刘远辉,谭宁,叶飘,刘勇,何谊婷,冉鹏

• 1:南方医科大学广东省人民医院广东心血管病研究所心内科

摘要(Abstract)：

目的探讨肌酐相对正常患者行经皮冠脉介入术(PCI)后发生对比剂肾病(CIN)的危险因素分析。方法收入2010年1月至2011年4月在广东省人民医院心内科住院拟行PCI术且肌酐相对正常(≤1.5mg/dl,1mg/dl=88.4μmol/L)患者972例,观察此类患者CIN的发生率、临床危险因素及院内死亡率。CIN的诊断标准为:接触对比剂后48～72h内血清肌酐浓度升高>0.5mg/dl(>44.2μmol/L)或者较原基础值升高25%以上,并排除其他诱因引起的急性肾功能损害。结果 972例患者中,CIN发生率为13.9%。CIN(+)组与CIN(-)组进行统计学分析比较,在年龄>75岁(χ2=28.91,P=0.005)、女性(χ2=5.500,P=0.019)、低蛋白血症(χ2=11.953,P=0.002)、LVEF<45%(χ2=4.103,P=0.043)、急诊PCI(χ2=39.874,P<0.001)、使用利尿剂(χ2=23.654,P<0.001)、MehranCIN积分(t=-2.419,P=0.016)方面差异有统计学意义;多变量Logistic回归分析显示,术前肌酐相对正常患者发生CIN的独立危险因素包括年龄>75岁、急诊PCI、使用利尿剂、术后低血压(分别是OR=2.3,95%CI1.4～3.8,P=0.001;OR=2.8,95%CI1.8～4.2,P<0.001;OR=1.8,95%CI1.1～2.8,P=0.016;OR=2.5,95%CI1.1～5.6,P=0.025)。CIN(+)组比CIN(-)组院内死亡率显著增加(5.1%比0.3%,χ2=17.590,P<0.001)。结论术前肌酐相对正常患者行PCI术后仍可能发生CIN,且增加其死亡率;这些患者发生CIN的独立危险因素包括年龄>75岁、急诊PCI、使用利尿剂、术后低血压;对于此类患者应给予充分的肾脏保护预防措施。

关键词(KeyWords)： 肾病;血管成形术,经腔,经皮冠状动脉;低血压;危险因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘远辉,谭宁,叶飘,刘勇,何谊婷,冉鹏

参考文献(References)：

• [1]Nash K,Hafeez A,Hou S.Hospital-acquired renal insufficiency.Am J Kidney Dis,2002,39:930-936.
• [2]Mehran R,Aymong ED,Nikolsky E,et al.A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention:development and initial validation.J Am Coll Cardiol,2004,44:1393-1399.
• [3]Mccullough PA,Adam A,Becker CR,et al.Epidemiology and prognostic implications of contrast-induced nephropathy.Am J Cardiol,2006,98:5K-13K.
• [4]Bailie GR,Uhlig K,Levey AS.Clinical practice guidelines in nephrology:evaluation,classification,and stratification of chronic kidney disease.Pharmacotherapy,2005,25:491-502.
• [5]Gupta RK,Bang TJ.Prevention of Contrast-Induced Nephropathy(CIN)in Interventional Radiology Practice.Semin Intervent Radiol,2010,27:348-359.
• [6]Mccullough PA.Contrast-induced acute kidney injury.J Am Coll Cardiol,2008,51:1419-1428.
• [7]Kay J,Chow WH,Chan TM,et al.Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention:a randomized controlled trial.JAMA,2003,289:553-558.
• [8]Santos RO,Malvar B,Silva R,et al.[Contrast-induced nephropathy].Acta Med Port,2011,24:809-820.
• [9]Wright RS,Anderson JL,Adams CD,et al.2011ACCF/AHA focused update of the Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction(updating the2007guideline):a report of the American Collegeof Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American College of Emergency Physicians,Society for Cardiovascular Angiography and Interventions,and Society of Thoracic Surgeons.J Am Coll Cardiol,2011,57:1920-1959.
• [10]Kolh P,Wijns W,Danchin N,et al.Guidelines on myocardial revascularization.Eur J Cardiothorac Surg,2010,38Suppl:S1-S52.
• [11]Li JH,He NS.Prevention of iodinated contrast-induced nephropathy.Chin Med J(Engl),2011,124:4079-4082.
• [12]Morabito S,Pistolesi V,Benedetti G,et al.Incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography.J Nephrol,2012,25:1098-1107.
• [13]Mehran R,Aymong ED,Nikolsky E,et al.A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention:development and initial validation.J Am Coll Cardiol,2004,44:1393-1399.
• [14]Iakovou I,Dangas G,Mehran R,et al.Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention.J Invasive Cardiol,2003,15:18-22.
• [15]Valente S,Lazzeri C,Giglioli C,et al.Contrast-induced nephropathy in urgent coronary interventions.J Cardiovasc Med(Hagerstown),2006,7:737-741.
• [16]Cronin RE.Contrast-induced nephropathy:pathogenesis and prevention.2010:191-204.
• [17]Rosenstock JL,Gilles E,Geller AB,et al.Impact of heart failure on the incidence of contrast-induced nephropathy in patients with chronic kidney disease.Int Urol Nephrol,2010,42:1049-1054.
• [18]Dangas G,Iakovou I,Nikolsky E,et al.Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables.Am J Cardiol,2005,95:13-19.
• [19]Solomon R,Werner C,Mann D,et al.Effects of saline,mannitol,and furosemide to prevent acute decreases in renal function induced by radiocontrast agents.N Engl J Med,1994,331:1416-1420.