冠状动脉介入术患者造影剂肾病的危险因素多中心调查

Investigation of Risk Factors of Contrast-Induced Nephropathy in Multi-centers after Coronary Artery Intervention

目的:多中心调查住院冠脉造影(CAG)和经皮冠状动脉介入术(PCI)患者造影剂肾病(CIN)的危险因素。方法:前瞻性收集上海浦东地区六家医院接受冠状动脉介入术患者的资料,分析造影剂肾病发生情况及相关危险因素。结果:入选患者197例,CIN发病率8.63%(17/197)。老年人(年龄≥70岁)72例(36.5%),糖尿病71例(36.0%),高血压148例(75.1%),心功能Ⅱ级以上者22例(11.2%)、心梗患者23例(11.7%)。发生CIN患者与非CIN患者在性别、年龄、2型糖尿病、术前心功能、血红蛋白、红细胞压积、总胆固醇、术前及术后肌酐清除率(Ccr)、术后血肌酐(Scr)、术后肾小球滤过率(GFR)、多只冠脉病变等方面差异有统计学意义(P<0.05)。相关分析Logistic多元逐步回归显示高龄(年龄≥70岁,相对危险度RR=7.3,P<0.05)、女性(RR=3.6,P<0.05)、心肌梗死(RR=5.6,P<0.05)、造影剂剂量≥180ml(RR=4.0,P<0.05)是CIN的危险因素。结论:心内科住院行CAG和PCI的患者CIN发生率较高,糖尿病、高血压、心功能不全等CIN公认的高危因素普遍存在;年龄70岁以上、女性、心肌梗死、较高造影剂剂量可能是心内科住院行CAG和PCI者CIN发生的危险因素。

Objective：To investigate the incidence of contrast-induced nephropathy （CIN） in patients underwent coronary angiography （CAG） and percutaneous coronary intervention （PCI）.Methods：From April 2009 to July 2009,197 patients admitted to sixes centers in Pudong of Shanghai and treated with PCI and CAG were prospectively collected.Risk factors of CIN were analyzed.Results：Of 197 patients,17 experienced CIN （the incidence was 8.63%）.72（36.5%） were aged （age≥70）,71（36.0%） had diabetes mellitus,148（75.1%） hypertension,22（11.2%） heart function NYHA class〉Ⅱ,and 23（11.7%） myocardial infarction.There were significant difference between CIN and non-CIN patients in age,gender,diabetes mellitus,heart function,hemoglobin,haematocrit,cholesterol,creatinine clearance rate （Ccr） before and after CAG,serum creatinine and glomerular filtration rate （GFR） after CAG （P〈0.05）.In multivariate analysis,age≥70 [relative ratio （RR）=7.3,P0.05],female （RR=3.6,P〈0.05）,myocardial infarction （RR=5.6,P〈0.05） and contrast volume≥180 ml（RR=4.0,P〈0.05） were risk factors of CIN.Conclusion：It is deserved to pay attention to the incidence of CIN in hospitalized patients undergoing PCI and CAG.The risk factors of CIN are very universal.Female,age≥70,myocardial infarction and contrast volume≥180 ml are the potential risk factors for CIN.