心导管造影剂对心脏介入患者肾功能的影响及评估

摘要

目的：探讨心导管造影剂对心脏介入患者肾功能的影响及血胱抑素C（Cys C）对肾功能损伤的预测价值。方法回顾性分析2010年1月至2013年12月乌鲁木齐市第四人民医院应用碘海醇行心导管造影的95例心脏介入患者的临床资料，根据患者造影后48 h内是否发生造影剂肾病（CIN）分为CIN组及非CIN组。分别于造影前、造影后12、24、48 h测定患者Cys C、血肌酐（Scr）、血尿素氮（BUN）、尿转铁蛋白（TRF）水平。结果95例患者中发生CIN 14例（14．74％）。与造影前相比，CIN组患者造影后12、24 h Cys C水平明显升高，48 h后有所下降，但仍高于造影前及非CIN组同一时间的水平。CIN组患者造影后12 h Scr、BUN、TRF水平与造影前相比无变化（P＞0．05），造影后24 h Scr、TRF开始升高，造影48 h后达到最高峰，且明显高于造影前及非CIN组，差异有统计学意义（P＜0．05）。非CIN组各时间点Cys C、Scr、BUN、TRF水平无变化（P＞0．05）。以造影后12、24 h Cys C水平较造影前上升25％作为诊断CIN的标准，其灵敏性分别为84．5％和89．6％，特异性分别为75．9％和82．9％。结论造影后12、24 h血浆Cys C水平可作为诊断CIN早期预测指标，较Scr、TRF更早地反映造影剂对肾功能的损伤情况。%Objective To investigate the effects of cardiac catheterization contrast agent and the predictive val-ue of cystatin C (Cys C)on renal function in patients with cardiac intervention .Methods The clinical data of 95 car-diac intervention patients were analyzed from January 2009 to December 2013 .According to whether the patient suf-fered from contrast-induced nephropathy (CIN) or not in 48 hours ,the patients were divided into the CIN group and non-CIN group .The levels of Cys C ,serum creatinine (Scr) ,blood uric acid nitrogen (BUN) ,urinary transferrin (TRF) were detected before angiography ,after angiography 12 hours ,24 hours ,48 hours .Results There were 14 pa-tients (14 .74% ) suffer from CIN .Compared to the the level of Cys C before contrast ,those after contrast 12 hours , 24 hours increased significantly ,and that declined slightly after contrast 48 hours ,but was also higher than that of the non-CIN group at the same time .The levels of BUN ,TRF unchanged after contrast 12 hours(P>0 .05) .The levels of Scr ,TRF after contrast 24 hours were higher than those before contrast and in non-CIN group (P<0 .05) .The levels of Cys C ,Scr ,BUN ,TRF of non-CIN group did not change (P>0 .05) .According to the standard that the level of Cys C after contrast 12 hours and 24 hours increased by 25% compared with that before contrast ,the sensitivity were 84 .5% and 89 .6% ,the specificity were 75 .9% and 82 .9% respectively .Conclusion The levels of Cys C after contrast 12 hours and 24 hours could be used as an early predictor of CIN ,which could be more earlier reflect the re-nal function damage of contrast agents compared with Scr and TRF .