| Objective: To explore the correlation between NT-proBNP and contrast-induced nephropathy(CIN)in patients with coronary atherosclerotic heart disease(CHD)and diabetes,and to provide evidence for the preoperative prevention of CIN.Methods: From January 2018 to October 2020,the patients who underwent coronary arteriography(CAG)in the Affiliated Hospital of Northwest University for Nationalities due to chest pain,chest tightness,shortness of breath,and other symptoms of myocardial ischemia were observed.A total of 144 patients with preoperative measurement of NTproBNP,coronary heart disease combined with diabetes,and other common CIN-inducing factors were excluded.Thirty-two patients whose creatinine increased by more than 5 mg/L(44.2 μmol/L)from baseline or 25% from the preoperative baseline value within 48-72 hours after CAG were classified as CIN group and 112 patients who did not reach the diagnostic index of CIN served as a control group.The general information,left ventricular ejection fraction(LVEF),number of stents,number of lesions,operation time,and laboratory test indicators of the two groups after admission were compared: NT-proBNP,white blood cell count,hemoglobin,serum albumin,blood creatinine,Whether the differences in urea,uric acid,cystatin C,triglycerides,blood cholesterol,low-density lipoprotein,creatine kinase isoenzyme,troponin I,and c-reactive protein are significant.The data was a single-factor analysis,ROC curve was drawn to explore the sensitivity and specificity of NT-proBNP in predicting the occurrence of CIN and to provide cut-off values.The influencing factors of CIN were further studied by multivariate Logistic regression.Results: 1.Compared with the control group,the gender,hyperlipidemia,smoking,drinking,preoperative ACEI/ARB medication,preoperative β-blocker medication,preoperative diuretic medication,preoperative aspirin medication,Preoperative clopidogrel medication,preoperative ticagrelor medication,preoperative statin medication,preoperative heparin medication,diastolic blood pressure,number of implanted stents,whether it is reimaging,operation time,white blood cells,hemoglobin,fibrinogen,Preoperative blood creatinine,preoperative urea nitrogen,preoperative uric acid,triglycerides,cholesterol,lowdensity lipid,creatine kinase isoenzyme and troponin I were not statistically significant(P>0.05).2.The difference between the CIN group,age,hypertension,systolic blood pressure,left ventricular ejection fraction,preoperative calcium channel antagonist medication,cardiac function exceeding grade III,coronary artery disease,serum albumin,preoperative cystatin C,c reactive protein,and preoperative NT-proBNP was statistically significant(P<0.05).Among them,age,hypertension,systolic blood pressure,preoperative calcium channel antagonist medication,heart function above grade III,coronary artery disease,preoperative cystatin C,c-reactive protein,and preoperative NT-proBNP levels are generally higher than the control group.The left ventricular ejection fraction and blood albumin in the CIN group were generally lower than those in the control group.3.The ROC curve was drawn for NTproBNP,and the area under the curve was 0.735(P=0.000<0.05).NT-proBNP is statistically significant in predicting the occurrence of CIN in CHD patients with diabetes.The calculated maximum Youden index is 0.477,the corresponding cut-off value is 335.4pg/ml,the sensitivity is 78.10%,and the specificity is 69.60%.4.Performing binary logistic regression showed that age ≥ 70 and preoperative NT-proBNP were independent risk factors for predicting CIN(P-value <0.05).Both OR values are greater than 1,and the 95% CI does not exceed 1.Conclusion: 1.There is a significant correlation between the level of NT proBNP and the occurrence of CIN in patients with coronary heart disease and diabetes mellitus after intervention.NT proBNP is an independent risk factor for the occurrence of CIN in patients with coronary heart disease and diabetes mellitus after intervention.The higher the level of NT proBNP before intervention,the higher the incidence of CIN.2.NT proBNP ≥335.4pg/ml is of medium diagnostic value in the diagnosis of CIN in patients with coronary heart disease and diabetes mellitus after PCI. |
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