急性心肌梗死患者急诊经皮冠状动脉介入治疗后对比剂肾病的研究

Contrast-induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

目的:了解对比剂对急性心肌梗死行急诊经皮冠状动脉(冠脉)介入治疗(PCI)患者肾功能的影响,探讨对比剂肾病(CIN)的相关因素及其对患者预后的影响。方法:入选118例行急诊PCI的急性ST段抬高心肌梗死患者,测定其术前和术后48、72h的血清肌酐,记录其治疗经过和住院期间发生的不良事件。结果:118例患者中发生CIN(CIN组)28例(23.7%)。CIN组基线肾小球滤过率(GFR)和左心室射血分数(LVEF)低于非CIN组(均P<0.05),而肌酸激酶(CK)峰值高于非CIN组(P<0.05)。CIN组住院时间比非CIN组长(P<0.01),住院期间不良事件发生率更多。Logistic回归分析发现,LVEF<40%、CK峰值>3000U/L与CIN的发生有关。结论:CIN是急诊PCI患者的常见并发症,可能增加住院期间不良事件的发生率,临床工作中要积极预防CIN的发生。

Objective To analyze the effect of contrast medium on renal function in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention （PCI）, and to assess the clinical predictors and outcome of contrast-induced nephropathy （CIN）. Methods In 118 patients with acute myocardial infarction who underwent primary PCI, serum creatinine （Scr） concentration was measured at baseline and on the 48th hour, 72nd hour after PCI, and clinical events were observed during hospitalization. Results CIN occurred in 28 （23.7%） patients. The baseline glomerular filtration rate （GFR） was lower in CIN group than that in non-CIN group （P〈0.05）. The left ventricnlar ejection fraction（LVEF） was lower and peak creatine kinase was higher in CIN group than that in non-CIN group（P〈0.05）. The CIN group had longer hospital stay （P〈0.01） and more complicated clinical course than non-CIN group. Multivariate analysis showed that LVEF〈40%, peak CK〉3 000 U/L were correlated with CIN. Conclusions Contrast-induced nephropathy frequently complicates primary percutaneous coronary intervention. It is associated with higher in-hospital complications. Thus, preventive strategies are needed.