【摘要】 目的探讨中性粒细胞明胶酶脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)联合B型脑钠肽(B-type natriuretic peptide,BNP)对老年冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CHD)病人发生造影剂肾病(contrast-induced nephropathy,CIN)的早期诊断价值。方法选取2014~2015年在南京医科大学第二附属医院老年科住院确诊或可疑CHD拟行冠状动脉造影和(或)介入治疗的102例病人进行前瞻性观察研究,根据CIN诊断标准按病人临床转归将病人分为CIN组(8例)与非CIN组(94例)。分别于术前,术后24 h、48 h检测血浆NGAL与BNP水平,评估其对CIN的诊断价值。结果术后24 h、48 h,CIN组的血肌酐(serum creatinine,Scr)、NGAL水平较术前及非CIN组明显增高;CIN组术后24 h BNP水平较术前明显增高(均P<0.05)。术前,CIN组血NGAL水平与年龄、Scr、BNP呈正相关(r=0.862、0.550、0.835,均P<0.05);血BNP与年龄、Scr呈正相关(r=0.917、0.741,均P<0.05)。术后24 h联合BNP+NGAL检测对CIN的诊断价值明显优于任一单独指标(AUC=0.863,95%CI:0.718~1.001,P<0.05)。结论动态监测血NGAL和BNP对早期识别老年CIN有重要的预测价值。更多还原

【Abstract】 Objective To investigate the predictive value of neutrophil gelatinase-associated lipocalin( NGAL) combined with B-type natriuretic peptide( BNP) on early diagnosis of contrastinduced nephropathy( CIN) in geriatric patients with coronary atherosclerotic heart disease( CHD).Methods A total of 102 patients with confirmed or suspicious CHD by coronary angiography and/or interventional therapy in the Second Affiliated Hospital of Nanjing Medical University from 2014 to 2015 were enrolled in this prospective study. Patients were divided into CIN group( n = 8) and non-CIN group( n = 94) by CIN diagnostic standard. The levels of NGAL and BNP were evaluated for diagnostic value of CIN before and 24 h,48 h after operation. Results The levels of serum creatinine( Scr) and NGAL in CIN group 24 h,48 h after operation were significantly higher than those before operation and in nonCIN group,and the level of BNP in CIN group 24 h after operation was significantly higher than that before operation( all P<0. 05). NGAL in CIN group before operation was positively correlated with age,Scr and BNP( r = 0. 862,0. 550,0. 835,all P< 0. 05). BNP in CIN group before operation was positively correlated with age and Scr( r = 0. 917,0. 741,all P<0. 05). NGAL combined with BNP 24 h after operation was markedly better than any single index in the predicting of CIN( AUC = 0. 863,95%CI: 0. 718-1. 001,P<0. 05). Conclusions Dynamic monitoring of NGAL and BNP may predict CIN eariler in the elderly.更多还原