尿NGAL联合血清胱抑素C早期诊断冠心病患者造影剂肾病的临床价值
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摘要
目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合血清胱抑素C(Cys-C)早期诊断冠心病患者造影剂肾病(CIN)的临床价值。方法选取2015年5月—2017年12月收治的128例行支架置入术治疗的冠心病,观察CIN的发生情况,检测尿NGAL、血清Cys-C、肌酐(Scr)和尿白介素-18(IL-18)水平,分析尿NGAL与血清Cys-C、Scr、尿IL-18的相关性。结果本组经支架置入介入术治疗后CIN发生率为14. 06%。治疗后,CIN组尿NGAL、IL-18及血清Cys-C、Scr水平均较治疗前升高(P <0. 05)。冠心病患者中CIN组尿NGAL、IL-18及血清Cys-C和Scr阳性检出率均高于非CIN组(P <0. 01)。尿NGAL与血清Cys-C、Scr、尿IL-18均呈正相关性(r=0. 286、0. 326、0. 342,P <0. 05)。尿NGAL联合血清Cys-C共同检测对早期诊断冠心病患者CIN的灵敏度和特异度高于尿NGAL、血清Cys-C、尿IL-8和血清Scr单独检测(P <0. 05)。结论在冠心病CIN患者中尿NGAL和血清Cys-C水平均显著升高,且联合检测对早期诊断冠心病患者CIN具有较高的灵敏度和特异度,故认为可将其作为早期诊断冠心病患者CIN的首选检测指标。
Objective To investigate clinical value of urinary neutrophil gelatinase associated lipocalin( NGAL combined with serum cystatin C( Cys-C) in early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease. Methods A total of 128 coronary heart disease patients with stent implantation admitted during May 2015 and December 2017 were selected to observe incidence rate of radiographic contrast nephropathy. Levels of urinary NGAL,serum Cys-C,creatinine( Scr) and urinary interleukin-18( IL-18) were detected,and correlations between urinary NGAL with serum Cys-C,Scr and IL-18 were analyzed. Results Incidence rate of radiographic contrast nephropathy in the 128 patients after stent implantation was 14. 06%. After treatment,urinary NGAL,IL-18,serum Cys-C and Scr levels were significantly higher than those before treatment in radiographic contrast nephropathy group( P < 0. 05).Among patients with coronary heart disease,positive rates of urinary NGAL,IL-18,serum Cys-C and Scr in radiographic contrast nephropathy group were significantly higher than those in non-radiographic contrast nephropathy group( P <0. 01). Urinary NGAL was positively correlated with serum Cys-C,Scr and urinary IL-18( r = 0. 286,0. 326,0. 342,P < 0. 05). Values of sensitivity and specificity of urinary NGAL combined with serum Cys-C in early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease were significantly higher than those by urinary NGAL or serum Cys-C,urinary IL-8 and serum Scr detections only( P < 0. 05). Conclusion Urinary NGAL and serum Cys-C levels are significantly higher in coronary heart disease patients with radiographic contrast nephropathy,and combined detection has high sensitivity and specificity in early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease,and therefore it can be used as the first index for early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease.
Objective To investigate clinical value of urinary neutrophil gelatinase associated lipocalin( NGAL combined with serum cystatin C( Cys-C) in early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease. Methods A total of 128 coronary heart disease patients with stent implantation admitted during May 2015 and December 2017 were selected to observe incidence rate of radiographic contrast nephropathy. Levels of urinary NGAL,serum Cys-C,creatinine( Scr) and urinary interleukin-18( IL-18) were detected,and correlations between urinary NGAL with serum Cys-C,Scr and IL-18 were analyzed. Results Incidence rate of radiographic contrast nephropathy in the 128 patients after stent implantation was 14. 06%. After treatment,urinary NGAL,IL-18,serum Cys-C and Scr levels were significantly higher than those before treatment in radiographic contrast nephropathy group( P < 0. 05).Among patients with coronary heart disease,positive rates of urinary NGAL,IL-18,serum Cys-C and Scr in radiographic contrast nephropathy group were significantly higher than those in non-radiographic contrast nephropathy group( P <0. 01). Urinary NGAL was positively correlated with serum Cys-C,Scr and urinary IL-18( r = 0. 286,0. 326,0. 342,P < 0. 05). Values of sensitivity and specificity of urinary NGAL combined with serum Cys-C in early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease were significantly higher than those by urinary NGAL or serum Cys-C,urinary IL-8 and serum Scr detections only( P < 0. 05). Conclusion Urinary NGAL and serum Cys-C levels are significantly higher in coronary heart disease patients with radiographic contrast nephropathy,and combined detection has high sensitivity and specificity in early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease,and therefore it can be used as the first index for early diagnosis of radiographic contrast nephropathy in patients with coronary heart disease.
