急诊冠状动脉介入治疗后造影剂肾病的临床研究

Clinical study on contrast-induced nephropathy in urgent percutaneous coronary interventions treatment

目的了解低渗非离子造影剂对行急诊冠状动脉介入（PCI）治疗的急性心肌梗死（AMI）患者造影剂肾病（CIN）的发生率、危险因素及其对预后的影响。方法接受急诊PCI治疗的AMI患者196例，均应用低渗非离子造影剂。分析造影剂对行PCI治疗患者的肾功能的影响，并对危险因素进行Logistic多因素回归分析。结果196例患者中，发生CIN38例（CIN组），未发生CIN158例（非CIN组），CIN的发生率为19．4％；CIN组中原有肾功能不全（基线肌酐清除率〈1．0ml/s）5例（13．2％），左心功能不全（LVEF〈40％）16例（42．1％），与非CIN组比较差异均有统计学意义（P均〈0．01）。造影剂的剂量CIN组为（331±167）ml，非CIN组为（247±126）ml。两组比较差异有统计学意义（P〈0．01）；Logistic多因素回归分析显示，肾功能不全、左心功能不全及造影剂的剂量是CIN的独立危险因素，住院期间及6个月随访期间，CIN组主要心脏不良事件发生率明显高于非CIN组（P〈0．01）。结论CIN在AMI患者行急诊PCI治疗后发生率较高，原有肾功能不全、左心功能不全及造影剂的剂量是CIN的独立危险因素，CIN能增加主要心脏不良事件的发生率。

Objective To analyze the effect of low osmotic nonionic contrast media on renal function in patients undergoing urgent percutaneous coronary interventions （PCI） treatment, and investigate the incidence,prognosis and predictive factors of contrast-induced nephropathy （CIN）. Methods One hundred and ninety-six patients undergoing urgent PCI treatment were enrolled. All patients received low osmotic nonionic contrast media. The serum creatinine （Cr） concentration at baseline were measured each day for the following three days. Multivariate predictors of CIN were determined using Logistic regression. The incidence of major adverse cardiac events was investigated in hospital and in follow-up period of 6 months. Results CIN occurred in 38 patients（CIN group） and the incidence of CIN was 19.4%. In those who had renal insufficiency or left heart function failure, the incidence of CIN group was significantly higher （P 〈 0.01 ）. The average contrast media dose in CIN group [ （331 ± 167 ） ml ] was significant higher than that in non-CIN group [ （ 247 ± 126 ） ml ] , P 〈 0.01. Identified by Logistic regression, pre-existed renal dysfunction （baseline Ccr 〈1.0 ml/s）,the dose of contrast media,left heart function failure were independent risk factors of CIN. In the period of follow-up, the incidence of major adverse cardiac events was higher in CIN group than that in non-CIN group. Conclusions Patients submitted to urgent PCI treatment are quite often at high risk for CIN. Pre-existed renal dysfunction, the dose of contrast media, left heart function failure are independent risk factors of CIN. The patients of CIN have higher incidence of major adverse cardiac events.