| Background:With the widely application of percutaneous coronary intervention, postoperative renal injury induced by contrast medium incidence increased gradually. Contrast-induced nephropathy (CIN) is an acute renal dysfunction induced by contrast media. CIN has no uniform diagnostic criteria at present, often using serum creatinine (SCr) as an evaluation biomarker, but the SCr can not make an early prediction of CIN. Elderly patients often have high risk of CIN. Therefore, it is need to investigate a more sensitive and more reliable biomarkers to estimate CIN in the early stage. Recently, neutrophil gelatinase-associated lipid transfer protein (NGAL) is considered as novel markers of acute renal injury.Based on the above, this study use SCr, the estimation of glomerular filtration rate (eGFR) and Cyst C to evaluate renal function.Comparation the change of the plasma and urine NGAL before and after coronary intervention, aim to explore whether the NGAL is early predictor of CIN. Analysis the risk factors for CIN Logistic regression model.Methods:A total of 156 patients were enrolled in the study.98 cases were male,58 cases were female.All patients received coronary angiography or PCI. Collection all patients'blood and urine before treatment,6 hours,12 hours,24 hours,48-72hour. SCr and Cyst C were tested by enzymic method, calculation of eGFR, plasma and urine NGAL was tested by ELISA. CIN was defined following the traditional criteria. Analysis the plasma and urine NGAL levels of CIN group and non-CIN group. Confirm the correlation between NGAL leve and the incidence of CIN. The area under the receiver operating characteristic (ROC) curve (AUC) was used to estimate diagnostic accuracy and sensitivity of NGAL in CIN. Analysis of risk factors for CIN Logistic regression model.The SPSS 13.0 program was used for statistical analysis. Results:CIN was diagnosed in 15 of 156 (9.6%) patients(CIN group).6h,12h after the use of contrast medium, the level of plasma elevated significantly (P＜0.01).6h, 12h,24h after the use of contrast medium, the level of urine NAGL elevated significantly (P＜0.01, P＜0.05).24h after,the level of Cyst C was elevated significantly (P＜0.05), whereas the differernce of SCr was not significant.6h after the operation, The level of plasma NGAL in CIN group increased significantly compare with non-CIN group (P<0.05).6h,12h,24h after, the level of urine NAGL elevated significantly in CIN group compare with non-CIN group (P<0.01).24h,48-72h after, the level of Cyst C in CIN group was increased significantly than that in non-CIN group.Only 48-72h after the operation SCr in CIN group was increased significantly. ROC analysis confirmed the diagnostic accuracy and sensitivity of NGAL in CIN.6h after, the area under the curve, were (0.745, P<0.01) and (0.842, P<0.01). There was significant correlation between NGAL and SCr in CIN group, as well as between NGAL and Cyst C. Cohort study showed that the cases with significant increment of NGAL after the procedure was more risky to CIN (RR=3.748). Univariate Analysis showed that following variables related to CIN:age>70 years, LVEF levels, LVEF<45%, low Hct, operative time, SCr level, eGFR levels and contrast volume>300ml. Logistic regression analysis showed that following variables remained to be significant factors relating to CIN:age>70 years, LVEF<45%, operative time, SCr level, eGFR levels and contrast volume>300ml. All of them P< 0.001.Conclusion:Serum and urine NGAL could be early biomarkers of CIN compared with SCr, and Cyst C, especially the urine NGAL. Renal insufficiency, elderly (aged>70 years), heart failure (LVEF<45%), operative time, contrast volume (> 300ml) are independent risk factors for CIN.
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