引文
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[8]稂琳璐.血清脂质运载蛋白、胱抑素C和尿β2微球蛋白在妊娠高血压患者早期肾损伤诊断中的价值[J].中国临床医生杂志,2017,45(6):55-58.
[9]詹颉,张华,闫福堂,等.血清NGAL与Cr,BUN,RBP,Cys-C联合检测在糖尿病肾病早期诊断中的应用[J].现代检验医学杂志,2016,31(4):100-103.
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[11]Kafkas N,Liakos C,Zoubouloglou F,et al.Neutrophil Gelatinase-Associated Lipocalin as an Early Marker of Contrast-Induced Nephropathy After Elective Invasive Cardiac Procedures[J].Clin Cardiol,2016,39(8):464-470.
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[13]赵兰蒂,代世昌,杨建彬,等.心电图联合超声心动图检查对不同程度冠心病心力衰竭患者的临床诊断价值[J].临床误诊误治,2017,30(11):55-59.
[14]潘兴飞,张绍全,黄小萍,等.白细胞介素32γ通过活化核转录因子κB通路诱导LX-2细胞表达基质金属蛋白酶9[J].医学分子生物学杂志,2016,13(3):149-152.
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[16]郝林涛,韩凌,邹作君.尿NGAL和血、尿胱抑素C对早期糖尿病肾脏疾病诊断价值的研究[J].中国中西医结合肾病杂志,2016,17(3):240-242.
[17]白寿军,王亚琨,朱迎春,等.尿肾损伤分子-1的检测对造影剂肾病早期诊断的临床意义[J].中国医药导报,2016,13(15):173-176.
[18]翟玉娥,孙树凯,马金龙,等.血清NGAL、Cys C、Cr和BUN水平检测对高血压肾病的早期诊断价值[J].山东医药,2016,56(33):63-65.
[19]Liu Y,Li H X,Ying Z W,et al.Serum Neutrophil Gelatinase-Associated Lipocalin and Cystatin C for Assessing Recovery of Graft Function in Patients Undergoing LivingDonor Kidney Transplantation[J].Clin Lab,2016,62(1-2):155-163.
[20]刘志成,苑荣亮,张成,等.人星状病毒非结构蛋白ns P1 a/1相互作用的宿主细胞靶蛋白筛选[J].医学分子生物学杂志,2016,13(5):281-285.
[21]石晓明,蒋戈利,刘文红,等.八段锦对冠心病患者心脏康复过程心肺功能的影响[J].解放军医药杂志,2017,29(2):24-27.
[22]刘小艳,刘涛,李煜.川东北地区汉族人群血同型半胱氨酸与冠心病的相关性研究[J].西部医学,2017,29(3):347-350.
[23]范艳平,赵铁梅,卢经君,等.脂蛋白相关磷脂A2与稳定型冠心病主要心血管事件的相关性[J].临床误诊误治,2018,31(1):86-89.
[24]王双桂,朱振华,董维维.检测m Alb、NGAL、Cys-C、HCY对糖尿病早期肾损害的诊断价值[J].中国医师杂志,2017,19(5):745-747.
[25]Okyay K,Ylldlrlr A,?i?ek M,et al.Serum cystatin Cand neutrophil gelatinase-associated lipocalin in predicting the severity of coronary artery disease in diabetic patients[J].Anatolian Journal of Cardiology,2016,16(10):756-761.
[26]许长红,江坤仁.血、尿中性粒细胞明胶酶相关脂质运载蛋白与胱抑素C对肝硬化并发急性肾损伤的诊断价值[J].临床肝胆病杂志,2017,33(11):2136-2140.
[27]张华,詹颉,苏宝凤,等.血清NGAL与肾功其他指标联合检测在原发性高血压肾病早期诊断中的应用[J].现代检验医学杂志,2016,31(4):54-57.
