Wu Rui, Kong Yiwei, Yin Jianyong, Liang Rulian, Lu Zeyuan, Wang Niansong, Zhao Qing, Zhou Yang, Yan Chungen, Wang Feng, Liang Mingyu
Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China.
Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Kidney Blood Press Res. 2018;43(1):170-180. doi: 10.1159/000487499. Epub 2018 Feb 16.
BACKGROUND/AIMS: Antithrombin Ⅲ (AT Ⅲ) is an important endogenous anticoagulant and has strong anti-inflammatory properties. Low ATⅢ activity is considered to be a predictor of poor outcomes in several conditions, including acute kidney injury after cardiac surgery. However, the association between the ATⅢ level and the occurrence of contrast induced nephropathy (CIN) has not been elucidated. In this study, our aim was to identify the potential predictive value of ATⅢ for CIN.
We enrolled a total of 460 patients who underwent coronary angiography (CAG) from January 2015 to December 2016 in coronary care units (CCU). ATⅢ activity in plasma collected before CAG was measured and <75% was considered low activity according to reference values. A cross-sectional study on CIN after CAG was conducted and the risk factors were analyzed. CIN was diagnosed according to the KDIGO guideline.
Of these 460 patients undergoing CAG, 125 (27.17%) progressed to CIN. The incidence of CIN was significantly higher in patients with low ATⅢ activity compared to patients with normal ATⅢ activity (Pearson's chi-squared test P=0.002). As ATⅢ activity declined, the prevalence of CIN progressively increased, with the highest value (58.8%) in patients with an ATⅢ activity <60%. Moreover, the ATⅢ activity was significantly lower in CIN patients than in non-CIN patients (84.43±16.3% vs. 92.14±13.94%, P<0.001). After multivariable analysis, ATⅢ activity <75% remained a significant independent predictor of CIN (OR 2.207,95%CI [1.29-3.777]; P=0.004) as well as baseline serum creatinine (OR 1.009,95%CI [1.001-1.016]; P=0.026).
Patients with low ATⅢ activity had a higher risk of developing CIN after CAG. The initial ATⅢ activity may be a novel independent predictor for CIN.
背景/目的：抗凝血酶Ⅲ（ATⅢ）是一种重要的内源性抗凝剂，具有很强的抗炎特性。低ATⅢ活性被认为是多种疾病不良预后的预测指标，包括心脏手术后的急性肾损伤。然而，ATⅢ水平与造影剂肾病（CIN）发生之间的关联尚未阐明。在本研究中，我们的目的是确定ATⅢ对CIN的潜在预测价值。
我们纳入了2015年1月至2016年12月在冠心病监护病房（CCU）接受冠状动脉造影（CAG）的460例患者。测量CAG前采集的血浆中ATⅢ活性，根据参考值，<75%被认为是低活性。对CAG后发生的CIN进行横断面研究并分析危险因素。根据KDIGO指南诊断CIN。
在这460例接受CAG的患者中，125例（27.17%）进展为CIN。与ATⅢ活性正常的患者相比，ATⅢ活性低的患者CIN发生率显著更高（Pearson卡方检验P=0.002）。随着ATⅢ活性下降，CIN的患病率逐渐增加，ATⅢ活性<60%的患者患病率最高（58.8%）。此外，CIN患者的ATⅢ活性显著低于非CIN患者（84.43±16.3%对92.14±13.94%，P<0.001）。多变量分析后，ATⅢ活性<75%仍然是CIN的显著独立预测指标（OR 2.207，95%CI[1.29 - 3.777]；P=0.004）以及基线血清肌酐（OR 1.009，95%CI[1.001 - 1.016]；P=0.026）。
ATⅢ活性低的患者在CAG后发生CIN的风险更高。初始ATⅢ活性可能是CIN的一个新的独立预测指标。
