冠状动脉介入诊疗术患者造影剂肾病的危险因素研究

Risk factors of contrast-induced nephropathy in patients undergoing coronary artery intervention

目的研究经皮冠状动脉介入术(PCI)和冠状动脉造影术患者造影剂肾病(CIN)的危险因素。方法选择2008年10月～2009年3月在齐鲁医院接受冠状动脉造影术和/或PCI的200例患者,分别监测造影前3d内(任意1d)和造影后第3、7天的血清肌酐(Scr)、尿素氮(BUN)和尿β2微球蛋白(β2-MG),分析冠状动脉诊疗术患者CIN的危险因素。结果200例患者中,有14例(7%)发生CIN。在CIN组和非CIN组,原有肾功能不全、糖尿病、高血压患者的比例,两组间比较,差异有统计学意义(P<0.05)。年龄、身体质量指数(BMI)、血管紧张素转换酶抑制药(ACEIs)、冠状动脉粥样硬化、造影剂剂量和高脂血症,两组间差异无统计学意义(P>0.05)。logistic多因素逐步回归分析显示原有肾功能不全和糖尿病是CIN的独立危险因素。结论高血压是CIN的一个相关危险因素;年龄、BMI、ACEIs、冠状动脉粥样硬化、造影剂剂量和高脂血症等不是CIN的相关危险因素;原有肾功能不全和糖尿病是CIN的独立危险因素。

Objective To study the risk factors of contrast-induced nephropathy（CIN）in patients undergoing coronary artery angiography and/or percutaneous coronary intervention（PCI）.Methods 200 patients undergoing PCI or coronary angiograph from October 2008 to March 2009 were enrolled in this study.Levels of serum creatinine,blood urine nitrogen and urine β2-microglobulin were determined three days before and at 3,7 days after coronary artery intervention.Result Among the 200 patients,14 patients（7%）developed CIN.The incidence of pre-existing renal dysfunction,hypertension,diabetes mellitus in CIN patients and in non-CIN patients did not significantly vary（P〈0.05）.Age,body mass index（BMI）,angiotensin converting enzyme inhibitors（ACEIs）,coronary arteriosclerosis,dosages of contrast agent and hyperlipemia did not significantly vary between the two groups（P〉0.05）.Identified by regression,pre-existing renal dysfunction and diabetes mellitus were independent risk factors of CIN.Conclusions Hypertension is one related risk factor of CIN,while age,BMI,ACEIs,coronary arteriosclerosis,dosages of contrast agent and hyperlipemia are not.Pre-existing renal dysfunction and diabetes mellitus are independent risk factors of CIN.