[28]李平华,宋倩,黄连铭.血清肌酐、胱抑素C、NGAL检测对妊娠相关急性肾损伤诊断及预后评估的价值[J].中国计划生育学杂志,2017,25(5):308-313.
[29]赵新祥,郑宏伟,房师荣,等.急性百草枯中毒患者血清Scr、BUN、β2-MG、Cys-C及尿NGAL水平变化[J].山东医药,2017,57(9):64-66.
[30]姜晨阳.清晨高血压患者血清NGAL、Cys C水平的临床研究[J].心血管康复医学杂志,2018,27(1):9-11.
[31]胡明磊,金献冠,李钰.脓毒症AKI生物学标志物在CRRT中的临床价值[J].医学研究杂志,2017,46(9):100-103,191.
[32]阮红刚,付潮泓,许腊梅.Cys C联合NGAL在急性肾损伤中的评估价值[J].临床急诊杂志,2016,17(12):960-962.
[33]Papassotiriou G P,Kastritis E,Gkotzamanidou M,et al.Neutrophil Gelatinase-Associated Lipocalin and Cystatin CAre Sensitive Markers of Renal Injury in Patients With Multiple Myeloma[J].Clin Lymphoma Myeloma Leuk,2016,16(1):29-35.
[34]谢雪梅,魏从真,赵小洁,等.先天性心脏病术后急性肾损伤患儿尿液NGAL、血清Cys C水平变化及意义[J].山东医药,2016,56(8):73-74.
[35]杨建宝,李金巍.高血压肾病患者的中性粒细胞明胶酶相关脂质运载蛋白、胱抑素C、肌酐、尿素氮水平及其临床意义研究[J].中国临床医生杂志,2018,46(4):408-410.
[36]彭卫华,陈凌舟,许敏敏,等.ANCA相关性小血管炎肾损害患者尿液肾损伤生物标志物的检测及意义[J].中国中西医结合肾病杂志,2017,18(10):860-865.
[2]王心悦.糖尿病与非糖尿病患者发生心律失常的类型和危险因素分析[J].中国医药指南,2016,14(3):102-103.
[3]雷蕾,李良平,张虎.血清胱抑素C联合尿中性粒细胞明胶酶相关脂质运载蛋白对肝硬化腹水继发急性肾损伤的诊断价值[J].临床肝胆病杂志,2018,34(1):101-105.
[4]张玉梅,李劲松,张登庆.冠状动脉粥样硬化性心脏病行心血管介入治疗的临床效果分析[J].血管与腔内血管外科杂志,2018,4(5):413-417.
[5]董自杰,李彦青,李雪,等.尿液NGAL、血清Cys C联合诊断在儿童急性肾损伤中应用价值[J].中国临床研究,2017,30(8):1110-1112.
[6]黄炎,黄伟,章爽,等.血清NGAL、hs-CRP、Cys C和U-m ALB对糖尿病肾病早期诊断价值的初步探讨[J].实用预防医学,2017,24(10):1168-1171.
[7]杨丽萍,赵谷天,陈宗宁,等.冠心病合并房颤患者的甲状腺激素水平变化及其机制探讨[J].西部医学,2016,28(10):1386-1388,1392.
[8]稂琳璐.血清脂质运载蛋白、胱抑素C和尿β2微球蛋白在妊娠高血压患者早期肾损伤诊断中的价值[J].中国临床医生杂志,2017,45(6):55-58.
[9]詹颉,张华,闫福堂,等.血清NGAL与Cr,BUN,RBP,Cys-C联合检测在糖尿病肾病早期诊断中的应用[J].现代检验医学杂志,2016,31(4):100-103.
[10]陈玲玲,严士荣,杨波.冠心病及其危险因素与血浆脂蛋白相关磷脂酶A2变化的关系[J].江苏大学学报:医学版,2015,25(4):360-362.
[11]Kafkas N,Liakos C,Zoubouloglou F,et al.Neutrophil Gelatinase-Associated Lipocalin as an Early Marker of Contrast-Induced Nephropathy After Elective Invasive Cardiac Procedures[J].Clin Cardiol,2016,39(8):464-470.
[12]高立峰,张旭光.中性粒细胞明胶酶相关载脂蛋白、胱抑素C与肌酐联合检测在双侧输尿管结石继发急性肾损伤早期诊断中的临床价值[J].中国卫生检验杂志,2017,27(19):2803-2804,2808.
