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目的试验旨在检测Fg(Fibrinogen,纤维蛋白原)含量在造影剂暴露患者尿液中的变化,评估其对造影剂肾病的早期诊断价值,并分析造影剂肾病的影响因素。方法采用前瞻性研究方法收集100名山西医科大学第二医院因治疗需要应用造影剂患者的临床资料,酶联免疫吸附测定法(ELISA)检测每位入组患者暴露于造影剂前2小时、暴露于造影剂后2、12、24小时尿液中Fg含量。全自动生化分析仪检测患者暴露于造影剂前24小时以及暴露于造影剂48小时后血肌酐(Serum creatinine,SCr),按照术后是否发生造影剂肾病(Contrast-induced nephropathy,CIN)分为CIN组和非CIN组。按照需要使用单因素方差分析、Pearson卡方检验、Fisher确切概率法、Pearson相关、Spearman相关、受试者工作特征曲线(receiver operating characteristic curve,ROC)等方法进行统计学分析。结果 100例入组患者中有6例发生造影剂肾病,发病率6%。整体样本尿Fg含量暴露后2小时开始升高(P<0.05)12小时达高峰(P<0.05),24小时后降至基线水平(P<0.05)。在暴露后12、24小时,CIN组尿Fg含量显著性高于非CIN组(P<0.05),尿Fg含量均与SCr水平正相关(r=0.245,P=0.017;r=0.241,P=0.019)。ROC曲线分析显示,暴露后12小时尿Fg的曲线下面积为0.739,取截断点为12.16 ng/ml时诊断造影剂肾病的敏感性和特异性分别为66.7%和73.4%。肾功能不全(χ2=14.93,P<0.05)、高脂血症(χ2=3.04,P<0.05)、感染(χ2=4.54,P<0.05)、年龄≥70岁(χ2=3.13,P<0.05),造影剂剂量150~300 ml(χ2=5.42,P<0.05)为造影剂肾病的危险因素。结论尿Fg最早可暴露于造影剂后2小时出现升高,可能作为早期造影剂肾损伤的生物标志物。肾功能不全、高脂血症、伴发感染、年龄>70岁患者使用造影剂以及造影剂剂量≥150 ml时应该注意造影剂肾病的发生。
Objective The purpose of the experiment was to detect the changes of Fg (Fibrinogen) in the urine of contrast-exposed patients and to evaluate the early diagnostic value of contrast agent nephropathy and to analyze the influencing factors of contrast agent nephropathy. Method prospective study of Shanxi Medical collector 100 due to the second hospital clinical needs of the patient a contrast agent data applications, patient ELISA assay (ELISA) detection of each group was exposed to the contrast medium 2 hours before exposure Urine Fg content 2, 12, 24 hours after contrast agent. Serum creatinine (SCr) was measured 24 hours before exposure to contrast medium and 48 hours after exposure to contrast medium according to the automatic biochemical analyzer. According to the occurrence of Contrast-induced nephropathy (CIN) after surgery, the patients were divided into CIN Group and non-CIN group. One-way ANOVA, Pearson chi-square test, Fisher exact test, Pearson correlation, Spearman correlation and receiver operating characteristic curve (ROC) were used for statistical analysis as needed. Results 100 of the enrolled patients, 6 cases of contrast agent nephropathy occurred, the incidence of 6%. Urine Fg content in whole samples began to increase 2 hours after exposure (P <0.05), reached the peak at 12 hours (P <0.05), and dropped to baseline after 24 hours (P <0.05). At 12 and 24 hours after exposure, the urinary Fg content in CIN group was significantly higher than that in non-CIN group (P <0.05), while the urine Fg content was positively correlated with SCr level (r = 0.245, P = 0.017; 0.019). ROC curve analysis showed that the area under the curve of urinary Fg at 12 hours after exposure was 0.739, and the sensitivity and specificity for diagnosing contrast agent nephropathy with a cut-off point of 12.16 ng / ml were 66.7% and 73.4%, respectively. (Χ2 = 3.43, P <0.05), hyperlipemia (χ2 = 3.04, P <0.05), infection (χ2 = 4.54, ), Contrast agent dose 150 ~ 300 ml (χ2 = 5.42, P <0.05) as risk factors for contrast agent nephropathy. Conclusions Urinary Fg may appear as early as 2 hours after exposure to contrast agent and may serve as a biomarker of early contrast agent renal injury. Renal insufficiency, hyperlipidemia, associated with infection, age> 70 years of age patients with contrast medium and contrast agent dosage ≥ 150 ml should pay attention to the occurrence of contrast agent nephropathy.