摘要
目的 探讨急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术后对比剂急性肾损伤(CI-AKI)的发生率与纤维蛋白原(FIB)水平和CHA_(2)DS_(2)-VASc评分的关系,并进一步比较FIB、CHA_(2)DS_(2)-VASc评分以及两者联合对CI-AKI的预测价值。方法 回顾性分析2018年12月至2021年1月因ACS就诊并行PCI的934例患者的临床资料,计算入院CHA_(2)DS_(2)-VASc评分。按照术后肌酐变化情况将所有患者分为CI-AKI组及非CI-AKI组,比较两组之间的基线资料。Spearman相关分析评估FIB和CHA_(2)DS_(2)-VASc评分的相关性。绘制ROC曲线以评价FIB、CHA_(2)DS_(2)-VASc评分及两者联合水平对PCI术后CI-AKI的预测价值,并采用Logistic回归分析ACS患者PCI术后CI-AKI的影响因素。结果 高FIB、高CHA_(2)DS_(2)-VASc评分的患者术后具有更高的CI-AKI发生率。相关性分析显示FIB和CHA_(2)DS_(2)-VASc评分呈正相关(R=0.236,P<0.001)。两者联合预测ACS患者PCI术后CI-AKI的ROC曲线下面积为0.727(95%CI:0.697~0.755,P<0.001),敏感度为63.3%,特异性为72.6%。以FIB、CHA_(2)DS_(2)-VASc评分预测ACS患者发生CI-AKI的截断值将934例ACS患者分为低危组(404例)、中危组(383例)和高危组(147例),多因素Logistic回归分析结果显示,白蛋白水平(OR=0.913,95%CI:0.867~0.962,P=0.001)、FIB水平(OR=1.451,95%CI:1.185~1.777,P<0.001)、CHA_(2)DS_(2)-VASc评分(OR=1.271,95%CI:1.504~1.780,P<0.001)是ACS患者PCI术后CI-AKI的独立影响因素(P<0.05)。结论 术前纤维蛋白原水平与CHA_(2)DS_(2)-VASc评分对PCI术后发生CI-AKI具有一定的预测价值,两者联合能提高ACS患者PCI术后CI-AKI发生预测的准确性。
Objective To investigate the relationship between the incidence of contrast-induced acute kidney injury(CI-AKI) and the level of fibrinogen(FIB) and CHA_(2)DS_(2)-VASc scores in patients with acute coronary syndromes(ACS) undergoing percutaneous coronary intervention(PCI),and to further compare the predictive value of FIB,CHA_(2)DS_(2)-VASc scores and their combination for CI-AKI.Methods The clinical and laboratory data of 934 ACS patients who underwent PCI in our hospital from December 2018 to January 2021 were retrospectively analyzed,and CHA_(2)DS_(2)-VASc scores were calculated.According to postoperative creatinine changes,all patients were divided into CI-AKI and non-CI-AKI groups,and baseline information was compared between the two groups.The correlation between FIB and CHA_(2)DS_(2)-VASc scores was assessed by Spearman correlation analysis.ROC curves were plotted to evaluate the predictive value of FIB,CHA_(2)DS_(2)-VASc scores,and their combined levels on CI-AKI,and logistic regression analysis was used to study the risk factors of CI-AKI in patients with ACS after PCI.Results Patients with high FIB and high CHA_(2)DS_(2)-VASc scores had a higher incidence of CI-AKI after PCI.Correlation analysis showed that FIB and CHA_(2)DS_(2)-VASc scores were positively correlated(R=0.236,P<0.001).The combined prediction of the area under the ROC curve of CI-AKI after PCI in ACS patients was 0.727(95%CI:0.697~0.755,P<0.001),the sensitivity was 63.3%,and the specificity was 72.6%.The cut-off values of FIB and CHA_(2)DS_(2)-VASc scores to predict the occurrence of CI-AKI in ACS patients divided 934 ACS patients into low-risk(404 cases),mediumrisk(383 cases),and high-risk groups(147 cases).Multivariate logistic regression analysis showed that albumin level(OR=0.913,95%CI:0.867~0.962,P=0.001),FIB level(OR=1.451,95%CI:1.185~1.777,P<0.001),CHA_(2)DS_(2)-VASc score(OR=1.271,95%CI:1.504~1.780,P<0.001) were independent influences on CI-AKI after PCI in patients with ACS,(P<0.05).Conclusion The preoperative fibrinogen level and CHA_(2)DS_(2)-VASc score have certain predictive value for the occurrence of CI-AKI after interventional diagnosis and treatment.The combination of the two can improve the accuracy of the prediction of CI-AKI after PCI in ACS patients.
作者
李晶
马凯
张柏祥
郑迪
陆远
李文华
Li Jing;Ma Kai;Zhang Baixiang;Zheng Di;Lu Yuan;Li Wenhua(Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu,221000,China;不详)
出处
《中国循证心血管医学杂志》
2022年第10期1221-1225,1240,共6页
Chinese Journal of Evidence-Based Cardiovascular Medicine
