[高敏C反应蛋白与直接经皮冠状动脉介入治疗后对比剂肾病之间的关联]

[Association between high-sensitivity C-reactive protein and contrast-induced nephropathy after primary percutaneous coronary intervention].

作者信息

He Yi-ting, Tan Ning, Liu Yuan-hui, Chen Si-qun, Liu Yong, Huang Shui-jin, Yang Da-hao, Ye Piao, Ran Peng

机构信息

Department of Cardiology, Guangdong Academy of Medical Sciences, Guangzhou, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2013 May;41(5):394-8.

PMID:24021122

Abstract

OBJECTIVE

To explore the association between high-sensitivity C-reactive protein (hs-CRP) and contrast-induced nephropathy (CIN) in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) .

METHODS

A total of 220 STEMI patients undergoing primary PCI from Guangdong general hospital were recruited. Patients were divided into four groups according to the quartile of hs-CRP (Q1 group:hs-CRP < 6.26 mg/L,Q2 group:6.26-14.44 mg/L, Q3 group:14.45-33.08 mg/L, Q4 group:hs-CRP > 33.08 mg/L) . Baseline data, CIN incidence and other in-hospital outcomes were compared among groups. CIN was defined as an increase in serum creatinine of more than 5 mg/L from baseline within 48-72 hours after contrast media exposure. Receiver operator characteristics (ROC) curves and multivariate logistic regression were used to assessed the correlation between hs-CRP and CIN.

RESULTS

CIN occurred in 21 (9.8%) patients. CIN incidence of hs-CRP quartitles were 1.8%(1/55), 1.8% (1/55), 14.5% (8/55) and 20.0% (11/55) (P-trend < 0.01), respectively. In-hospital death (P-trend > 0.05) , required renal replace therapy (P-trend > 0.05) were similar among groups. ROC analysis revealed that the optimal cutoff value of hs-CRP to predict the onset of CIN was 16.85 mg/L (sensitivity: 81.0%, specificity: 61.8%, AUC: 0.748). Univariate logistic analysis showed that hs-CRP was strongly related with CIN incidence (OR = 6.88,95%CI:2.23-21.21, P < 0.01). Multivariate logistic regression analysis showed that after adjusting other traditional risk factors including female gender, anemia, ACEI/ARB use, IABP support, LVEF < 40%, age > 75 years, baseline eGFR and diabetes, hs-CRP > 16.85 mg/L was still a significant independent predictor of CIN in patients with STEMI undergoing primary PCI. Additionally, age > 75 years (OR = 7.27,95%CI:1.85-28.63, P < 0.01), eGFR (OR = 6.38,95% CI:1.48-27.41, P < 0.05) were also independent risk factors of CIN.

CONCLUSIONS

hs-CRP is positively correlated with CIN incidence. STEMI patients with higher hs-CRP level post PCI is at higher risk of developing CIN.

摘要

目的

探讨接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中，高敏C反应蛋白（hs-CRP）与造影剂肾病（CIN）之间的关联。

方法

招募了广东省总医院220例接受直接PCI的STEMI患者。根据hs-CRP四分位数将患者分为四组（Q1组：hs-CRP<6.26mg/L，Q2组：6.26 - 14.44mg/L，Q3组：14.45 - 33.08mg/L，Q4组：hs-CRP>33.08mg/L）。比较各组的基线数据、CIN发生率及其他院内结局。CIN定义为造影剂暴露后48 - 72小时内血清肌酐较基线升高超过5mg/L。采用受试者工作特征（ROC）曲线和多因素逻辑回归分析评估hs-CRP与CIN之间的相关性。

结果

21例（9.8%）患者发生CIN。hs-CRP四分位数组的CIN发生率分别为1.8%（1/55）、1.8%（1/55）、14.5%（8/55）和20.0%（11/55）（P趋势<0.01）。各组间院内死亡（P趋势>0.05）、需要肾脏替代治疗（P趋势>0.05）情况相似。ROC分析显示，预测CIN发生的hs-CRP最佳截断值为16.85mg/L（敏感性：81.0%，特异性：61.8%，AUC：0.748）。单因素逻辑分析显示，hs-CRP与CIN发生率密切相关（OR = 6.88，95%CI：2.23 - 21.21，P<0.01）。多因素逻辑回归分析显示，在调整包括女性、贫血、使用ACEI/ARB、IABP支持（主动脉内球囊反搏）、左心室射血分数（LVEF）<40%）、年龄>75岁、基线估算肾小球滤过率（eGFR）及糖尿病等其他传统危险因素后，hs-CRP>16.85mg/L仍是接受直接PCI的STEMI患者发生CIN的显著独立预测因素。此外，年龄>75岁（OR = 7.27，95%CI：1.85 - 28.63，P<0.01）、eGFR（OR = 6.38，95%CI：1.48 - 27.41，P<0.05）也是CIN的独立危险因素。