尿可溶性髓样细胞触发受体-1对老年经皮冠状动脉介入术后患者造影剂肾病的预测价值

    Predictive value of urinary triggering receptors expressed on myeloid cells-1 on contrast-induced nephropathy after percutaneous coronary intervention

      摘要
    • 摘要: 目的探讨尿可溶性髓样细胞触发受体-1(triggering receptors expressed on myeloid cells-1,s TREM-1)对老年经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后患者造影剂肾病(contrast-induced nephropathy,CIN)的早期诊断意义。方法选取行PCI术患者,按是否发生CIN分为CIN组(n=21)和非CIN组(n=179)。对比两组患者血肌酐、估算肾小球滤过率(estimated glomerular filtration rate,e GFR)、尿s TREM-1差异,分析尿s TREM-1与血肌酐及e GFR的相关性,以及尿s TREM-1对CIN的早期诊断价值。结果 CIN组患者年龄(71.48±8.51)岁比(62.92±9.16)岁及2型糖尿病患病率(57.15%比34.64%)明显高于非CIN组(P<0.05)。术后4 h、24 h、48 h,CIN组患者尿s TREM-1含量(111.02±14.73)ng/L比(47.45±10.36)ng/L、(123.81±28.51)ng/L比(49.29±12.46)ng/L、(134.69±30.37)ng/L比(45.31±9.48)ng/L明显高于非CIN组(P<0.05);术后4 h、24 h,两组患者血肌酐及e GFR比较差异无统计学意义(P>0.05),术后48 h,CIN组患者血肌酐(89.05±21.13)μmol/L比(63.42±12.42)μmol/L明显高于非CIN组(P<0.05),e GFR(76.28±21.89)m L·min-1·(1.73m2)-1比(112.94±30.46)m L·min-1·(1.73m2)-1明显低于非CIN组(P<0.05)。尿s TREM-1与血肌酐呈正相关(P<0.05),而尿s TREM-1与e GFR呈负相关(P<0.05)。受试者工作特征(receiver operator characteristic,ROC)曲线分析显示,术后4 h尿s TREM-1的曲线下面积为0.740(95%CI:0.482~0.998),截断点为89.0 ng/L,敏感度和特异度分别为62.6%、73.5%;术后24 h尿s TREM-1的曲线下面积为0.931(95%CI:0.868~0.994),截断点为98.0 ng/L,敏感度和特异度分别为86.6%、73.8%;术后48 h尿s TREM-1的曲线下面积为0.948(95%CI:0.894~1.001),截断点为108.0 ng/L,敏感度和特异度分别为87.9%、88.4%。结论尿s TREM-1可反映PCI术后早期肾功能变化,在CIN早期诊断中具有良好的应用价值。

       

      Abstract: Objective To evaluate the predictive value of urinary soluble triggering receptors expressed on myeloid cells-1(s TREM-1)on contrast-induced nephropathy(CIN)after percutaneous coronary intervention(PCI).Methods Patients undergoing PCI were divided into two groups of CIN(n=21)and non-CIN(n=179)according to the occurrence of CIN. Serum creatinine,estimated glomerular filtration rate(e GFR)and urinary s TREM-1 were compared between two groups. The correlation between urinary s TREM-1,serum creatinine and e GFR were analyzed. And early diagnostic value of urinary s TREM-1 in CIN was examined.Results Age(71.48±8.51)year vs(62.92±9.16)yearand diabetic rate(57.15% vs 34.64%)of CIN group were significantly higher than those in non-CIN group(P<0.05). At 4 h、24 h、48 h post-operation,urinary s TREM-1(111.02±14.73)ng/L vs(47.45±10.36)ng/L,(123.81±28.51)ng/L vs(49.29±12.46)ng/L,(134.69±30.37)ng/L vs(45.31±9.48)ng/Lof CIN group was significantly higher than that of non-CIN group (P<0.05). At 4 h、24 h postoperation,serum creatinine and e GFR showed no significant inter-group differences(P>0.05). At 48 h post-operation,serum creatinine(89.05±21.13)vs(63.42±12.42)μmol/Lof CIN group was significantly higher than that of non-CIN group (P<0.05); e GFR(76.28±21.89) m L·min-1·(1.73m2)-1vs(112.94±30.46)m L·min-1·(1.73m2)-1of CIN group was significantly less than that of non-CIN group(P<0.05). Urinary s TREM-1 was positively correlated with serum creatinine(P<0.05)while urinary s TREM-1 negatively correlated with e GFR(P<0.05). Receiver operator characteristic(ROC)analysis showed that AUC of urinary s TREM-1 was 0.740(95% CI:0.482-0.998)at 4 h post-operation;the sensitivity and specificity for diagnosing CIN were 62.6% and 73.5% at a cut-off level of 89.0 ng/L. AUC of urinary s TREM-1 was 0.931(95% CI:0.868-0.994)at 24 h post-operation and the sensitivity and specificity diagnosing CIN were 86.6% and 73.8% at a cut-off level of 98.0 ng/L.AUC of urinary s TREM-1 was 0.948(95% CI:0.894-1.001)at 48 h post-operation and the sensitivity and specificity for diagnosing CIN were 87.9% and 88.4% at a cut-off level of 108.0 ng/L.Conclusion Urinary s TREM-1 may reflect the early changes of renal function after PCI. It has an excellent value in the early diagnosis of CIN.

       

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