公锐,孙蕾,王效增,荆全民,赵昕,马颖艳,王耿,韩雅玲

• 1:沈阳军区总院医院心内科

摘要(Abstract)：

目的评估碘克沙醇对中国慢性肾病患者行经皮冠状动脉介入治疗(PCI)术后发生主要不良心脑血管事件(MACCE)和对比剂诱发急性肾损伤(CIAKI)的影响。方法自2013年10月30日至2015年10月9日在中国的30个中心入选3042例患者,对入选的患者住院期间观察3 d,出院后随访1个月。根据患者是否存在慢性肾病分为慢性肾病组(105例)和非慢性肾病组(2937例)。主要研究终点为住院期间即PCI术后72 h MACCE(包括靶病变再次血运重建、卒中、支架内血栓、心源性死亡及心肌梗死)和CIAKI的发生率。次要终点为PCI术后72 h~30 d的MACCE发生率。结果 (1)慢性肾病组患者年龄[(66.28±9.32)岁比(62.89±10.90)岁,P=0.003]、高血压病(83.81%比59.14%,P<0.001)、充血性心力衰竭(15.24%比1.94%,P<0.001)、血脂异常(73.33%比57.44%,P=0.001)、糖尿病(51.43%比23.90%,P<0.001)、消化性溃疡(6.67%比2.86%,P=0.036)及缺血性卒中(20.00%比9.02%,P<0.001)比例均高于非慢性肾病组,既往应用抗高血压药(83.81%比69.83%,P=0.002)、利尿药(11.43%比4.09%,P=0.002)、调脂药物(84.76%比74.60%,P=0.018)、降糖药物(43.81%比17.23%,P<0.001)、抗血小板聚集药物(94.29%比78.21%,P<0.001)和抗凝药物(39.05%比24.28%,P=0.001)比例均高于非慢性肾病组,差异均有统计学意义。(2)慢性肾病组和非慢性肾病组患者手术路径(桡动脉路径92.38%比96.97%,尺动脉路径5.71%比2.83%,股动脉路径0.95%比0.03%,肱动脉路径0.95%比0.17%;P=0.006)、术前水化容积[(905.94±486.04)ml比(521.20±344.76)ml,P<0.001]、术后水化容积[(859.00±433.97)ml比(712.42±419.74)ml,P=0.011]、水化总量[(1407.78±773.45)ml比(976.20±592.68)ml,P<0.001]、术后病变狭窄程度[(2.10±3.81)%比(1.04±4.15)%,P<0.001]、对比剂剂量[(114.48±52.44)ml比(141.35±57.86)ml,P<0.001]和机器注射对比剂流率[(3.38±1.02)ml/s比(4.67±1.29)ml/s,P<0.001]等围术期指标比较,差异均有统计学意义。(3)慢性肾病组PCI术后应用β阻滞药(11.43%比19.31%,P=0.043)、调脂药物(17.14%比28.77%,P=0.009)、他汀类药物(16.19%比27.99%,P=0.008)及抗血小板聚集药物(28.57%比39.94%,P=0.019)比例均低于非慢性肾病组患者,差异均有统计学意义。(4)两组患者住院期间及PCI术后72 h~30 d MACCE发生率比较,差异均无统计学意义(均P>0.05)。(5)两组患者住院期间CIAKI发生率比较,差异无统计学意义(P>0.05)。结论碘克沙醇对行PCI的中国慢性肾病患者与非慢性肾病患者MACCE和CIAKI发生率无显著影响。

关键词(KeyWords)： 经皮冠状动脉介入治疗;主要不良心脑血管事件;对比剂诱发急性肾损伤

Abstract:

Keywords:

基金项目(Foundation): 通用电气药业对本研究的支持

作者(Author): 公锐,孙蕾,王效增,荆全民,赵昕,马颖艳,王耿,韩雅玲

参考文献(References)：

• [1]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2016》概要.中国循环杂志,2017,32(6):521-530.
• [2]Levine GN,Bates ER,Blankenship JC,et al.2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention:executive summary:a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines and the society for cardiovascular angiography and interventions.Circulation,2011,124(23):2574-2609.
• [3]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016).中华心血管病杂志,2016,44(5):382-400.
• [4]刘浩生.2016年中国大陆地区冠心病介入治疗数据分享.中华医学信息导报,2017,32(10):17.
• [5]Shul'zhenko LV,Pershukov IV,Batyraliev TA,et al.The role of reduction of glomerular fi ltration rate in outcomes of drug-eluting stents implantation in patients with ischemic heart disease and chronic kidney disease.Kardiologiia,2010,50(4):4-11.
• [6]Prasad A,Sohn A,Morales J,et al.Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory:Results from a survey of Society of Cardiovascular Angiography and Intervention(SCAI)cardiologists.Catheter Cardiovasc Interv,2017,89(3):383-392.
• [7]Crimi G,Gritti V,Galiff a VA,et al.Drug eluting stents are superior to bare metal stents to reduce clinical outcome and stentrelated complications in CKD patients,a systematic review,metaanalysis and network meta-analysis.J Interv Cardiol,2017.[Epub ahead of print]
• [8]Klein LW,Sheldon MW,Brinker J,et al.The use of radiographic contrast media during PCI:a focused review:a position statement of the Society of Cardiovascular Angiography and Interventions.Catheter Cardiovasc Interv,2009,74(5):728-746.
• [9]Mc Cormack PL.Iobitridol:a review of its use as a contrast medium in diagnostic imaging.Clin Drug Investig,2013,33(2):155-166.
• [10]Romagnani P,Remuzzi G,Glassock R,et al.Chronic kidney disease.Nat Rev Dis Primers.2017,3:17088
• [11]Rosansky SJ,Schell J,Shega J,et al.Treatment decisions for older adults with advanced chronic kidney disease.BMC Nephrol,2017,18(1):200.
• [12]Parikh NI,Hwang SJ,Larson MG,et al.Chronic kidney disease as a predictor of cardiovascular disease(from the Framingham Heart Study).Am J Cardiol,2008,102(1):47-53.
• [13]Azzalini L,Spagnoli V,Ly HQ.Contrast-Induced Nephropathy:From Pathophysiology to Preventive Strategies.Can J Cardiol,2016,32(2):247-255.
• [14]Tehrani S,Laing C,Yellon DM,et al.Contrast-induced acute kidney injury following PCI.Eur J Clin Invest,2013,43(5):483-490.