摘要
目的通过检测CYP2C19基因多态性及血清NGAL为预测冠心病患者介入术后对比剂肾病(CIN)发生提供有效方法。方法回顾性收集南京医科大学第二附属医院2017年4月-2018年4月行冠状动脉造影或介入治疗的冠心病患者136例,按照术后是否发生CIN,将患者分为CIN组(10例),非CIN组(126例)。分别进行CPY2C19基因测序及手术前后血Cr,尿素氮与血NGAL的检测。结果 (1)CPY2C19基因多态性中快代谢基因型与中,慢代谢基因型在CIN的发生率有统计学意义(χ2=4.12,P<0.05),中,慢代谢基因型在CIN的发病率上明显高于快代谢型。(2)术后24hCIN组血Cr及NGAL水平高于术前,且高于术后24h非CIN组(t=2.798,t=19.88,P<0.05)。(3)Pearson相关分析显示,术后24h血NGAL水平分别与术后24h血Cr,BUN呈正相关(P<0.05)。(4)ROC曲线显示术后24hNGAL曲线下面积为0.915;血Cr曲线下面积为0.943,此时血NGAL检测截断点取219.15ng/ml时,尤登指数最大,此时敏感度100%,特异性70%。血清Cr截断点取97.45μmol/L时,尤登指数最大,此时敏感度90%,特异度9.5%。结论 CIN的发生与冠心病患者本身的CYP2C19基因多态性有关,血NGAL相较于血Cr可以提早预测CIN的发生。
Objective Through detecting CYP2 C19 polymorphism and serum NGAL to provide an effective method for predicting the incidence of contrast-induced nephropathy(CIN)after coronary intervention in patients with coronary heart disease.Methods A retrospective study was conducted on 136 patients with coronary artery disease who underwent coronary angiography or interventional treatment from April 2017 to April 2018 in the Second Affiliated Hospital of Nanjing Medical University.The patients were divided into CIN group(10 cases)and non-CIN group(126 cases),according to whether or not CIN occurred after surgery.Detection of CPY2 C19 polymorphisms in patients before surgery.Serum creatinine,urea nitrogen,and blood NGAL levels were measured before and after surgery.Results There was a statistically significant difference in the incidence of CIN between the fast metabolizing genotypes and the moderately and slowly metabolizing genotypes in the CPY2 C19 polymorphism(2χ=4.12,P<0.05).The moderately and slowly genotypes were significantly associated with the incidence of CIN.The blood levels of Cr and NGAL were higher in the CIN group than non-CIN group(t=4.33,P<0.05)and the preoperative group at 24 hours after operation.Cr in the CIN group was higher than non-CIN group(t=4.33,P<0.05).Pearson correlation analysis showed that plasma NGAL levels at 24 hours postoperatively were positively correlated with serum Cr and BUN levels(P<0.05).The ROC curve showed that the area under the NGAL curve was 0.915 at 24 hours postoperatively;the area under the serum Cr curve was 0.943 at 24 hours postoperatively.When the blood NGAL test cut-off point was 219.15 ng/ml at 24 hours after surgery,the Ueden index was maximal,with a sensitivity of 100%and a specificity of 70%.When the serum Cr cutoff point was 97.45 umol/L at 24 hours after surgery,the Ueden index was the highest,with a sensitivity of 90%and a specificity of 9.5%.Conclusion The occurrence of CIN is related to the CYP2 C19 polymorphism in patients withcoronary heart disease.Blood NGAL can predict the occurrence of CIN earlier than serum Cr.
作者
曲晨
高逸冰
王迪斌
李秀珍
朱嵘
高莹
谭晓
QU Chen;GAO Yi-bing;WANG Di-bin(the Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu210011,China)
出处
《中国实验诊断学》
2019年第8期1320-1324,共5页
Chinese Journal of Laboratory Diagnosis
基金
新疆维吾尔自治区卫生计生委青年科技人才专项科研项目(2016Y23)
新疆克州人民政府“帕米尔3123人才”重点项目(RK2016030)
江苏省青年医学人才项目(QNRC2016666)
