冠心病合并糖尿病患者冠脉介入术后造影剂肾病的相关因素分析

Related factors of contrast-induced nephropathy after percutaneous coronary intervention in patients with coronary artery disease and diabetes mellitus

目的观察冠心病合并糖尿病患者冠状动脉介入术后造影剂肾病的相关因素。方法连续选取接受冠脉内支架术的冠心病合并糖尿病患者79例,根据介入术前后48 h血清肌酐变化情况分为两组,即造影剂肾病组(CIN组)16例,肾功能正常组(非CIN组)63例,回顾性分析两组患者的临床资料,应用Logistic回归分析发生造影剂肾病的相关因素。结果术后造影剂肾病组年龄≥70岁、术前血清肌酐(SCr)≥1.5 mg/L、心功能≥3级、术中造影剂用量过大、围手术期未进行水化治疗、右冠状动脉和三支血管病变的比例明显高于肾功能正常组(P<0.05)。应用Logistic回归分析发现术后发生造影剂肾病的危险因素为年龄≥70岁、术前血清肌酐≥1.5 mg/L、心功能≥3级、术中造影剂用量过大、围手术期未进行水化治疗(P<0.05,OR>1)。结论年龄≥70岁、术前血清肌酐(SCr)≥1.5 mg/L、心功能≥3级、术中造影剂用量过大、围手术期未进行水化治疗是冠心病合并糖尿病患者冠脉介入术后发生造影剂肾病的危险因素。

Objective To study the related factors of contrast-induced nephropathy（CIN） after percutaneous coronary intervention（PCI）in patients with coronary artery disease and diabetes mellitus.Method 79 hospitalized patients had been successfully done PCI were divided into CIN group（n=16） and non-CIN group（n=56） according to serum creatinine（SCr）increase of 48 hours after exposure to contrast medium.We analyzed retrospectively the clinical information and adopted to logistic regression test to analyze the related factors of contrast-induced nephropathy.Result Compared with the non-CIN group,patients in CIN group had higer incidences of old age（age≥70 yrs）,heart failure（NYHA grades≥grade 3）,baseline serum creatinine ≥1.5mg/L,the hige dose of contrast medium volume,no saline hytration during operation,right coronary artery lesions and three vessal disease（P〈0.05）.The logistic regression test,showed that related factors of contrast-induced nephropathy were age≥70 yrs,NYHA grades≥grade 3,baseline serum creatinine ≥1.5mg/L,the hige dose of contrast medium volume,no saline hytration during operation.Conclusion Age more than 70 yrs heart failure（NYHA grades≥grade 3）,baseline serum creatinine ≥1.5 mg/L,the hige dose of contrast medium volume,no saline hytration during peri-intervention are the risk factors of contrast-induced nephropathy（CIN） after PCI in patients with coronary artery disease and diabetes mellitus.