作者：孙延虎1 ，郑迪 2 ，张权 2 ，李文华 2

单位：

1.221002 江苏省徐州市，徐州医科大学；2.221002 江苏省徐州市，徐州医科大学附属医院心内科；通信作者：李文华，E-mail：xzwenhua0202@163.com

Units：

1.Xuzhou Medical University，Xuzhou 221002，China；2.Department of Cardiology，the Affiliated Hospital of Xuzhou Medical University，Xuzhou 221002，China；Corresponding author：LI Wenhua，E-mail：xzwenhua0202@163.com

关键词：

急性冠脉综合征；对比剂肾病；经皮冠状动脉介入治疗；白蛋白；预测价值

Keywords：

Acute coronary syndrome；Contrast-induced nephropathy；Percutaneous coronary intervention；Albumin；Predictive value

CLC：

R 542.2

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.y01

Funds：

摘要：

背景　对于对比剂肾病（CIN），目前临床尚无特效治疗方法，因此早期识别并干预 CIN 高危患者对提高经皮冠状动脉介入治疗（PCI）效果、改善患者预后具有重要意义。目的　探讨术前血清白蛋白水平对急性冠脉综合征（ACS）患者 PCI 后 CIN 的预测价值。方法　选取 2018 年 9 月—2019 年 9 月在徐州医科大学附属医院行 PCI的 ACS 患者 482 例，根据 PCI 后 CIN 发生情况分为 CIN 组（n=52）和非 CIN 组（n=430），根据术前血清白蛋白水平四分位数间距分为 Q1 组（≤ 39.5 g/L，n=120）、Q2 组（39.6~42.7 g/L，n=121）、Q3 组（42.8~45.3 g/L，n=120）和 Q4 组（>45.3 g/L，n=121）。比较非 CIN 组和 CIN 组患者一般资料、对比剂用量及实验室检查指标，并比较不同术前血清白蛋白水平患者 PCI 后 CIN 发生率；ACS 患者 PCI 后 CIN 的影响因素分析采用多因素 Logistic 回归分析，并绘制 ROC 曲线以评价术前血清白蛋白水平对 ACS 患者 PCI 后 CIN 的预测价值。结果　（1）非 CIN 组和 CIN 组患者年龄、男性比例、体质指数、收缩压、舒张压、吸烟率、高血压发生率、糖尿病发生率及使用 β- 受体阻滞剂、血管紧张素转换酶抑制剂 / 血管紧张素Ⅱ受体拮抗剂、钙通道阻滞剂、他汀类药物、硝酸酯类药物者所占比例比较，差异无统计学意义（P>0.05）；CIN 组患者 AMI 发生率、使用利尿剂者所占比例、使用低分子肝素者所占比例及对比剂用量高于非 CIN 组（P<0.05）。（2）非 CIN 组和 CIN 组患者术前三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、空腹血糖、白细胞计数、血肌酐、血尿酸、血尿素、胱抑素 C 及估算肾小球滤过率（eGFR）比较，差异无统计学意义（P>0.05）；CIN 组患者术前血清白蛋白、血红蛋白水平及术后 eGFR 低于非 CIN 组，术前血小板与淋巴细胞比值（PLR）及术后血肌酐、血尿酸、血尿素、胱抑素 C 高于非 CIN 组（P<0.05）。（3）Q3 组患者 PCI 后 CIN 发生率低于 Q1 组，Q4 组患者 PCI 后 CIN 发生率低于 Q1 组和 Q2 组（P<0.05）。（4）多因素 Logistic 回归分析结果显示，术前血清白蛋白水平〔OR=0.765，95%CI（0.700，0.837）〕、血红蛋白〔OR=0.981，95%CI（0.967，0.996）〕、PLR〔OR=1.005，95%CI（1.001，1.010）〕是 ACS 患者 PCI 后 CIN 的独立影响因素（P<0.05）。（5）ROC 曲线显示，术前血清白蛋白水平预测 ACS 患者 PCI 后 CIN 的曲线下面积为 0.790〔95%CI（0.751，0.826）〕，最佳截断值为 40.8 g/L，灵敏度为 75.0%，特异度为 70.2%。结论　术前血清白蛋白水平是 ACS 患者 PCI 后 CIN 的影响因素，且对 PCI 后 CIN 具有一定预测价值，有助于早期识别 CIN 高危患者。

