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纤维蛋白原联合CHA2DS2-VASc评分对ACS患者PCI术后对比剂急性肾损伤的预测价值

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摘要:

目的 探讨急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术后对比剂急
性肾损伤(CI-AKI)的发生率与纤维蛋白原(FIB)水平和CHA2DS2-VASc评分的关系,并进一步比
较FIB、CHA2DS2-VASc评分以及两者联合对CI-AKI的预测价值。方法 回顾性分析 2018年12月至2021
年1月因ACS就诊并行PCI的934例患者的临床资料,计算入院CHA2DS2-VASc评分。按照术后肌酐变化
情况将所有患者分为CI-AKI组及非CI-AKI组,比较两组之间的基线资料。Spearman相关分析评估FIB
和CHA2DS2-VASc评分的相关性。绘制ROC曲线以评价FIB、CHA2DS2-VASc评分及两者联合水平对PCI
术后CI-AKI的预测价值,并采用Logistic回归分析ACS患者PCI术后CI-AKI的影响因素。结果 高FIB、
高CHA2DS2-VASc评分的患者术后具有更高的CI-AKI发生率。相关性分析显示FIB和CHA2DS2-VASc评
分呈正相关(R=0.236,P<0.001)。两者联合预测ACS患者PCI术后CI-AKI的ROC曲线下面积为0.727
(95%CI:0.697~0.755,P<0.001),敏感度为63.3%,特异性为72.6%。以FIB、CHA2DS2-VASc评
分预测ACS患者发生CI-AKI的截断值将934例ACS患者分为低危组(404例)、中危组(383例)和高
危组(147例),多因素Logistic回归分析结果显示,白蛋白水平(OR=0.913,95%CI:0.867~0.962,
P=0.001)、FIB水平(OR=1.451,95%CI:1.185~1.777,P<0.001)、CHA2DS2-VASc评分(OR=1.271,
95%CI:1.504~1.780,P<0.001)是ACS患者PCI术后CI-AKI的独立影响因素(P<0.05)。结论 术前纤
维蛋白原水平与CHA2DS2-VASc评分对PCI术后发生CI-AKI具有一定的预测价值,两者联合能提高ACS患
者PCI术后CI-AKI发生预测的准确性。

Abstract:

Objective To investigate the relationship between the incidence of contrast-induced acute kidney injury (CI-AKI) and the level of fibrinogen (FIB) and CHA2DS2-VASc scores in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), and to further compare the predictive value of FIB, CHA2DS2-VASc scores and their combination for CI-AKI. Methods The clinical and laboratory data of 934 ACS patients who underwent PCI in our hospital from December 2018 to January 2021 were retrospectively analyzed, and CHA2DS2-VASc scores were calculated. According to postoperative creatinine changes, all patients were divided into CI-AKI and non-CI-AKI groups, and baseline information was compared between the two groups. The correlation between FIB and CHA2DS2-VASc scores was assessed by Spearman correlation analysis. ROC curves were plotted to evaluate the predictive value of FIB, CHA2DS2-VASc scores, and their combined levels on CI-AKI, and logistic regression analysis was used to study the risk factors of CI-AKI in patients with ACS after PCI. Results Patients with high FIB and high CHA2DS2-VASc scores had a higher incidence of CI-AKI after PCI. Correlation analysis showed that FIB and CHA2DS2-VASc scores were positively correlated (R=0.236, P<0.001). The combined prediction of the area under the ROC curve of CI-AKI after PCI in ACS patients was 0.727 (95%CI: 0.697~0.755, P<0.001), the sensitivity was 63.3%, and the specificity was 72.6%. The cut-off values of FIB and CHA2DS2-VASc scores to predict the occurrence of CI-AKI in ACS patients divided 934 ACS patients into low-risk (404 cases), mediumrisk (383 cases), and high-risk groups (147 cases). Multivariate logistic regression analysis showed that albumin level (OR=0.913, 95%CI: 0.867~0.962, P=0.001), FIB level (OR=1.451, 95%CI: 1.185~1.777, P<0.001), CHA2DS2-VASc score (OR=1.271,95%CI: 1.504~1.780, P<0.001) were independent influences on CI-AKI after PCI in patients with ACS, P<0.05). Conclusion The preoperative fibrinogen level and CHA2DS2-VASc score have certain predictive value for the occurrence of CI-AKI after interventional diagnosis and treatment. The combination of the two can improve the accuracy of the prediction of CI-AKI after PCI in ACS patients.

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