UNGAL For Early Diagnosis Of Contrast-induced Nephropathy After Percutaneous Coronary Intervention In Elderly Patients With Coronary Heart Disease

Objective:To investigate the early diagnostic value of urinary neutrophil gelatinase-associated lipocal(uNGAL)in elderly patients of Coronary heart disease(CHD)with contrast-induced nephropathy(CIN)after percutaneous coronary intervention.Methods:1 A prospective study was conducted in a total of 348 patients with coronary artery disease who underwent elective coronary angiography and PCI in First Hospital of Hebei Medical University from June 2017 to January 2019.The general condition of the selected patients was recorded,and the preoperative routine examination was completed.The leves of uNGAL and SCr of selected patients were assessed before surgery and 4 and 24 hours after surgery.According to whether CIN occurred after operation,the patients were divided into CIN group and non-CIN group and the clinical data between the two groups were compared.According to the age group of the World Health Organization,the patients were divided into the elderly group(?60 years old)and the young and middle-aged group(<60 years old).The basic clinical data and the incidence rate were compared between the two groups.The predictive function of uNGAL on the two groups was observed.2 Statistical analysis of data was performed using SPSS 21.0 data software.The measurement data subject to the normal distribution is expressed as mean±standard deviation(sx ±),and the measurement data that does not obey the normal distribution is expressed by the median(interquartile range),ie,M(QR).At test or a rank sum test was used between the two groups of measurement data.The count data was compared using a chi-square test.Correlation tests between CIN and related risk factors were performed using Spearman or Pearson.Risk factors analysis of CIN using logistic regression analysis.The subject operating characteristic curve(ROC)is depicted,the area under the curve(AUC)is calculated,and the sensitivity and specificity of the uNGAL diagnostic CIN are analyzed.P<0.05 was considered statistically significant.Results:1 The study included 348 patients,of whom 58 had CIN in the CIN group and the remaining 290 in the non-CIN group.There were significant differences in age,smoking history and diabetes history,eGFR,Merhan score(?6),number of stents(?1),and contrast agent dose in the CIN group and non-CIN group(P<0.05).The age,diabetes history,Merhan score,number of stents(?1),and contrast dose were higher in the CIN group than in the non-CIN group.2 There were 148 patients in the subgroup of the elderly,34 patients in the CIN group,and 114 patients in the non-CIN group.There were 200 young and middle-aged groups,24 patients in the CIN group,and 176 patients in the non-CIN group.Differences in body mass index(BMI),hemoglobin,homocysteine,Merhan score,eGFR,diseased blood vessels,combined smoking history,and drinking history in the elderly and middle-aged groups.All were statistically significant(P <0.05).3 In the elderly patients,the SCr levels in the CIN group and the non-CIN group were statistically significant(P<0.05)at 24 hours after surgery,there was a statistically significant difference in SCr levels between the 24 hours after surgery and the preoperative results of the same group(P<0.05).The levels of uNGAL in the two groups were statistically different at 4 hours and 24 hours after operation(P<0.05),but the levels of uNGAL in the 4 hours and 24 hours after surgery were different from those in the same group(P<0.05).The SCr levels in the young and middle-aged group were significantly different between the CIN group and the non-CIN groups at 24 hours after surgery(P<0.05),there was a statistically significant difference in SCr levels between the 24 hours after surgery and the preoperative results in the CIN group(P<0.05).There was a statistically significant difference in uNGAL levels between the two groups at 24 hours postoperatively(P<0.05),there was a statistically significant difference in uNGAL levels 24 hours after surgery compared with the preoperative results of the same group(P<0.05).4 According to relevant analysis,the incidence of eGFR and CIN in the subgroup of elderly patients is negatively correlated(r=-0.329,P<0.001).While diabetes,homocysteine,number of stents,contrast dose,Merhan score,the 4 and 24 hours postoperative uNGAL level,24 hours postoperative SCr level were positively correlated with CIN in the elderly group(P<0.05).Logistic regression analysis showed that the level of eGFR was associated with the onset of CIN and was an independent risk factor for CIN.5 From the ROC curve,the area under the curve of uNGAL diagnosis of CIN at 4 hours after surgery was 0.658,while the cutoff value was 47.50(ng/ml),the sensitivity was 0.661,and the specificity was 0.686.Conclusion:The increase of uNGAL level early after percutaneous coronary intervention has high sensitivity and specificity for the diagnosis of early contrast nephropathy in elderly patients with CHD,and can be used as a reference index for early diagnosis of CIN.