| Background: with the increasing use of contrast media in the field of interventional and medical imaging,the incidence of contrast induced nephropathy(CIN)is also increasing.The renal injury caused by contrast media has brought greater economic burden to patients.Therefore,early identification of high-risk groups and targeted to take preventive measures have become the focus of attention of the majority of medical workers.Today,the serum creatinine(Cr)is still as the main reference index for the clinical diagnosis of CIN.At present,the pathogenesis of CIN is not yet clear,but there are reports that inflammation is an important part of its pathogenesis,C reactive protein(CRP)and procalcitonin(PCT)are inflammatory markers.Domestic and foreign scholars have found that CRP and PCT are independent risk factors of CIN,which has a high clinical value for the early identification of CIN.Objective:This study was to investigate the correlation between the level of CRP and PCT before operation and the incidence of CIN,and further study whether the combination of CRP and PCT has a higher predictive value for the onset of CIN.Methods:A total of 350 consecutive patients undergoing percutaneous coronary intervention(PCI)in our hospital from January 2016 to December 2016 were enrolled in this study.Among them,251 were male and female were 99.The age ranged from 27 to 77 years.The data of the patients were collected before the operation,such as the renal function,CRP,PCT and so on.4 hours before surgery,all patients were given 500 ml saline at the rate of 1ml/kg.h continuous intravenous hydration,and then PCI.Continue to give 1500 ml saline hydration 24 hours according to the above speed after surgery,then intravenous injection of furosemide 20 mg.Renal function was measured at 48 hours after operation.According to the definition of CIN,the patients were divided into CIN group(n = 28)and non CIN group(n = 321)?To study the statistical difference between the two groups of CRP,PCT and other indicators.The median CRP and PCT were 2.1mg/L and 98.05pg/m L,respectively.CRP and PCT were combined as an inflammatory index and further divided into 3 groups According to CRP < 2.1,PCT < 98.05;CRP ?2.1,PCT < 98.05 or CRP < 2.1,PCT ? 98.05;CRP ? 2.1,PCT ?98.05.To study the significant difference in the incidence of CIN among the 3 groups.Results:1 The inflammation index baseline data of the 3 groups in gender,age,weight,height,smoking history,diabetes,hyperlipidemia,ACEI or ARB,statins,multivessel disease,contrast agent dose,ejection fraction,left ventricular size,hemoglobin,Cystatin C,blood glucose,total cholesterol,the same homocysteine and albumin have no significant difference(P>0.05).There are significant differences in hypertension,acute myocardial infarction,contrast agent type,e/E ',serum BNP and so on(P<0.05)(Table1).The baseline data of CIN group and non CIN group in gender,age,weight,height,smoking history,hypertension,diabetes,hyperlipidemia,ACEI or ARB,statins,multivessel disease,contrast agent dose,ejection fraction,e/E,CRP,blood red eggs white,Cystatin C,total cholesterol,homocysteine,albumin,have no significant difference(P>0.05).There are significant differences in acute myocardial infarction,fasting blood glucose,contrast agent type,left ventricular size,PCT,serum BNP and so on(P<0.05)(Table2).2 According to CRP < 2.1mg/L and CRP ?2.1 mg/L were divided into two groups,according to PCT < 98.05pg/m L and PCT? 98.05 pg/m L were divided into two groups.The incidence of CIN between the two groups was statistically significant(P<0.05)(Table2).The incidence of CIN in the three groups was 1.1%,8.5%,and 13.5%,respectively.There was significant difference between the three groups(P<0.05)(Table3).3 ROC curve analysis,The area of ROC curve of PCT was 0.665,the sensitivity was 71.4% and the specificity was 59.3%(95% CI:0.573-0.756,P=0.004)when the diagnostic critical value was about 126.66 pg/m L.The area of ROC curve of CRP was 0.608,and the sensitivity was 28.6% and the specificity was 85.1%(95%CI:0.490-0.7274,P=0.057)when the diagnostic critical value was about 8.850 mg/L.Considering the small number of participants,CRP showed only a tendency to predict CIN,with no statistical difference.CRP and PCT were combined as a joint predictor of Combination with a combined diagnostic test.The area of ROC curve of Combination was 0.674,the sensitivity was 82.1% and the specificity was 52.8%(95% CI: 0.585-0.763,P=0.002)when the diagnostic critical value was about 109.04(Table4,Fig1).4 Logistic regression analysis: The high preoperative BNP and the high inflammatory index were risk factors of CIN,and the incidence of CIN when BNP and inflammatory index both elevated was higher than that when only one of them elevated.The OR was 2.405,95.0%CI[1.325,4.367](Table5).Conclusion: Elevated PCT and CRP were risk factors for the incidence of CIN,combination of which had higher predictive value for the incidence of CIN. |
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