[13]赵兰蒂,代世昌,杨建彬,等.心电图联合超声心动图检查对不同程度冠心病心力衰竭患者的临床诊断价值[J].临床误诊误治,2017,30(11):55-59.
[14]潘兴飞,张绍全,黄小萍,等.白细胞介素32γ通过活化核转录因子κB通路诱导LX-2细胞表达基质金属蛋白酶9[J].医学分子生物学杂志,2016,13(3):149-152.
[15]马国强,李春晓,张勇涛,等.依折麦布联合瑞舒伐他汀对冠心病血脂、颈动脉粥样硬化斑块和超敏C反应蛋白的影响[J].解放军医药杂志,2017,29(10):91-94.
[16]郝林涛,韩凌,邹作君.尿NGAL和血、尿胱抑素C对早期糖尿病肾脏疾病诊断价值的研究[J].中国中西医结合肾病杂志,2016,17(3):240-242.
[17]白寿军,王亚琨,朱迎春,等.尿肾损伤分子-1的检测对造影剂肾病早期诊断的临床意义[J].中国医药导报,2016,13(15):173-176.
[18]翟玉娥,孙树凯,马金龙,等.血清NGAL、Cys C、Cr和BUN水平检测对高血压肾病的早期诊断价值[J].山东医药,2016,56(33):63-65.
[19]Liu Y,Li H X,Ying Z W,et al.Serum Neutrophil Gelatinase-Associated Lipocalin and Cystatin C for Assessing Recovery of Graft Function in Patients Undergoing LivingDonor Kidney Transplantation[J].Clin Lab,2016,62(1-2):155-163.
[20]刘志成,苑荣亮,张成,等.人星状病毒非结构蛋白ns P1 a/1相互作用的宿主细胞靶蛋白筛选[J].医学分子生物学杂志,2016,13(5):281-285.
[21]石晓明,蒋戈利,刘文红,等.八段锦对冠心病患者心脏康复过程心肺功能的影响[J].解放军医药杂志,2017,29(2):24-27.
[22]刘小艳,刘涛,李煜.川东北地区汉族人群血同型半胱氨酸与冠心病的相关性研究[J].西部医学,2017,29(3):347-350.
[23]范艳平,赵铁梅,卢经君,等.脂蛋白相关磷脂A2与稳定型冠心病主要心血管事件的相关性[J].临床误诊误治,2018,31(1):86-89.
[24]王双桂,朱振华,董维维.检测m Alb、NGAL、Cys-C、HCY对糖尿病早期肾损害的诊断价值[J].中国医师杂志,2017,19(5):745-747.
[25]Okyay K,Ylldlrlr A,?i?ek M,et al.Serum cystatin Cand neutrophil gelatinase-associated lipocalin in predicting the severity of coronary artery disease in diabetic patients[J].Anatolian Journal of Cardiology,2016,16(10):756-761.
[26]许长红,江坤仁.血、尿中性粒细胞明胶酶相关脂质运载蛋白与胱抑素C对肝硬化并发急性肾损伤的诊断价值[J].临床肝胆病杂志,2017,33(11):2136-2140.
[27]张华,詹颉,苏宝凤,等.血清NGAL与肾功其他指标联合检测在原发性高血压肾病早期诊断中的应用[J].现代检验医学杂志,2016,31(4):54-57.
[28]李平华,宋倩,黄连铭.血清肌酐、胱抑素C、NGAL检测对妊娠相关急性肾损伤诊断及预后评估的价值[J].中国计划生育学杂志,2017,25(5):308-313.
[29]赵新祥,郑宏伟,房师荣,等.急性百草枯中毒患者血清Scr、BUN、β2-MG、Cys-C及尿NGAL水平变化[J].山东医药,2017,57(9):64-66.
[30]姜晨阳.清晨高血压患者血清NGAL、Cys C水平的临床研究[J].心血管康复医学杂志,2018,27(1):9-11.
[31]胡明磊,金献冠,李钰.脓毒症AKI生物学标志物在CRRT中的临床价值[J].医学研究杂志,2017,46(9):100-103,191.
[32]阮红刚,付潮泓,许腊梅.Cys C联合NGAL在急性肾损伤中的评估价值[J].临床急诊杂志,2016,17(12):960-962.
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