Mehran评分在中国人群造影剂肾病风险预测中的有效性分析-东南大学学报医学版

Mehran评分在中国人群造影剂肾病风险预测中的有效性分析

单位：1. 中南大学湘雅三医院药学部, 湖南长沙 410013;
2. 中南大学湘雅三医院临床药理中心, 湖南长沙 410013

分类号：R97;R445.9

出版年·卷·期（页码）：2018·37·第六期（998-1001）

摘要：

目的：验证Mehran评分在中国人群造影剂肾病风险评估中的有效性，为临床提供参考。方法：收集3 614例在中南大学湘雅三医院住院行冠脉造影及介入治疗患者的临床资料（包括年龄、性别、基础肌酐值、术后3 d最大肌酐值、红细胞压积、血压，是否行主动脉内球囊反搏术，是否心衰等），分析Mehran评分对造影剂肾病风险评估的有效性。应用拟合优度检验（H-L）评价Mehran评分的校正能力，应用受试者工作特征曲线（ROC）下面积评价Mehran评分预测造影剂肾病的准确性，验证在两种造影剂肾病诊断标准下Mehran评分预测的有效性。结果：3 614例患者中203例发生造影剂肾病，发病率为5.62%；23例（0.64%）患者血清肌酐较基础值升高≥ 44.2 μmol·L^-1，201例（5.56%）患者血清肌酐较基础值升高≥ 25%。按照使用造影剂后72 h内出现血清肌酐较基础值升高≥ 44.2 μmol·L^-1的CIN诊断标准进行H-L检验分析，提示Mehran评分具有良好的拟合优度（χ²=7.46，df=5，P=0.189），ROC曲线下面积为0.726（95%CI 0.604~0.849，P<0.05）；按照使用造影剂后血清肌酐较基础值升高≥ 25%的CIN诊断标准进行H-L检验分析，提示Mehran评分也具有良好的拟合优度（χ²=4.38，df=5，P=0.496），ROC曲线下面积为0.497（95%CI 0.456-0.537，P=0.868）。结论：在两种诊断标准下Mehran评分都具有较好的拟合优度。按照诊断标准血清肌酐较基础值升高≥ 44.2 μmol·L^-1，Mehran评分可以比较准确地预测影剂肾病；按照诊断标准血清肌酐较基础升高≥ 25%，Mehran评分不能很好地预测造影剂肾病，需要更大的队列进一步验证。

Objective:To validate the effectiveness of Mehran score on the risk prediction of contrast-induced nephropathy(CIN) in Chinese population, so as to provide reference for clinical practice. Methods:A total of 3 614 patients who underwent coronary angiography and interventional therapy at the Third Xiangya Hospital of Central South University were enrolled in this study, and their clinical data including age, gender, basic creatinine value, maximum creatinine value at 3 days postoperatively, hematocrit, blood pressure, whether or not referred to intra-aortic balloon anti-bombing and heart failure, etc.were collected and then the effectiveness of the Mehran score was analyzed, Goodness-of-fit of Mehran score was assessed by the Hosmer-Lemeshow (H-L) test, and the accuracy of the Mehran score in predicting CIN was evaluated by the area under receiver operating characteristic curve (ROC). The effectiveness of the Mehran score was verified under two diagnostic criteria of CIN. Results:Of the 3 614 patients, 203 cases occurred CIN, and the incidence rate was 5.62%;there were 23 cases(0.64%) serum creatinine increased ≥ 44.2 μmol·L^-1 basal value, while 201 cases (5.56%) with serum creatinine increased ≥ 25% basal value.According to the diagnostic criteria of serum creatinine increased ≥ 44.2 μmol·L^-1 basal value, H-L test analysis showed that the Mehran score had a good goodness-of-fit(χ²=7.46, df=5, P=0.189). And the area under the ROC curve was 0.726 (95% CI 0.604-0.849, P<0.05). When using the diagnostic criteria that serum creatinine increased ≥ 25% basal value, H-L test analysis suggested that the Mehran score had a good goodness-of-fit too(χ²=4.38, df=5, P=0.496).And the area under the ROC curve was 0.497 (95% CI 0.456-0.537, P=0.868). Conclusion:The goodness-of-fit of Mehran score is better under both diagnostic criteria.According to the diagnostic criteria of serum creatinine increased ≥ 44.2 μmol·L^-1 basal value, the Mehran score predict CIN more accurately;whereas based on the diagnostic criteria of serum creatinine increased ≥ 25% basal value, the Mehran scorecan not predict CIN well, and a larger queue is required for further validation.

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