Korkmaz Ahmet, Ozyazgan Burcu, Kosem Arzu, Elalmis Ozgul Ucar, Guray Umit, Ileri Mehmet, Neselioglu Salim, Erel Ozcan
Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey.
North Clin Istanb. 2019 Aug 26;6(3):210-218. doi: 10.14744/nci.2018.72335. eCollection 2019.
Contrast-induced nephropathy (CIN) is a common complication of diagnostic or interventional procedures that may arise from administration of intravascular contrast media. Recent studies have reported the thiol-disulfide ratio as a novel oxidative stress marker. Therefore, we investigated the role of thiol levels in predicting CIN in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (PCI).
A total of 302 patients were enrolled in the study. CIN was defined as an increase in serum creatinine concentration ≥0.5 mg/dL compared with the admission value or a >25% relative rise during the first 48-72 hours after the procedure. To evaluate the relationship between thiol levels and CIN, the patients were divided into a CIN group and a non-CIN group.
CIN occurred in 44 (15%) patients. Native thiol (274.8±84.7 μmol/L vs. 220.8±97.1 μmol/L, p=0.001) and total thiol (305.4±89.7 μmol/L vs. 260.1±102.1 μmol/L, p=0.009) levels were higher in patients within the non-CIN group. Disulfide (15.8±6.6 μmol/L vs. 19.6±8.4 μmol/L, p=0.002) levels, and mean disulfide/total thiol ratios (8.4±3.7 vs. 5.9±3.1, p=0.001) were higher in patients with CIN (+) group. In univariate analysis, the initial native thiol, total thiol, disulfide levels, and disulfide/total thiol ratio were found to have prognostic significance in the development of CIN. In the multivariate regression analysis, only the disulfide/total thiol ratio (OR=1.190; 95% CI: 1.090-1.300; p=0.001) was significantly and independently associated with CIN. The cutoff value of the disulfide/total thiol ratio to predict CIN on admission in patients with STEMI who underwent primary PCI was 7, with a sensitivity of 68.2% and a specificity of 79.8%.
Our results suggest that thiol/disulfide homeostasis could be a good biochemical risk marker for CIN in STEMI patients who underwent primary PCI.
对比剂肾病（CIN）是诊断或介入操作常见的并发症，可能由血管内注射对比剂引起。近期研究报道硫醇-二硫键比值是一种新的氧化应激标志物。因此，我们研究了硫醇水平在预测接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者发生CIN中的作用。
共纳入302例患者。CIN定义为与入院时相比，血清肌酐浓度升高≥0.5mg/dL，或在操作后最初48 - 72小时内相对升高>25%。为评估硫醇水平与CIN之间的关系，将患者分为CIN组和非CIN组。
44例（15%）患者发生CIN。非CIN组患者的天然硫醇（274.8±84.7μmol/L对220.8±97.1μmol/L，p = 0.001）和总硫醇（305.4±89.7μmol/L对260.1±102.1μmol/L，p = 0.009）水平较高。CIN（+）组患者的二硫键（15.8±6.6μmol/L对19.6±8.4μmol/L，p = 0.002）水平及平均二硫键/总硫醇比值（8.4±3.7对5.9±3.1，p = 0.001）较高。单因素分析发现，初始天然硫醇、总硫醇、二硫键水平及二硫键/总硫醇比值对CIN的发生具有预后意义。多因素回归分析显示，只有二硫键/总硫醇比值（OR = 1.190；95%CI：1.090 - 1.300；p = 0.001）与CIN显著独立相关。接受直接PCI的STEMI患者入院时预测CIN的二硫键/总硫醇比值临界值为7，敏感性为68.2%，特异性为79.8%。
我们的结果表明，硫醇/二硫键稳态可能是接受直接PCI的STEMI患者发生CIN的良好生化风险标志物。
