Objectives: To investigate the early diagnostic value of neutrophil gelatinase-associated apolipoprotein (NGAL) on contrast induced nephropathy (CIN) in patients after percutaneous coronary intervention (PCI). Methods: A total of 200 patients received coronary angiography (CAG) and PCI in our hospital from 2016-01 to 2017-02 were enrolled and the research included in 2 groups: CIN group, 23 and Non-NCI group, according to 4:1 ratio, 92 patients without NCI. Serum levels of creatinine, blood and urine levels of NGAL were examined and compared at pre-operation and 4 h, 24 h, 48 h and 72 h after the operation between 2 groups. Results: All patients received CAG and CIN occurred in 23/200 (11.5%) patients. Compared with Non-CIN group, CIN group had more patients with elder age, more smokers and diabetes, P<0.05. Pre-operative blood and urine NGAL were both at normal level and it was similar between 2 groups, P>0.05. In CIN group, urine NGAL was significantly increasing at 4 h after operation and gradually increasing to 72 h after operation; blood NGAL was significantly increasing at 4 h after operation, it began decreasing at 24 h after operation and remained a relatively high level at 72 h after operation; post-operative blood and urine levels of NGAL were different from pre-operative condition at each time points, all P<0.05. In Non-CIN group, post-operative blood and urine levels of NGAL were similar to pre-operative condition, P>0.05. Post-operative blood and urine NGAL were different at the same time point between 2 groups, P<0.01. AUC of ROC for post-operative urine NGAL at 4h, 24h, 48h and 72h were 0.908, 0.926, 0.931 and 0.957 respectively, the sensitivity and specificity for CIN diagnosis were 91.3% and 100% at 4 time points; AUC of ROC for post-operative blood NGAL at 4 h and 24 h were 0.964 and 0.913, the sensitivity and specificity for CIN diagnosis were 87.3% and 100% at both time points. Conclusions: Blood and urine levels of NGAL may reflect renal function changes earlier than serum creatinine in CAG/PCI patients, it had the higher sensitivity and specificity for CIN diagnosis and could be used as the early predictor for CIN occurrence.%目的:探讨中性粒细胞明胶酶相关载脂蛋白(NGAL)对经皮冠状动脉(冠脉)介入治疗(PCI)术后发生造影剂肾病(CIN)的早期诊断意义.方法:选取我院心内科2016-01至2017-02期间收治的行冠脉造影术及PCI术患者共200例为研究对象,术后发生CIN为CIN组23例,按4:1的比例选取未发生造影剂肾病为非CIN组92例,检测两组术前及术后4 h,24 h, 48 h,72 h血肌酐、血和尿的NGAL进行对比.结果: 200例患者均完成冠脉造影术,其中发生CIN 23例,发病率为11.5%;CIN组患者合并高龄、吸烟率及糖尿病的比例大于非CIN组(P<0.05 ).CIN组和非CIN组术前血、尿NGAL含量均处于正常水平,两组差异无统计学意义(P>0.05);CIN组术后4 h尿NGAL明显增高且逐渐增高至72 h;血NGAL术后4 h明显升高,24 h开始下降但术后72 h仍处于较高水平,CIN组术后血、尿NGAL各时间点与术前比较差异均有统计学意义(P<0.05).非CIN组术后血、尿NGAL较术前增高不明显(P>0.05).CIN组和非CIN组术后同时间点血、尿NGAL比较差异有统计学意义(P<0.01).ROC曲线分析发现,术后尿NGAL各时段4 h、24 h、48 h、72 h的曲线下面积(AUC)分别为0.908、0.926、0.931、0.957,这四个时间点诊断的敏感度均为91.3%,特异度均为100%;血NGAL术后4 h、24 h的曲线下面积(AUC)分别为0.964、0.913,这两个时间点诊断的敏感度均为87.3%,特异度均为100%.结论:血、尿的NGAL是较血清肌酐更早的反映冠脉造影及介入治疗术后肾功能变化的早期生物标志物,具有较高的敏感度及特异度,可作为CIN的早期预测指标.
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