王若蒙,张拓,张维峰,孙士群,王志敬,张湘,沈玲红,何奔

• 1:上海交通大学医学院附属仁济医院心内科
• 2:上海市浦东新区周浦医院急诊科

摘要(Abstract)：

目的比较两种对比剂诱发的急性肾损伤诊断标准与行冠状动脉介入术患者的临床特征及术后不良事件相关性的差异。方法回顾性分析2013年7月至2014年12月于上海交通大学医学院附属仁济医院心脏中心行冠状动脉造影术(CAG)或经皮冠状动脉介入治疗(PCI)的患者共1063例。分别采用欧洲泌尿生殖放射学会对比剂肾病(CIN)诊断标准和改善全球肾病预后组织(KDIGO)诊断标准对冠状动脉介入术后对比剂诱发急性肾损伤(CI-AKI)的患者进行诊断。比较两种诊断标准与冠状动脉介入术后12个月内主要不良事件(MAEs)发生风险的相关性。结果 KDIGO诊断标准下,CI-AKI患者23例(2.2%),而采用CIN诊断标准,CI-AKI患者93例(8.7%),两种诊断标准比较差异有统计学意义(P<0.001)。KDIGO诊断标准下的CI-AKI患者,随着Mehran评分危险分级的增加,患者所占比例呈现逐渐增加的趋势,而在CIN诊断标准中则呈现相反的趋势。在12个月随访过程中,有61例(5.7%)患者发生MAEs,但两种诊断标准下CI-AKI患者的MAEs发生率比较,差异无统计学意义(P>0.05)。多元logistics回归分析显示:CIN诊断标准预测MAEs为OR6.69,95%CI 3.55~12.61,P<0.001;KDIGO诊断标准预测MAEs为OR 8.38,95%CI 2.28~30.72,P=0.001。结论采用KDIGO诊断标准和CIN诊断标准诊断冠状动脉介入术后CI-AKI的发病率存在明显差异。相较于CIN诊断标准,KDIGO诊断标准可能与行冠状动脉介入术患者的高危特征以及术后MAEs的发生更为相关。

关键词(KeyWords)： 对比剂;急性肾损伤;冠状动脉造影;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金会(81600518);; 上海卫生和计划生育委员会(20164Y0111)

作者(Author): 王若蒙,张拓,张维峰,孙士群,王志敬,张湘,沈玲红,何奔

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