艾民,刘广学,颜昌福,夏福纯,周双陆,贺剑

• 1:昆明理工大学附属攀钢集团总医院心内科
• 2:凉山州会东县人民医院心内科

摘要(Abstract)：

目的探讨冠状动脉造影(coronary angiography,CAG)术前血清同型半胱氨酸(homocysteine,Hcy)水平与术后对比剂肾病(contrast induced nephropathy,CIN)的相关性。方法选择2013年5月至2016年5月在昆明理工大学附属攀钢集团总医院心内科住院疑似冠心病(coronary heart disease,CHD)并行CAG的患者2264例,根据术后发生CIN情况分为非CIN组(2162例)及CIN组(102例),分析患者临床基线资料、Hcy、肌酸酐(creatinine,Cr)及估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)。结果非CIN组年龄[(51.3±11.4)岁比(57.2±13.6)岁,P=0.031]、糖尿病(12.3%比25.5%,P=0.017)、慢性肾病(4.2%比12.7%,P=0.025)及对比剂剂量[(122±21)ml比(147±24)ml,P=0.012]均显著低于CIN组,差异均有统计学意义;非CIN组血红蛋白(Hb)[(131.5±10.4)g/L比(109.3±9.6)g/L,P=0.042]、左心室射血分数(LVEF)[(57.7±6.7)%比(50.3±5.1)%,P=0.044]均显著高于CIN组,差异均有统计学意义。logistic回归分析显示年龄、糖尿病、慢性肾病、对比剂剂量、Hb、LVEF、Cr及Hcy水平升高是发生CIN的主要危险因素。术前非CIN组Hcy水平显著低于CIN组,差异有统计学意义[(12.81±6.71)μmol/L比(21.74±11.9)μmol/L,P<0.05],但两组患者Cr及eGFR比较,差异均无统计学意义(均P>0.05);术后72 h非CIN组Cr显著低于CIN组[(69.34±19.54)μmol/L比(87.34±21.38)μmol/L,P=0.013],而eGFR显著高于CIN组[(79.34±19.54)ml/min比(67.34±21.38)ml/min,P=0.011]。线性回归分析显示,术前Hcy水平与术后Cr呈正相关(r=0.547,P<0.01),但与术后eGFR呈负相关(r=-0.271,P<0.01)。结论 CAG术前Hcy水平可作为预测术后发生CIN的有效指标之一。

关键词(KeyWords)： 冠状动脉造影术;对比剂肾病;同型半胱氨酸;肌酸酐;估算的肾小球滤过率

Abstract:

Keywords:

基金项目(Foundation): 四川省卫生和计划生育委员会科研课题(150097)

作者(Author): 艾民,刘广学,颜昌福,夏福纯,周双陆,贺剑

参考文献(References)：

• [1]蔡莹,赵威,高炜.对比剂肾病早期诊断生物标志物的研究进展.中国介入心脏病学杂志,2016,24(6):343-346.
• [2]Cybulska B,Klosiewicz-Latoszek L.Homocysteine—is it still an important risk factor for cardiovascular disease.Kardiol Pol,2015,73(11):1092-1096.
• [3]Wu CC,Zheng CM,Lin YF,et al.Role of homocysteine in endstage renal disease.Clin Biochem,2012,45(16):1286-1294.
• [4]Barbieri L,Verdoia M,Schaffer A,et al.Pre-diabetes and the risk of contrast induced nephropathy in patients undergoing coronary angiography or percutaneous intervention.Diabetes Res Clin Pract,2014,106(3):458-464.
• [5]Shacham Y,Gal-Oz A,Leshem-Rubinow E,et al.Association of admission hemoglobin levels and acute kidney injury among myocardialinfarction patients treated with primary percutaneous intervention.Can J Cardiol,2015,31(1):50-55.
• [6]Mc Cullough PA,Soman SS.Contrast-induced nephropathy.Crit Care Clin,2005,21(2):261-280.
• [7]Perrin T,Descombes E,Cook S.Contrast induced nephropathy in invasive cardiology.Swiss Med Wkly,2012,142(4):w13608.
• [8]陈思,陈韵岱,钱赓,等.急性冠状动脉综合征患者冠状动脉造影术后对比剂肾病危险因素分析.中国循证心血管医学杂志,2016,8(6):742-745.
• [9]Subramanian S,Tumlin J,Bapat B,et al.Economic burden of contrast induced nephropathy:implications for prevention strategies.J Med Econ,2007,10(2):119-134.
• [10]Owen RJ,Hiremath S,Myers A,et al.Canadian Association of Radiologists consensus guidelines for the prevention of contrast induced nephropathy:update 2012.Can Assoc Radiol J,2014,65(2):96-105.
• [11]Ashjazadeh N,Fathi M,Shariat A.Evaluation of homocysteine level as a risk factor among patients with ischemicstroke and its subtypes.Iran J Med Sci,2013,38(8):233-239.
• [12]de SáFerreira A.Plasma Homocysteine and Arterial Stiffness:Risk Factors or Risk Markers for Cardiovascular Diseases?J Clin Hypertens,2015,17(8):601-602.
• [13]Jamison RL,Hartigan P,Kaufman JS,et al.Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease:a randomized controlled trial.JAMA,2007,298(10):1163-1170.
• [14]Fox CS,Gona P,Larson MG,et al.Amulti-marker approach to predict incident CKD and microalbuminuria.J Am Soc Nephrol,2010,21(12):2143-2149.
• [15]Azzalini L,Spagnoli V,Ly HQ.Contrast-Induced Nephropathy:From Pathophysiology to Preventive Strategies.Can J Cardiol,2016,32(2):247-255.