本文關(guān)鍵詞： 對(duì)比劑急性腎損害 中性粒細(xì)胞明膠酶相關(guān)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(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的： 探討多種生物標(biāo)記物在PCI術(shù)后對(duì)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(dá)國(guó)際心血管病醫(yī)院心內(nèi)科收治的接受擇期PCI且術(shù)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(shù)、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?jǐn)?shù)(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(zhǎng)度以及支架植入后最小支架內(nèi)徑等。于術(shù)前及術(shù)后不同時(shí)間分別測(cè)定血漿中性粒細(xì)胞明膠酶相關(guān)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(xì)胞明膠酶相關(guān)載脂蛋白(NGAL)、尿腎臟損傷因子-1(Kidney injury molecule-1, Kim-1)及術(shù)后48h肌酐(Scr),并根據(jù)對(duì)比劑腎病診斷標(biāo)準(zhǔn),分為CIAKI組及正常組。1.對(duì)CIAKI發(fā)生的危險(xiǎn)因素進(jìn)行Logistic回歸分析,明確CIAKI發(fā)生的主要危險(xiǎn)因素。2.觀察兩組多種生物標(biāo)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(píng)價(jià)各項(xiàng)標(biāo)志物診斷CIAKI的臨床意義。NGAL. Cystatin C、 Kim-1測(cè)定均采用ELISA方法,血肌酐采用比濁法檢測(cè)。 研究結(jié)果： 1.所有患者術(shù)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(jīng)PCI治療后發(fā)生CIAKI的危險(xiǎn)因素。 2.①兩組患者術(shù)前血漿NGAL、血漿Cystatin C、尿NGAL及尿Kim-1沒(méi)有明顯差異(P0.05)。②與術(shù)前相比,CIAKI組術(shù)后各種生物標(biāo)記物水平均比術(shù)前升高,且差異顯著(P0.05)；其中CIAKI組血漿NGAL于術(shù)后2小時(shí)開(kāi)始逐漸升高,至4小時(shí)達(dá)到最高值,與正常組比較,差異顯著(P0.05)；CIAKI組術(shù)后患者血漿Cystatin C于術(shù)后4小時(shí)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(shù)后8小時(shí)明顯升高,與正常組比較,差異顯著(P0.05); CIAKI組尿Kim-1于術(shù)后8小時(shí)升高,并持續(xù)升高24小時(shí),與正常組相比,差異顯著(P0.05)。③通過(guò)各種生物標(biāo)記物對(duì)于CIAKI的診斷作用ROC曲線的比較可以看出,各種生物標(biāo)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(biāo)高。 研究結(jié)論： 1.高血壓和造影劑用量可能是肌酐正�；颊呓�(jīng)PCI治療后發(fā)生CIAKI的危險(xiǎn)因素。 2.PCI后CIAKI患者各項(xiàng)生物標(biāo)志物在術(shù)后不同的時(shí)間點(diǎn)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(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R541.4;R692.5

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