尿富含半胱氨酸蛋白61在对比剂肾病中的早期诊断价值

    The value of urinary cysteine rich protein 61 in early diagnosis of contrast-induced nephropathy

      摘要
    • 摘要: 目的 探讨尿富含半胱氨酸蛋白61（cysteine-rich protein 61，CYR61）在对比剂肾病（contrast-induced nephropathy，CIN）早期诊断中的价值。方法 于2017年1月至2018年8月在徐州医科大学附属淮安医院招募择期拟行经皮冠状动脉介入术的患者。采集患者一般临床资料、血生化、血常规、血凝常规。留取患者术前及术后2 h、4 h、8 h尿标本，采用ELISA法检测尿CYR61水平。统计分析时根据术前估算肾小球滤过率（eGFR）将患者分为eGFR ≥ 60 mL·min-1·（1.73 m2）-1（n=197）和eGFR<60 mL·min-1·（1.73 m2）-1（n=50）两组，两组中再按患者是否发生CIN分为CIN组与非CIN组，分别进行亚组分析，并绘制受试者工作曲线（ROC）评价尿CYR61在CIN早期诊断中的价值。结果 在eGFR ≥ 60 mL·min-1·（1.73 m2）-1组与eGFR<60 mL·min-1·（1.73 m2）-1组中，发生CIN的患者的尿CYR61水平均在术后4 h达到高峰，此后尿CYR61水平出现下降。将术后4 h尿CYR61用于诊断CIN的发生，分别绘制ROC曲线，结果表明，eGFR ≥ 60 mL·min-1·（1.73 m2）-1患者采用术后4 h尿CYR61诊断CIN的最佳临界值为293.67 ng/L，灵敏度与特异度分别为90.91%、83.33%，AUC为0.88（95%CI 0.82~0.92）；eGFR<60 mL·min-1·（1.73 m2）-1患者采用术后4 h尿CYR61诊断CIN的最佳临界值为266.23 ng/L，灵敏度与特异度分别为100.00%、78.79%，AUC为0.89（95%CI 0.77~0.96）。结论 在eGFR ≥ 60 mL·min-1·（1.73 m2）-1患者和eGFR<60 mL·min-1·（1.73 m2）-1患者中，术后4 h尿CYR61水平可作为CIN的早期诊断指标。

       

      Abstract: Objective To investigate the value of urinary cysteine-rich protein 61 (CYR61) in early diagnosis of contrast-induced nephropathy (CIN). Methods Those patients who were scheduled to have percutaneous coronary intervention (PCI) from January 2017 to August 2018 in Huai'an Hospital Affiliated to Xuzhou Medical University. General clinical data, and those on blood biochemistry, routine test and routine coagulation test were collected. Urine samples were taken before operation, 2 hours, 4 hours and 8 hours after operation. Urinary cysteine rich protein 61 (CRY61) level was detected by ELISA. For statistical analysis, based on the preoperative estimated glomerular filtration rate (eGFR), the patients were divided into two groups:eGFR ≥ 60 mL·min-1·(1.73 m2)-1 group (n=197) and eGFR<60 mL·min-1·(1.73 m2)-1 group (n=50), and each was divided into CIN subgroup and non-CIN subgroup according to whether the patients had CIN or not. Subgroup analysis was carried out respectively. The value of urine CYR61 in early diagnosis of CIN was evaluated by receiver operating curve (ROC). Results In the eGFR ≥ 60 mL·min-1·(1.73 m2)-1 group and eGFR<60 mL·min-1·(1.73 m2)-1 group, the urinary CYR61 level of patients with CIN reached its peak at 4 hours after operation, and then decreased. Therefore, the 4-hour postoperative urinary CYR61 was used to diagnose CIN. The ROCs of 4-hour postoperative urinary CYR61 were plotted respectively. The results revealed that, for those patients with eGFR ≥ 60 mL·min-1·(1.73 m2)-1, the optimal cutoff value for CIN diagnosis through the 4-hour postoperative urinary CYR61 was 293.67 ng/L, with sensitivity and specificity of 90.91% and 83.33% respectively, and AUC area under the curve (AUC) of 0.88 (95%CI 0.82~0.92); for those patients with eGFR<60 mL·min-1·(1.73 m2)-1, the cutoff value 266.23 ng/L, with sensitivity and specificity of 100.00% and 78.79%, and AUC of 0.89(95%CI 0.77~0.96). Conclusions In patients with eGFR ≥ 60 mL·min-1·(1.73 m2)-1 and those with eGFR<60 mL·min-1·(1.73 m2)-1, the 4-hour postoperative urinary CYR61 level can be used as an indicator for early diagnosis of CIN.

       

      • HTML全文
      • 参考文献(21)
      • 相关文章
      • 施引文献
    • 资源附件(0)

    /

    返回文章
    返回