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目的探讨对比剂剂量(CMV)与估算的肾小球滤过率(eGFR)比值(CMV/eGFR)对行冠脉诊疗介入术后对比剂肾病(CIN)的早期临床预测价值。方法连续收集徐州医学院附属医院心血管内科于2013年3月至9月195例行CAG术和/或PCI术的患者临床资料,于术前3 d内及术后24、48 h静脉采血3 ml,用于血肌酐(Scr)检测,以适合中国人的改良形式肾脏病饮食调整研究(modification of diet in renal disease,MDRD)公式计算eGFR,并计算CMV/eGFR。应用受试者工作特征曲线(ROC)评价分析CMV/eGFR的比值对CIN发生的敏感性和特异性。结果 195例患者中术后有13例(6.7%)发生CIN,当CMV/eGFR值<2.46,CIN发生率为2.6%(4/152),而当CMV/eGFR≥2.46,CIN发生率为20.9%(9/43)。CIN组与非CIN组患者在对比剂用量[(176.46±67.15)ml vs(105.31±43.05)ml,P<0.01],以及CMV/eGFR(2.94±1.28 vs 1.77±0.82,P<0.01)方面有统计学差异。ROC曲线表明取CMV/eGFR预测CIN的临界点为2.46,当>2.46时,其特异度为81.3%,灵敏度为76.9%。结论 CMV/eGFR对于冠脉诊疗介入术后患者发生CIN具有良好的早期预测价值。
Objective To investigate the early clinical value of contrast medium dose (CMV) and estimated glomerular filtration rate (eGFR) ratio (CMV / eGFR) in the diagnosis and treatment of contrast-induced nephropathy (CIN) after coronary intervention. Methods The clinical data of 195 patients undergoing CAG and / or PCI from March 2013 to September 2013 in Department of Cardiology, Affiliated Hospital of Xuzhou Medical College were continuously collected. Blood samples were collected 3 days before operation and 24 and 48 hours after operation ml for the detection of serum creatinine (Scr), calculate eGFR and calculate CMV / eGFR for the Chinese version of the modified of diet in renal disease (MDRD) formula. The receiver operating characteristic curve (ROC) was used to evaluate the sensitivity and specificity of the ratio of CMV / eGFR to CIN. Results CIN was found in 13 out of 195 patients (6.7%). The CIN incidence was 2.6% (4/152) when CMV / eGFR was less than 2.46 and 20.9% when CMV / eGFR was 2.46 % (9/43). CIN group and non-CIN group had significant differences in contrast medium dose (176.46 ± 67.15) ml vs (105.31 ± 43.05) ml, P <0.01 and CMV / eGFR (2.94 ± 1.28 vs 1.77 ± 0.82, P <0.01) Statistical differences. The ROC curve showed that the critical point of CIN predicted by CMV / eGFR was 2.46. When> 2.46, the specificity was 81.3% and the sensitivity was 76.9%. Conclusions CMV / eGFR has a good early predictive value for the occurrence of CIN after PCI in patients undergoing coronary intervention.