Diagnostic Value Of Early Acute Renal Injury Indicators In Contrast-induced Renal Injury

Objective:To analyze the clinical significance of combined detection of cystatin C?CysC?,?₂-microglobulin??₂-MG?,retinol binding protein?RBP?,N-acetyl-beta-D aminoglycosidase?NAG?,?1-microglobulin??1-MG?and urinary microalbumin?mALB?in early diagnosis of contrast agent renal injury.Methods:From May 2018 to November 2018,60 patients with coronary heart disease who underwent selective coronary angiography and PCI in Chest Pain Ward of Affiliated Hospital of Inner Mongolia Medical University were selected.60 patients refused operation because of patients and other related factors and received conservative treatment.Blood?CysC,RBP,?₂-MG?,urine?NAG,a1-MG,mALB?were measured before and 24 and 48hours after operation.According to whether or not to use contrast medium,they were divided into contrast medium group and non-contrast medium group.1.CysC,RBP,?₂-MG,NAG,a1-MG and mALB were compared and analyzed before,24 and 48hours after the use of contrast medium and non-contrast medium respectively.Independent sample t test was used for comparison between groups,and paired sample t test was used for comparison within groups.2.In order to further analyze the combined diagnostic ability of six indicators for renal injury,receiver operating curve?ROC?was used for further analysis.Regarding the use of contrast medium as dependent variable and CysC,RBP,?₂-MG,NAG,a1-MG and mALB as independent variables,a logistic regression model was established.Based on the regression,the predictive probability was calculated.From this,ROC curves for joint diagnosis of six indexes could be drawn,and then the ability of each index to predict renal injury independently and jointly was compared.Result:1.There were no significant differences in CysC,RBP,?₂-MG,NAG,a1-MG and mALB values between the contrast group and the non-contrast group before the use of contrast medium.There were significant differences in?₂-MG,NAG,a1-MG and mALB values between the contrast medium group and the non-contrast medium group after the use of contrast medium,but there were no significant differences in CysC and RBP.2.The AUCs of CysC,RBP,?₂-MG,NAG,a1-MG and mALB were 0.424,0.594,0.951,0.953,0.599and 0.575 24 hours after using contrast medium.The sensitivity was 0.200,0.550,0.850,0.850,0.400,0.450,and the specificity was 0.933,0.617,0.950,0,0.933 and0.833,respectively.3.The AUCs of CysC,RBP,?₂-MG,NAG,a1-MG and mALB were 0.424,0.593,0.943,0.950,0.601 and 0.572 48 hours after using contrast medium.The sensitivity was 0.233,0.533,0.883,0.883,0.400,0.367,and the specificity was 0.900,0.700,0.933,0.917,0.917 and 0.933,respectively.4.AUC was0.985,sensitivity was 0.967,specificity was 0.917,and AUC was 0.974,sensitivity was 0.867,specificity was 0.917 24 hours after using contrast medium,and AUC was0.974 48 hours after using contrast medium for combined diagnosis of CysC,RBP,?₂-MG,NAG,a1-MG and mALB.Conclusion:?1?There were significant differences in?₂-MG,NAG,a1-MG and mALB after using contrast medium and compared with non-contrast medium group,but there were no significant differences in CysC and RBP.?2?At 24h and 48h after using contrast medium,the two indices of?₂-MG and NAG alone and in combination can predict renal injury,while the four indices of CysC,RBP,a1-MG and mALB alone can not predict renal injury.?3?The combined diagnostic effect of the above six indicators is better than that of the single use of contrast medium in the early stage of renal injury,and the combined diagnostic effect of 24 hours is better than that of 48 hours.