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目的:探讨血清γ谷氨酰转肽酶(GGT)对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后发生造影剂肾病(CIN)的影响。方法:选取2015年1月至12月在本院心内科行PCI治疗的420例ACS患者。根据入院时GGT水平以三分位数法分为3组(低水平组,GGT<21 IU·L-1,33.3%;中水平组,21 IU·L-1≤GGT≤35 IU·L-1,33.3%;高水平组,GGT>35 IU·L-1,33.3%),比较不同GGT水平ACS患者PCI术后CIN发生率,分析其影响因素。结果:(1)420例患者发生CIN共57例,发生率为13.6%;与低水平组(9.3%)及中水平组(10.7%)相比较,高水平组CIN发生率(20.7%)显著升高(P=0.01)。(2)420例ACS患者PCI术后6个月内共死亡9例,发生率为2.1%;高水平组(3.6%)高于中水平组(2.9%)和低水平组(0),差异均有统计学意义(P=0.023)。ROC曲线显示,GGT为29.5 IU·L-1时预测CIN发生具有65%的敏感度及57%的特异度。多因素Logistic回归分析显示,校正相关混杂因素后,GGT>29.5 IU·L-1时,发生CIN的风险显著增加(OR=1.21,95%CI 1.1~1.53,P=0.01)。结论:高水平的GGT可能增加ACS患者PCI术后CIN的发生风险。
Objective: To investigate the effect of serum gamma glutamyl transpeptidase (GGT) on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods: A total of 420 patients with ACS undergoing PCI from January 2015 to December 2015 in our department were enrolled. The levels of GGT at admission were divided into 3 groups according to the tertile method (low level group, GGT <21 IU · L-1, 33.3%; middle level group, 21 IU · L-1≤GGT≤35 IU · L- 1,33.3%, GGT> 35 IU · L-1, 33.3%). The incidence of CIN after PCI was compared between patients with different GGT levels and the influencing factors were analyzed. Results: (1) CIN was found in 57 out of 420 patients (13.6%). The incidence of CIN in the high-level group (20.7%) was significantly higher than that in the low-level group (9.3% Increased (P = 0.01). (2) Among the 420 ACS patients, 9 died within 6 months after PCI, with a rate of 2.1%. The high-grade group (3.6%) was higher than the middle-level group (2.9%) and the low-level group (0) All were statistically significant (P = 0.023). The ROC curve showed a CIN incidence of 65% sensitivity and 57% specificity at GGT of 29.5 IU · L-1. Multivariate Logistic regression analysis showed that the risk of CIN increased significantly (G = 29.5 IU · L-1, OR = 1.21, 95% CI 1.1-1.53, P = 0.01) after adjusting for confounding factors. Conclusion: High levels of GGT may increase the risk of CIN after PCI in patients with ACS.