目的 探讨D-二聚体（D-dimer， D-D）联合血浆氨基末端脑钠肽前体（N-terminal pro-B-type natriuretic peptide， NT-proBNP）对急性冠脉综合征（acute coronary syndrome， ACS）患者发生肾功能不全的临床诊断价值。 方法 本研究为回顾性队列研究，选取2021年1月至2023年12月在天津市第一中心医院胸痛中心就诊的ACS患者682例为研究对象。根据未行冠状动脉造影前的肌酐值计算的肾小球滤过率分为肾功能不全组和肾功能正常组，分别为102例和580例。采用二元logistic回归分析法分析ACS患者发生肾功能不全的影响因素，采用受试者工作特征曲线（receiver operator characteristic， ROC）评价D-D、NT-proBNP水平对ACS患者中发生肾功能不全的诊断价值。 结果 肾功能不全组的D-D、NT-proBNP水平显著高于肾功能正常组（P < 0.05）；单因素logistic回归分析显示D-D、NT-proBNP水平升高均是ACS患者发生肾功能不全的独立危险因素。多因素logistic回归分析显示D-D联合NT-proBNP检测是ACS患者发生肾功能不全的独立危险因素。ROC结果显示，D-D水平诊断ACS患者发生肾功能不全的AUC为0.805，敏感度58.82%，特异度100%；NT-proBNP水平诊断ACS患者心肌梗死后发生肾功能不全的AUC为0.737，敏感度67.65%，特异度73.62%；D-D联合NT-proBNP诊断ACS患者发生肾功能不全的AUC为0.838，敏感度68.63%，特异度为93.28%。联合检测诊断价值优于各项单独检测。 结论 ACS患者中发生肾功能不全的D-D、NT-proBNP水平显著升高，是肾功能不全发生的独立危险因素，且联合检测有助于诊断肾功能不全。

Objective The study aimed to explore the clinical diagnostic value of D?Dimer （D?D） combined with N?terminal pro?B?type natriuretic peptide（NT?proBNP） in the occurrence of renal dysfunction in patients with acute coronary syndrome （ACS）. Methods As a retrospective cohort study， we selected 682 patients as the research subjects. The patients were with acute coronary syndrome who visited the Chest Pain Center of Tianjin First Central Hospital during January 2021 and December 2023. Based on the eGFR values calculated from the creatinine levels before coronary angiography， patients were divided into the renal insufficiency group and the normal renal function group， comprising 102 cases and 580 cases， respectively. Binary logistic regression was adopted to analyze the influence factors of renal dysfunction in ACS patients， and the receiver operating characteristic （ROC） curve was utilized to evaluate the diagnostic value of D?D and NT?proBNP levels for renal dysfunction in ACS patients. Results The levels of D?D and NT?proBNP in the renal insufficiency group were significantly higher than those in the normal renal function group （P < 0.05）. Univariate logistic regression analysis showed that the rise of D?D and NT?proBNP levels were both independent risks for renal dysfunction in ACS patients. Multivariate logistic regression analysis indicated that the combined detection of D?D and NT?proBNP was an independent risk factor for renal dysfunction in ACS patients. The ROC results showed that the AUC， sensitivity， and specificity of the D?D level in diagnosing renal dysfunction in ACS patients were 0.805， 58.82%， and 100%， respectively. The AUC， sensitivity， and specificity of NT?proBNP level in diagnosing renal dysfunction after myocardial infarction in ACS patients were 0.737， 67.65%， and 73.62%， respectively. The AUC， sensitivity， and specificity of D?D combined with NT?proBNP in diagnosing renal dysfunction in ACS patients were 0.838， 68.63%， and 93.28%， respectively. The diagnostic value of combined detection was superior to that of individual testing. Conclusions The levels of D?D and NT?proBNP were significantly elevated in ACS patients with renal dysfunction， which were independent risk factors for the occurrence of renal dysfunction， and the combined detection could help diagnose renal dysfunction.