冠状动脉介入诊疗术对肾功能影响的532例分析Contrast-induced nephropathy in 532 patients undergoing coronary intervention
陈侃,钱菊英,葛雷,刘学波,樊冰,王齐兵,张峰,黄东,马剑英,葛均波
摘要(Abstract)：
目的探讨对比剂肾病(contrast-induced nephropathy,CIN)在非选择性患者中的发病率及其危险因素,以及等渗对比剂碘克沙醇的肾安全性。方法共入选532例接受冠状动脉介入诊疗术的患者,测定患者术前1周内任一天及术后48h的肾功能。以术后48h血肌酐(serum creatinine,SCr)较术前升高25%或升高44.2μmol/L(0.5mg/dL)为CIN的诊断标准,分析对比剂对肾功能的影响。用Logistic多因素回归分析CIN发生的危险因素。结果(1)532例患者中29例发生CIN,发病率为5.5%;(2)术前估计肾小球滤过率(estimate glomerular filtration rate,eGFR)<45mL/min的患者CIN发病率显著高于eGFR≥45mL/min的患者(17.5%比4.5%,P=0.002);(3)532例患者中,427例使用低渗对比剂,105例使用等渗对比剂碘克沙醇,低渗对比剂组术前平均eGFR显著高于等渗对比剂组(81.4±27.6mL/min比62.5±22.8mL/min,P=0.000),两者CIN发病率差异无统计学意义(5.6%比4.8%,P=0.797);(4)Logistic多因素分析显示,术前使用利尿剂、术前eGFR<45mL/min、对比剂用量≥500mL是CIN的独立危险因素。结论冠状动脉介入诊疗术后CIN在非选择性患者中的发病率为5.5%。在术前eGFR<45mL/min的患者中CIN的发病率显著升高。等渗对比剂碘克沙醇对肾的安全性可能略优于低渗对比剂。术前使用利尿剂、术前eGFR<45mL/min、对比剂用量≥500mL是CIN的独立危险因素。
关键词(KeyWords)： 冠状血管造影术;肾病;造影剂;碘克沙醇
基金项目(Foundation):
作者(Author): 陈侃,钱菊英,葛雷,刘学波,樊冰,王齐兵,张峰,黄东,马剑英,葛均波
参考文献(References)：
- [1]Berns AS.Nephrotoxicity of contrast media.Kidney Int,1989,36:730-740.
- [2]McCullough PA,Wolyn R,Rocher LL,et al.Acute renal failure after coronary intervention:Incidence,risk factors,and relation-ship to mortality.Am J Med,1997,103:368-375.
- [3]Toprak O.Risk Markers for Contrast-Induced Nephropathy.Am J Med Sci,2007,334:283-290.
- [4]Thomsen HS,Morcos SK.Contrast media and the kidney:Euro-pean Society of Urogenital Radiololgy(ESUR)guidelines.Br J Radiol,2003,76:513-518.
- [5]Rich MW,Crecelius CA.Incidence,risk factors,and clinical course of acute renal insufficiency after cardiac catheterization in patients70years of age or older.A prospective study.Arch In-tern Med,1990,150:1237-1242.
- [6]吉俊,丁小强,许迅辉,等.低渗非离子造影剂对冠状动脉介入诊疗术患者肾功能影响的前瞻性研究.中华肾脏病杂志,2006,22:388-392.
- [7]来莺,陈万春,赵德强,等.冠状动脉造影对肾功能影响1087例分析.岭南心血管病杂志,2006,12:398-400.
- [8]Barrett BJ,Carlisle EJ.Metaanalysis of the relative nephrotoxici-ty of high-and low-osmolality iodinated contrast media.Radiolo-gy,1993,188:171-178.
- [9]Aspelin P,Aubry P,Fransson S,et al.Nephrotoxic effects in high-risk patients undergoing angiography.N EnglJ Med,2003,348:491-499.
- [10]Jo SH,Youn TJ,Koo BK,et al.Renal toxicity evaluation and comparison between visipaque(iodixanol)and hexabrix(ioxa-glate)in patients with renal insufficiency undergoing coronary an-giography:The RECOVER study:A randomized controlled trial.J Am Coll Cardiol,2006,48:924-930.
- [11]Solomon R,Natarajan M,Doucet S,et al.Cardiac Angiography in Renally Impaired Patients(CARE)Study:A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease.Circulation,2007,115:3189-3196.
- [12]McCullough PA,Bertrand ME,Brinker JA,et al.Ameta-analy-sis of the renal safety of isosmolar iodixanol compared with low-os-molar contrast media.J Am Coll Cardiol,2006,48:692-699.