| Background: With the development of imaging technology and interventional therapy,the contrast medium is widely used in clinical diagnosis and treatment.Acute kidney injury caused by contrast medium(CIN)has become the third leading cause of hospital acquired acute renal failure.The occurrence of CIN can not only prolong hospitalization time,but also increase the medical cost,reduce the quality of life and increase the mortality.At present,the serum creatinine concentration is still the most commonly used indicators for the detection of CIN,however the concentration of Scr is affected not only by the renal clearance ability,but also by the drugs and individual differences such as age,gender,body musclemass,blood glucose,and ketone,chronic inflammation,renal reserve function.Patients with good function of reserve,even if there is significant renal damage,due to the compensatory effect,the SCr may be normal or only mildly elevated,so the assessment of renal function levels by Scr may be delayed.Therefore,due to Scr is influenced by many factors,make it lag behind the change of glomerular filtration rate,can not be an ideal,timely indicator to monitor renal function.Studies have shown,Cystatin C(Cys C)produced at a constant rate,don't affected by gender,age,inflammation and so on,and is cleared only through glomerular filtration,it has become an ideal endogenous markers that can reflect the change of GFR.Objective: This study disscuss the relationship between cystatin C and contrast induced nephropathy of post-PCI and glomerular filtration rate,Scr,Ccr by analysis of preoperative cystatin C values and the change of Scr within 48 hours after application of contrast medium.Methods:364 patients who are performed percutaneous coronary intervention(PCI)in catheterization room of cardiology department,the second hospital of Hebei Medical University were enrolled between December 2014 and December 2015.There are 266 males and 98 females.The general situation,past medical history,medication history,preoperative routine examination and other indexes were recorded.According to the level of preoperative cystatin C,patients were divided into two groups.The experimental group: cystatin C >1.03mg/L;control group: cystatin C concentration?1.03mg/L.The patients of two groups were hydrated with 0.9 percent saline intravenously at a rate of 1 ml per kilogram of body weight per hour beginning 4 hours before the scheduled angiography,then started to PCI,and continued to hydrate 24 hours after PCI,and rechecked the patient's renal function at postoperative 48 hours.According to the Modification of Diet in Renal Disease(MDRD)to estimate glomerular filtration rate(GFR),reatinine clearance rate was estimated according to the Cockcroft-Gault formula.The incidence of contrast induced nephropathy was compared between the two groups according to the diagnostic criteria of contrast induced nephropathy.The data was analyzed by SPSS16.0 statistical software.Categorical Continuous variables were expressed as the mean value ± standard deviation(SD)or median(inter-quartile range),categorical 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.The risk factors of C1 N were selected by logistic regression analysis.Two factors were analyzed by correlation analysis.A P value of<0.05 was considered statistically significant.Results: 1 The clinical baseline characteristics such as gender,blood sugar and diabetes were statistically significant(P<0.05).The clinical baseline characteristics such as body weight,body height,age,smoking history,acute myocardial infarction,heart failure,left ventricular size,type of contrast agent,C-reactive protein,ejection fraction,BNP and LVEDP and so on were not significantly different between the high serum Cystatin C group and the low serum Cystatin C group(P>0.05).The clinical baseline characteristics such as body weight,body height,age,gender,smoking history and so on were not significantly different between the CIN group and the non CIN group(P>0.05).The clinical baseline characteristics such as acute myocardial infarction,heart failure,type of contrast agent,C-reactive protein,ejection fraction,left ventricular size,BNP and LVEDP were statistically significant(P<0.05).2 Comparison of the incidence of contrast induced nephyropathy between the high levels Cystatin C group and the low levels cystatin C group.The incidence of CIN is 8.72% in high levels Cystatin C group,the incidence of CIN is 3.645% in low levels cystatin C group,and incidence of CIN in two groups were statistically significant(P<0.05);3 The preoperative,postoperative serum creatinine of high cystatin C group were higher than low cystatin C group in the same time period(P<0.05),preoperative and postoperative creatinine clearance rate and glomerular filtration rate were lower than low cystatin C group in the same period(P<0.05);4 The serum creatinine concentration were higher and creatinine clearance rate,GFR were lower 48 hours later after coronary angiography in the high cystatin C group(P>0.05).The serum creatinine concentration were lower and creatinine clearance rate,GFR were higher 48 hours later after coronary angiography in the low cystatin C group(P>0.05);5 The results of logistic analysis indicated that increased cystatin C is the risk factor of CIN.acute myocardial infarction,CRP,LVEDP were related to the occurrence of CIN;6 Serum CysC before PCI related to GFR(r=-0.271,P<0.01)and serum CysC after PCI related to GFR(r=-0.294,P<0.01).Serum CysC before PCI related to Ccr(r=-0.305,P<0.01)and serum CysC after PCI related to Ccr(r=-0.308,P<0.01).Serum CysC before PCI related to Scr(r=0.229,P<0.01)and serum CysC after PCI related to Scr(r=0.322,P<0.01).Conclusions:1 The level of serum cystatin C is related to CIN,increased cystatin C is an index of risk of CIN.2 The level of serum cystatin C is related to glomerular filtration rate,serum creatinine and creatinine clearance rate. |
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