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目的探讨血清半胱氨酸蛋白酶抑制剂C(CyC)在早期诊断对比剂急性肾损害(CIAKI)方面的价值及普罗布考预防急诊PCI术后对比剂急性肾损害的作用。方法本项前瞻性、随机化临床试验共纳入204例因急性冠状动脉综合征接受急诊PCI术的患者(其中普罗布考组96例,对照组108例)。在术前及术后1、2、3天分别取血测定CyC及血清肌酐(Scr)水平。结果以术后CyC增高大于或等于10%作为早期诊断CIAKI的切线值,其敏感性为96.3%,特异性为67.23%;阴性预测值为100%,阳性预测值为30.32%。以Scr为测定值的CIAKI的发生率是13.24%,其中普罗布考组4.17%,对照组21.30%(χ2=11.53,P<0.001)。以CyC为测定值的CIAKI的发生率是41.18%,其中普罗布考组29.16%,对照组51.85%(χ2=10.79,P<0.001)。结论 CyC是早期排除CIAKI的可靠指标。在急诊PCI治疗术的患者,围手术期预防性使用普罗布考能降低CIAKI发生的风险。
Objective To investigate the value of serum cystatin C (CyC) in the early diagnosis of contrast-induced acute kidney injury (CIAKI) and the effect of probucol on acute contrast-induced acute kidney injury after PCI. Methods This prospective, randomized clinical trial included 204 consecutive patients undergoing primary PCI with acute coronary syndrome (96 in the probucol group and 108 in the control group). The levels of CyC and serum creatinine (Scr) were determined before operation and 1,2,3 days after operation. Results The postoperative CyC increased 10% or more as the initial diagnosis of CIAKI tangent value, the sensitivity was 96.3%, the specificity was 67.23%; the negative predictive value was 100% and the positive predictive value was 30.32%. The incidence of CIAKI with Scr as a measure was 13.24%, with 4.17% in probucol group and 21.30% in control group (χ2 = 11.53, P <0.001). The incidence of CIAKI measured with CyC was 41.18%, with 29.16% in probucol group and 51.85% in control group (χ2 = 10.79, P <0.001). Conclusion CyC is a reliable indicator of CIAKI early exclusion. Perioperative prophylaxis with probucol reduces the risk of CIAKI in patients undergoing emergency PCI.