冠心病合并糖尿病和(或)高血压患者经皮冠状动脉介入治疗前后胱抑素C水平临床观察

Objective To evaluate the changes of cystatin C(CysC)levels before and after percutaneous coronary intervention(PCI)in the patients with coronary heart disease(CHD)complicating diabetes and/or hypertension, to analyze the critical value of CysC for diagnosing contrast-induced nephropathy(CIN)in CHD complicating diabetic and hypertension and to evaluate the consistency of CysC and creatinine for diagnosing CIN.Methods A total of 227 patients with CHD complicating diabetes and/or hypertension in this hospital from October 2016 to May 2018 were selected and divided into the simple CHD group(52 cases), CHD complicating hypertension group(74 cases), CHD complicating diabetes group(51 cases)and CHD complicating diabetes and hypertension group(50 cases).The serum CysC level and creatinine level before PCI and at 72 hafter PCI were recorded in each group.Then the changes of CysC level before and after PCI were statistically analyzed in each group.The incidences of CIN was calculated and evaluated in each group.The critical value of CysC for diagnosing CIN in the patients with CHD complicating diabetic and hypertension was calculated.The consistency between CysC and creatinine for diagnosing CIN was evaluated.Results The CysC level in the CHD complicating diabetes and hypertension group was the highest before and after PCI, then followed in turn by the CHD complicating diabetes group, CHD complicating hypertension group and simple CHD group(P<0.05), the CysC level in each group had statistical difference between before and after PCI(P<0.05);the CysC level after PCI in each group had statistical difference compared with that before PCI in the same group(P<0.05). The CIN occurrence rate had statistical difference among 4 groups(P<0.05).The consistency between CysC and creatinine for diagnosing CIN in CHD complicating diabetes and hypertension was general(κ=0.592, P=0.001), the CysC level after PCI was increased by 28.59% compared with before PCI, which could diagnose CIN, the maximal area under ROC curve was 92.50%, the sensitivity was 90.00% and the specificity was 82.50%.Conclusion The levels of CysC in the patients with CHD complicating diabetes and/or hypertension are different before and after PCI, the CysC level is the highest in the patients with CHD complicating diabetes and hypertension.The CIN occurrence rates are different in the patients with CHD complicating diabetes and/or hypertension, which is the highest in the patients with CHD complicating diabetes and hypertension(reaching 20.00%).CysC has a higher diagnostic value for CIN. [ABSTRACT FROM AUTHOR]