Monocyte To High-density Lipoprotein Ratio Cannot Predict Contrast-induced Nephropathy In Patients Undergoing Percutaneous Coronary Intervention

Background: Contrast-induced nephropathy is defined as the renal impairment with a 0.5mg/dL increase in serum creatinine level or a 25% increase from baseline 48 or 72 hours after the application of contrast media,excluding other causes.With the development of interventional techniques,the number of patients receiving coronary angiography and percutaneous coronary intervention has been increasing year by year.Meanwhile the incidence of contrast-induced nephropathy also gradually increased,and now CIN has become the third cause of acute renal failure in hospitals.Previous studies have shown that the risk factors of CIN contain the old age,existing renal insufficiency,combined with diabetes,hemodynamic instability,application of nephrotoxic drugs,hypovolemia and so on.The pathophysiological mechanism of CIN is complicated,which mainly includes the myelin hypoxia caused by renal vasoconstriction,generation of reactive oxygen,direct toxicity of contrast agent to renal tubules,inflammation and other aspects.The involvement of inflammatory cells and cytokines is one of the important pathogenesis of CIN.Monocyte to high-density lipoprotein ratio(MHR)which can better reflect the inflammatory state,is a new type of marker found in recent years.However,there are few studies on the correlation between preoperative MHR and CIN after percutaneous coronary intervention(PCI),and the relationship between them is still unclear.Objective:To investigate the correlation between preoperative monocytes to high-density lipoprotein cholesterol ratio(MHR)and contrast-induced nephropathy(CIN)after percutaneous coronary intervention(PCI).To look for other possible risk factors for the occurrence of CIN,which may provide a new direction for CIN screening high-risk groups as early as possible.Methods:A total of 1087 patients(773 males and 314 females)with coronary heart disease who underwent percutaneous coronary intervention in our hospital from November 2014 to March 2017.General information,current medical history,past medical history,history of medication and allergy of all the selected patients were recorded.And the routine preoperative examinations such as blood examination and renal function examination were improved.The routine time of blood collection was the second day without eating,and the emergency laboratory Beckman type blood cell analyzer was used.All patients were given 500 ml 0.9% sodium chloride injection with continuous intravenous infusion at a rate of 1ml/kg/h beginning 4 hours before surgery,then performed the PCI,followed by continuous hydration in accordance with the above method for 24 hour,and then intravenous injection of furosemide 20 mg.Renal function and other indicators were detected 48 hours after surgery.According the diagnostic criteria of CINI,patients were divided into CIN group(57 cases)and non-CIN group(1030 cases).Compare the clinical baseline data between the two groups,and to study the related risk factors of CIN and the correlation between MHR and contrast-induced nephropathy.To the end,Logistic regression analysis and Spearman correlation analysis were applied to observe whether MHR was a risk factor for CIN.P < 0.05 was considered statistically significant.Data analysis using SPSS 19.0 statistical software.Categorical Continuous variables were expressed as the mean value ±standard debiation(SD)or median(inter-quartile range):ategorical variables were summarized as percentages.The two samples were compared by t test or rank-sum test.The incidence of CIN was compared by the chi-square test or Fisher test.Using the logistic regression to analyze the risk factors that may be related to CIN(P < 0.05).Results:1.There were 57 patients in CIN group and 1030 patients in non-CIN group.There is no statistical significance in gender,height,weight,MHR,fasting blood glucose,total cholesterol,albumin,glycosylated hemoglobin,blood urea nitrogen,smoking history,history of hypertension and diabetes in CIN group and non-CIN group(P > 0.05).Meanwhile there is statistically significant differences in hyperlipidemia,BMI,left ventricular ejection fraction(LVEF),preoperative uric acid and preoperative C-reactive protein levels.(P < 0.05).2.Logistic regression analysis:the left ventricular ejection fraction and diabetes are correlated with the incidence of CIN.Conclusions:Different from the previous studies,MHR cannot be considered as a risk factor for CIN,but the left ventricular ejection fraction may have higher predictive value for CIN.