其中血漿NGAL診斷CIAKI的敏感性和特異性比其他三種指標高。 研究結論： 1.高血壓和造影劑用量可能是肌酐正�；颊呓汸CI治療后發(fā)生CIAKI的危險因素。 2.PCI后CIAKI患者各項生物標志物在術后不同的時間點顯著升高,為早期診斷PCI后CIAKI提供新的診斷方法。
[Abstract]:Objectives of the study: To investigate the clinical significance of multiple biomarkers in early diagnosis of acute renal injury after PCI. Research methods: Choose between April 2013 and August 2013. Two hundred patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome (ACS) receiving selective PCI and normal creatinine before operation were admitted to Tianjin Teda International Cardiovascular Disease Hospital. All patients were treated with low level. Osmotic contrast agent you Wei Xian 370 (. Iopramide injection. Age, body mass index (BMI), smoking, hypertension, diabetes, hyperlipidemia, old myocardial infarction, left ventricular ejection fraction (LVEF), contrast agent dosage, and admission creatinine level were recorded. The plasma neutrophil gelatinase-associated apolipoprotein (apolipoprotein NGALs) was measured before and after stent implantation according to the diameter of blood vessel the total length of stent and the minimum stent diameter after stent implantation. Cystatin, a plasma cysteine protease inhibitor, and urinary neutrophil gelatinase-associated apolipoprotein (NGALs). Urinary kidney injury factor-1 Kidney injury molecule-1 (Kim-1) and creatinine creatinine (SCR) at 48h after operation. The risk factors of CIAKI were analyzed by Logistic regression analysis. To identify the main risk factors for the occurrence of CIAKI. 2. To observe the changes of two groups of multiple biomarkers. The clinical significance of each marker in the diagnosis of CIAKI was evaluated by the operating characteristic curve (ROC) and the area under the curve. Kim-1 was determined by ELISA and serum creatinine by turbidimetry. Results of the study: 1. There were 16 cases of CIAKI in all the patients, the incidence rate was 8. Logistic regression analysis found that hypertension. The dosage of contrast agent may be the risk factor of CIAKI in patients with normal creatinine after PCI treatment. 2.1 there was no significant difference between the two groups in preoperative plasma NGALs, plasma Cystatin C, urinary NGAL and urinary Kim-1. The levels of various biomarkers in CIAKI group were higher than those before operation, and the difference was significant (P 0.05). The plasma NGAL in CIAKI group increased gradually at 2 hours after operation and reached the highest value at 4 hours. The difference was significant compared with the normal group (P 0.05). The level of plasma Cystatin C in CIAKI group was significantly higher than that in normal group at 4 hours postoperatively (P 0.05). The level of urinary NGAL in CIAKI group was significantly higher than that in normal group at 8 hours postoperatively (P 0.05). Urinary Kim-1 in the CIAKI group increased 8 hours after operation and continued to rise 24 hours, compared with the normal group. The difference was significant (P 0.05). By comparing the ROC curves of various biomarkers for the diagnosis of CIAKI, we can see that all kinds of biomarkers can reflect the changes of early renal function. The sensitivity and specificity of plasma NGAL in the diagnosis of CIAKI were higher than those of the other three indexes. The study concluded that: 1. Hypertension and dosage of contrast agent may be the risk factors of CIAKI in patients with normal creatinine after PCI treatment. 2. The biomarkers of CIAKI patients increased significantly at different time points after PCI, which provided a new diagnostic method for early diagnosis of CIAKI after PCI.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R541.4;R692.5

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