钱赓,陈思,姜潇思,张颖,阿鑫,李平,田进文,陈韵岱

• 1:中国人民解放军总医院第一医学中心心血管内科
• 2:中国人民解放军总医院肾脏疾病全国重点实验室
• 3:中国人民解放军总医院第六医学中心心血管内科
• 4:中国人民解放军总医院海南医院心血管内科

摘要(Abstract)：

目的 评估注射用尼可地尔对于ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）后对比剂肾病的预防效果。方法 本研究纳入2018年至2019年国内多家中心拟行直接PCI的STEMI患者，随机分为尼可地尔组和安慰剂组，分别在直接PCI术前静脉注射尼可地尔或安慰剂。围术期观察患者血肌酐水平的变化，研究终点为对比剂肾病的发生，定义为术后48～72 h的血肌酐相较基线血肌酐水平增加超过0.5 mg/dl或与基线血肌酐相比相对增加超过25%。结果 最终研究人群纳入了行直接PCI的238例STEMI患者，其中226例（尼可地尔组和安慰剂组各113例患者）完成了围术期肾功能的检测。与安慰剂组相比，尼可地尔组最终心肌梗死溶栓治疗试验（TIMI）血流分级水平显著提高（P=0.001），并且尼可地尔组对比剂肾病的发生率明显降低（9.7%比24.8%,P=0.003）。多因素Logistic回归分析显示注射用尼可地尔与对比剂肾病的发生率降低显著相关（OR 0.379,95%CI 0.16～0.86,P=0.021）。结论 尼可地尔是接受直接PCI手术的STEMI患者发生对比剂肾病的独立保护性因素。在直接PCI术前静脉注射尼可地尔可以有效预防STEMI患者术后对比剂肾病的发生。

关键词(KeyWords)： 对比剂肾病;ST段抬高型心肌梗死;直接经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划课题项目（2021YFC3002203）;; 中华国际医学交流基金会SKY影像科研基金项目（Z-2014-07-2301）

作者(Author): 钱赓,陈思,姜潇思,张颖,阿鑫,李平,田进文,陈韵岱

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