發(fā)布時間：2018-04-08 09:44

  本文選題：血清胱抑素C　切入點：超敏C反應蛋白　出處：《新疆醫(yī)科大學》2015年碩士論文

【摘要】：目的:評價血清胱抑素C聯(lián)合超敏C反應蛋白早期預測冠心病介入術后造影劑腎病中的應用價值,旨在為臨床預防、早期發(fā)現(xiàn)及治療造影劑誘導的造影劑腎病提供科學依據(jù)。方法:納入新疆維吾爾自治區(qū)人民醫(yī)院2014年7月至2014年12月300例行冠心病并接收介入治療的患者。入選患者均符合ACC/AHA和WHO制定的診斷標準。采集患者年齡、性別、身高、體重、血壓(含收縮壓、舒張壓及平均壓)、合并高血壓或糖尿病、應用ACEI/ARB類藥物等基本信息,并于術前檢查腎功能、血脂、血糖、心功能(EF值)等。術前按照適合中國人的腎臟疾病飲食調(diào)整公式(MDRD)計算估測的腎小球濾過率(eGFR)評價腎功能:eGFR(ml·min-1·1.73 m-2)=175×SCr(mg/dl)-1.234×年齡-0.179×(0.79女性)。CIN被定義為血管內(nèi)使用造影劑48-72h后血清肌酐值較基礎值升高25%或增加44μmol/l。在PCI術前及在PCI術前、以及術后12、24、48-72小時采集血標本。所有病例依照是否出現(xiàn)造影劑腎病組(CIN組)和非造影劑腎病組(No-CIN組)。結果:1、入組病例300例中,CIN組37例,發(fā)病率12.3%。2、CIN組術后24hCysC、Hs-CRP較對照組明顯升高,存在顯著差異。3、PCI術后CIN與高齡(年齡≥75歲)、糖尿病、高血壓、以往心梗、PCI病史、冠脈慢性閉塞病變、LVD≥55mm、造影劑≥300ml顯著正相關。4、通過ROC曲線分析,最大曲線下面積0.899,95%置信區(qū)間(0.850-0.947),根據(jù)約登指數(shù),24hCysC取界值為1.37mg/l,24hCysC對CIN的早期預測診斷敏感度為89.2%(95%CI:83.0-95.4),特異度73%(95%CI:64.2-81.9),約登指數(shù):0.622;最大曲線下面積0.744,95%置信區(qū)間(0.658-0.830),根據(jù)約登指數(shù),24hHs-CRP取界值為2.38mg/l,對CIN的早期預測診斷敏感度為75.7%(95%CI:67.2-84.3),特異度71.9%(95%CI:62.2-80.2),約登指數(shù):0.476。24hCysC、24hHs-CRP并聯(lián)試驗提高了診斷敏感度,降低了特異度,而串聯(lián)試驗提高了診斷特異度,降低了敏感度。5、多因素logistic回歸分析顯示,年齡≥75歲、糖尿病、慢性心衰、IABP使用、造影劑用量≥300ml均是CIN的危險因素(P0.05)。結論:血漿CysC聯(lián)合Hs-CRP對CIN的早期預測診斷具有較高價值。
[Abstract]:Objective: to evaluate the value of serum cystatin C combined with hypersensitive C-reactive protein in early prediction of contrast agent nephropathy after coronary intervention in order to provide scientific basis for clinical prevention, early detection and treatment of contrast agent nephropathy induced by contrast medium.Methods: 300 patients with coronary heart disease received interventional therapy from July 2014 to December 2014 in Xinjiang Uygur Autonomous region people's Hospital.All the selected patients met the diagnostic criteria established by ACC/AHA and WHO.Age, sex, height, weight, blood pressure (including systolic blood pressure, diastolic blood pressure and mean pressure), hypertension or diabetes mellitus, ACEI/ARB drugs and so on were collected. Renal function, blood lipid, blood sugar were examined before operation.Cardiac function (EF), et al.Preoperative estimation of glomerular filtration rate (GFR) according to the dietary adjustment formula for renal diseases in Chinese was used to evaluate the renal function: min-1 1.73 m ~ (-2) and 175 脳 SCr(mg/dl)-1.234 脳 age = -0.179 脳 0.79 female. Cin was defined as serum creatinine level increased by 25% or 44 渭 mol / L after intravascular contrast agent 48-72 h.Blood samples were collected before PCI and before PCI, and at 24 ~ 72 hours postoperatively.All cases were divided into two groups according to the presence of contrast agent nephropathy (cin group) and non contrast agent nephropathy group (No-CIN group).Results among 300 cases, 37 cases were in cin group. The incidence rate of CysCn Hs-CRP in the cin group was significantly higher than that in the control group at 24 h after operation. There was significant difference between CIN and the elderly (age 鈮，

本文編號：1721065