The Effect Of Abnormal Glucose Metabolism On The Contrast-induced Nephropathy And The Monitor Value Of Cystatin C On It

Objective: To compare the characteristics of different glucose metabolism on the contrast-induced nephropathy (CIN) following CAG/PCI and determine the related risk factors. Meanwhile, to discuss the monitor value of Cys-C on CIN for the clinical treatment reference.Methods:Patients who were planned to perform CAG/PCI were selected from Dec. 2008 in the first affiliated hospital of Jinan University. Then OGTT was done for clarifying different glucose metabolism. Data was collected and morbility of CIN was compared. Related risk factors were analyzed with logistic regression analysis and ROC curve was gotten for the relationship between Scr and Cys-C. The monitor value of Scr and Cys-c on CIN was compared.Results:1 Abnormal glucose metabolism in patients performed CAG/PCI accounts for 51.3%. Among them, IGT accounts for 25.6% and diabetes accounts for 25.6%. 2 Total morbility of CIN is 18.9%.36% in patients of repeated expose is higher significantly than 16.5% in patients of one expose. The CIN morbility of nomal group, IGT group and DM group is 9.5%,22.0%,34.0% separately. The CIN morbility in last two group is higher than that in the first group.3 The CIN morbility in patients who have renal or cardiac dysfunction before CAG/PCI is 60.0% and 57.0% separately. The CIN morbility in patients who suffered from both renal or cardiac dysfunction is higher (57.1% vs.23.5%, P=0.016; 60% vs.26.3%, P=0.048). The CIN morbility in patients has different DM history duration (<8ys,<16ys,≥16ys) is 16.7%,30.8%,58.8% separately (P=0.031). The CIN morbility increased with the DM duration.5 Logistic regression analysis shows renal dysfunction, DM, cardiac dysfunction, high volume of contrast medium and repeated expose are related risk factors of CIN in patients with CAG/PCI.6 In DM subgroup, duration of DM is another important risk factor.7 Linear correlation analysis shows Cys-C is positive correlation with Scr (r=0.721). ROC curve shows area under the curve of Cys-C and Scr is 0.857 and 0.740 separately.8 The CIN morbility in patients 24 hs,48hs and 72hs post CAG/PCI are 15.9%,25.0%,8.5% separately (P=0.045). Morbility is highest in 48hs.Conclusions:Abnormal glucose metabolism in patients performed CAG/PCI is high. Among them, the CIN morbility in IGT and DM group are higher. The CIN morbility increased with the DM duration in DM group and it is shows that duration of DM is another important risk factor of CIN. The CIN morbility in patients who suffered from renal or cardiac dysfunction before CAG/PCI is higher. Renal dysfunction, DM, cardiac dysfunction, high volume of contrast medium and repeated expose are related risk factors of CIN in patients with CAG/PCI. Cys-C is positive correlation with Scr. While Cys-C is more sensitive than Scr for determine the renal function changes and it is more reliable to forecast the risk of occurrence of CIN.