Abstract：

Background　There is no specific treatment of contrast-induced nephropathy（CIN）so far，thus earlyidentification and intervention of high-risk patients with CIN is of great significance for improving the percutaneous coronaryintervention（PCI）effect and the prognosis. Objective　To explore the predictive value of preoperative serum albumin levelon CIN after PCI in patients with acute coronary syndrome（ACS）. Methods　A total of 482 ACS patients underwent PCIwere selected in the Affiliated Hospital of Xuzhou Medical University from September 2018 to September 2019，and they weredivided into non-CIN group（n=430）and CIN group（n=52）according to the incidence of CIN after PCI，into Q1 group（with preoperative serum albumin level ≤ 39.5 g/L，n=120），Q2 group（with preoperative serum albumin level rangedfrom 39.6 to 42.7 g/L，n=121），Q3 group（with preoperative serum albumin level ranged from 42.8 to 45.3 g/L，n=120）and Q4 group（with preoperative serum albumin level>45.3 g/L，n=121）according to the inter-quartile range of preoperativeserum albumin level. General information，dosage of contrast and laboratory examination results were compared between non-CIN group and CIN group，meanwhile incidence of CIN after PCI was compared in ACS patients with different preoperativeserum albumin level；influencing factors of CIN after PCI in patients with ACS were analyzed by multivariate Logistic regressionanalysis，and ROC curve was plotted to evaluate the predictive value of preoperative serum albumin level on CIN after PCI inpatients with ACS. Results　（1）No statistically significant difference of age，male proportion，BMI，SBP，DBP，smokingrate，incidence of hypertension or diabetes mellitus，proportion of patients using β-blockers，ACEI/ARB，CCB，statins ornitrates was found between non-CIN group and CIN group（P>0.05）；incidence of AMI，proportion of patients using diureticsand low molecular weight heparin，and dosage of contrast in CIN group were statistically significantly higher than those in non-CIN group（P<0.05）.（2）No statistically significant difference of TG，TC，HDL，LDL，FBG，WBC，Scr，BUA，blood urea，Cystatin C or eGFR was found between non-CIN group and CIN group before operation（P>0.05）；preoperativeserum albumin level and hemoglobin，postoperative eGFR in CIN group were statistically significantly lower than those in non-CIN group（P<0.05），while preoperative PLR and postoperative Scr，BUA，blood urea and Cystatin C in CIN group werestatistically significantly higher than those in non-CIN group（P<0.05）.（3）Incidence of CIN in Q3 group was statisticallysignificantly lower than that in Q1 group after PCI，meanwhile incidence of CIN in Q4 group was statistically significantly lowerthan that in Q1 group and Q2 group after PCI，respectively（P<0.05）.（4）Multivariate Logistic regression analysis resultsshowed that，serum albumin level〔OR=0.765，95%CI（0.700，0.837）〕，hemoglobin〔OR=0.981，95%CI（0.967，0.996）〕and PLR〔OR=1.005，95%CI（1.001，1.010）〕before operation are independent influencing factors of CIN afterPCI in patients with ACS（P<0.05）.（5）AUC，the optimal cut-off value，sensitivity and specificity of preoperative serumalbumin level in predicting CIN after PCI in patients with ACS was 0.790〔95%CI（0.751，0.826）〕，40.8 g/L，75.0%，70.2%，respectively. Conclusion　Preoperative serum albumin level is one of independent influencing factor of CIN after PCI inpatients with ACS，and it has predictive value on CIN after PCI in patients with ACS to some extent，which is helpful to identifyhigh risk patients with CIN.

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