术前基础血清胱抑素C水平与对比剂诱导的急性肾损害的相关性研究

摘要

目的：探讨疑诊冠心病患者经冠状动脉造影和（或）冠状动脉介入治疗术前基础血清胱抑素C水平与对比剂诱导的急性肾损害（CI-AKI）的关系。方法连续入选2012年1月~2014年1月在成都医学院第一附属医院行冠状动脉造影和（或）冠状动脉介入治疗的疑诊冠心病患者1152例，对其资料进行回顾性分析。按基础血清胱抑素C水平的三分位数进行分组：T1组≤0.95 mg/L，共362例；T2组0.95~1.08 mg/L，共363例；T3组≥1.08 mg/L，共427例。通过多因素Logistic回归分析冠状动脉造影和（或）冠状动脉介入治疗术后发生CI-AKI的危险因素。结果 T1组共362例，平均年龄（61.9±7.2）岁，男性137例（37.8%）；T2组共363例，平均年龄（62.3±7.3）岁，男性152例（41.9%）；T3组共427例，平均年龄（63.1±7.2）岁，男性190例（44.5%）。纳入研究人群中发生CI-AKI的患者共73例（6.3%），CI-AKI患者的基础血清胱抑素C水平为（1.24±0.29）mg/L，显著高于非CI-AKI患者的（1.06±0.37）mg/L （P＜0.001）。T3组共48例（11.2%）发生CI-AKI，显著高于T1组7例（1.9%）、T2组8例（5.0%）（P＜0.001）。多因素Logistic回归分析显示，校正年龄、性别、糖尿病、肌酐、尿酸、对比剂用量等因素后，与T1组相比，T2组术后发生CI-AKI的风险未见明显升高（P＝0.178），T3组术后发生CI-AKI的风险增加2.89倍（P＝0.017）。结论冠状动脉造影和（或）冠状动脉介入治疗术前较高的基础血清胱抑素 C水平可增加CI-AKI的风险。%Objective To investigate the relationship between basal serum cystatin C levels and contrast-induced acute renal injury (CI-AKI) in patients with suspected coronary artery disease before undergoing coronary angiography and / or percutaneous coronary intervention.Methods A total of 1152 patients undergoing coronary angiography and / or percutaneous coronary intervention were enrolled, and divided into three groups according to the tertile of basal serum cystatin C levels (group T1: ≤0.95mg/L,n=362; group T2: 0.95-1.08mg/L,n=363; group T3:≥1.08mg/L,n=427). Multivariate logistic regression analysis was used to analyze the independent risk factors for CI-AKI.Results There were 362 patients in group T1 including 137 males (37.8%) with mean age (61.9±7.2), 363 patients group T2 including 152 males (41.9%) with mean age (62.3±7.3), and 427 patients in group T3 including 190 males (44.5%) with mean age (63.1±7.2). Among all of the study patients, 73 cases (6.3%) developed CI-AKI. Baseline cystatin C was higher in CI-AKI patients than in Non-CI-AKI patients [(1.24±0.29) mg/Lvs. (1.06±0.37) mg/L,P<0.001]. After adjustment for age, gender, creatinine, uric acid, diabetes mellitus, contrast medium volume, risk of CI-AKI was significantly higher in group T3 than in group T1 (OR: 2.890, 95%CI: 1.205~6.929,P=0.017). Conclusion Elevated basal serum cystatin C levels may increase the risk of CI-AKI before coronary angiography and / or percutaneous coronary intervention.