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目的:探讨血肌酐(Scr)等指标联合检测对冠状动脉介入术造影剂诱导的急性肾损伤(CI-AKI)早期诊断的价值。方法:选择接受冠状动脉介入术的住院患者260例,均使用低渗非离子造影剂碘海醇,根据CI-AKI诊断标准,分为CI-AKI组24例和非CI-AKI组236例。收集造影前后两组的血液、尿液标本,测定术前及术后12h、1天、3天、7天的Scr、估算的肾小球滤过率(eGFR)、胱抑素C(Cys-C)、尿肾损伤分子(KIM-1)、尿N-乙酰-β氨基葡萄糖苷酶(NAG)、尿β2微球蛋白(β2-MG)等指标。非CI-AKI组按照年龄比例随机选取60例,与CI-AKI组各项指标变化进行比较。结果:(1)CI-AKI组:术后12h,Scr、eGFR水平与术前比较,均差异不显著(P>0.05);Cys-C及尿KIM-1、NAG和β2-MG水平,均非常显著高于术前(P<0.01)。术后1天,Scr水平显著高于术前(P<0.05),eGFR水平显著低于术前(P<0.05);Cys-C及尿KIM-1、NAG和β2-MG水平,均显著高于术后12h(P<0.05)。术后3天,Scr、Cys-C及尿KIM-1、NAG和β2-MG水平较术后1天,均显著或非常显著下降(P<0.05,P<0.01),但仍显著高于术前(P<0.05);eGFR水平较术后1天显著升高(P<0.05),但仍显著低于术前(P<0.05)。术后7天,Scr、eGFR、Cys-C及尿β2-MG、NAG均恢复至术前水平,与术前及非CI-AKI组比较,均差异不显著(P>0.05);尿KIM-1水平较术后3天仍有显著下降(P<0.05)。(2)非CI-AKI组:术后12h,Scr、eGFR水平与术前比较,均差异不显著(P>0.05);尿KIM-1水平较术前轻度升高(P<0.05)。术后1天,Scr水平及尿KIM-1较术前轻度升高(P<0.05),eGFR水平较术前轻度下降(P<0.05)。术后2天、3天、7天,各指标与术前比较,均差异不显著(P>0.05)。结论:Scr、eGFR、Cys-C及尿KIM-1、NAG和β2-MG等联合检测,对于冠状动脉介入术CI-AKI早期诊断具有重要价值。
Objective: To investigate the value of combined detection of serum creatinine (Scr) and other indicators in the early diagnosis of acute renal injury (CI-AKI) induced by coronary intervention. Methods: A total of 260 hospitalized patients undergoing coronary intervention were enrolled in this study. All of them were treated with iohexol, a hypotonic nonionic contrast agent. According to CI-AKI criteria, 24 patients were divided into CI-AKI group and 236 patients without CI-AKI group. The blood and urine samples of both groups were collected before and after angiography. The levels of Scr, glomerular filtration rate (eGFR), cystatin C (Cys- C), KIM-1, NAG and β2-MG were measured. In the non-CI-AKI group, 60 cases were randomly selected according to the proportion of age and compared with the changes of each index in CI-AKI group. Results: (1) In CI-AKI group, the levels of Scr and eGFR at 12h after operation were not significantly different from those before operation (P> 0.05). The levels of Cys-C and urinary KIM-1, NAG and β2-MG Very significantly higher than preoperative (P <0.01). The level of Scr in postoperative day 1 was significantly higher than that before operation (P <0.05), and the level of eGFR was significantly lower than that before operation (P <0.05). The levels of Cys-C, urinary KIM-1, NAG and β2-MG were significantly higher After 12h (P <0.05). The levels of Scr, Cys-C, urinary KIM-1, NAG and β2-MG were significantly or very significantly decreased 3 days after operation (P <0.05, P <0.01) (P <0.05). The level of eGFR was significantly higher than that at 1 day after operation (P <0.05), but still lower than that before operation (P <0.05). The levels of Scr, eGFR, Cys-C, urinary β2-MG and NAG returned to the preoperative levels on the 7th day after operation. There was no significant difference between preoperative and non-CI-AKI groups (P> 0.05) 1 level was still significantly decreased 3 days after surgery (P <0.05). (2) In non-CI-AKI group, the levels of Scr and eGFR at 12h after operation were not significantly different from those before operation (P> 0.05). The urinary KIM-1 level was slightly higher than that before operation (P <0.05). At 1 day after operation, the levels of Scr and urine KIM-1 were slightly increased (P <0.05), while the levels of eGFR were slightly lower than those preoperatively (P <0.05). After 2 days, 3 days, 7 days, there was no significant difference between each index and preoperative (P> 0.05). Conclusion: The combined detection of Scr, eGFR, Cys-C and urine KIM-1, NAG and β2-MG is of great value in the early diagnosis of CI-AKI after coronary intervention.