Klotho蛋白对冠心病患者对比剂肾病的早期诊断研究Study of Klotho protein on early diagnosis of contrast nephropathy in patients with coronary heart disease
徐玉顺,郑丹,蔡海鹏,林祖近
摘要(Abstract)：
目的探讨Klotho蛋白对冠心病患者冠状动脉造影及经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的早期诊断价值。方法选取行冠状动脉造影及PCI的冠心病患者365例。于术前、术后6 h及24 h检测Klotho蛋白及血清肌酐(SCr)水平,根据术后是否发生CIN将患者分为CIN组和非CIN组,比较两组患者的基本临床资料与PCI资料。用ELISA法检测两组Klotho蛋白水平,并检测SCr水平,应用Person相关分析法分析两者相关性。结果 CIN组与非CIN组SCr水平在术后24 h差异有统计学意义(P=0.003),Klotho蛋白水平在术后6 h及24 h均差异有统计学意义(P=0.004,P<0.001);术后6 h、24 h CIN组Klotho蛋白水平较术前明显下降,差异有统计学意义(P=0.038,P=0.013)。CIN组术后24 h SCr水平与术前相比差异有统计学意义(P=0.029)。术后6 h、术后24 h Klotho蛋白与CIN的发病呈负相关(r=–0.332,P=0.004;r=–0.261,P<0.001),术后24 h SCr与CIN呈正相关(r=0.229,P<0.001)。SCr(OR 5.444,P=0.035)、Klotho蛋白(OR 5.833,P=0.031)为CIN发生的独立危险因素。Klotho蛋白曲线下面积(AUC)为0.714,SCr的AUC为0.686,联合诊断的AUC为0.823,有一定的诊断价值。结论冠心病CIN患者血清Klotho蛋白明显下降,对CIN早期诊断具有一定的临床参考价值。
关键词(KeyWords)： Klotho蛋白;急性肾损伤;对比剂肾病;经皮冠状动脉介入治疗;冠心病
基金项目(Foundation):
作者(Author): 徐玉顺,郑丹,蔡海鹏,林祖近
参考文献(References)：
- [1]陈小萍，甯超学，邓珏琳，等. Klotho基因多态性与冠心病及海南长寿人群的相关性研究.广东医学，2017,38(19):3001-3004,3010.
- [2] Kyeong HY,Yun KH. Contrast-induced acute kidney injury and inflammation. Korean Circ J, 2018, 48(1):84-85.
- [3]蔡梦云，杨希立，岑锦明，等. Klotho G-395A基因多态性与冠心病遗传易感性的关系.广东医学，2013,34(12):1832-1835.
- [4] Golembiewska E, Safranow K,Kabat-Koperska J,et al. Serum soluble Klotho protein level is associated with residual diuresis in incident peritoneal dialysis patients. Acta Biochim Pol,2013,60(2):191-194.
- [5]邹古明，颜红兵.对比剂肾病的诊断与治疗现状.中国介入心脏病学杂志，2005,13(3):194-196.
- [6] Dorval J, Dixon SR, Zelman RB,et al. Feasibility study of the Renal Guard balanced hydration system:a novel strategy for the prevention of contrast-induced nephropathy in high risk patients. Int J Cardiol,2013,166(2):482-486.
- [7] Hu MC, Shi M, Zhang J, et al. Klotho deficiency is an early biomarker of renal ischemia reperfusion injury and its replacement is protective. Kidney Int,2010, 78(12):1240-1251.
- [8]刘威，康林，曹贵方.血清抗衰老因子klotho水平与急性心肌梗死发生的关系.中国介入心脏病学杂志，2013,21(3):146-148.
- [9] Seo MY, Yang J,Lee JY, et al. Renal Klotho expression in patients with acute kidney injury is associated with the severity of the injury. Korean J Intern Med, 2015,30(4):489-495.
- [10] Qian Y,Che L,Yan Y,et al. Urine klotho is a potential early biomarker for acute kidney injury and associated with poor renal outcome after cardiac surgery. BMC Nephrol, 2019,20(1):268.