487例冠脉造影后造影剂肾病的临床研究

Clinical Study of Contrast-induced Nephropathy in Inpatients in Cardiology Department After Coronaryartery Intervention

目的：调查住院冠状动脉造影患者造影剂肾病的发病情况。方法：收集上海市第六人民医院2008年1月~2009年7月31日的回顾性病历,收入2008年~2009年度冠脉造影（coronary angiography）/冠脉干预（percutaneous coronary intervention）病例,分析入选病例的疾病构成和造影剂肾病（contrast-induced nephropathy,CIN）在不同情况下的发病率,比较CIN组与非CIN组患者的各项资料,分析CIN患病的危险因素。结果：入选患者487例中CIN发病率10.5%（51例）,经过Mehran的危险积分分层后提示CIN发病率随着危险积分上升,在极高危的一组中达到18.0%,多因素回归分析显示术前低血压、心衰、贫血、eGFR≤30ml/min是CIN的危险因素。结论：CIN与术前低血压、心衰、贫血、肾功能以及其相应临床指标密切相关;等渗造影剂对与CIN的发病不优于低渗造影剂;需密切关注心内科行CAG的患者CIN的发病率,积极采取有效的措施预防CIN的发生。

Objective：To investigate the incidence and risk factors of contrast-induced nephropathy（CIN）in patients underwent coronary angiography（CAG）.Methods：From January 2008 to July 2009,inpatients in cardiology department for CAG were prospectively collected.Overall incidence of CIN and the incidences under different conditions were analyzed.Patients were divided into CIN group and non-CIN group based on the presence of CIN,and the two groups were compared.Risk factors for CIN were analyzed.Results：Of the 487 patients,51 experienced CIN,and the overall incidence was 10.5%.the incidence was 18.0% in the group with risk score ≥16.Preoperative hypotension,heart failure,anemia,eGFR ≤30 ml/min were recognized as risk factors to CIN incidence rate.Conclusion：The CIN incidence is associated withpreoperative hypotension,heart failure,anemia,renal insufficiency.In term of contrast media selection,this study had shown that Iso-osmotic contrast media（IOCM）is not superior to Low-osmotic contrast media（LOCM）.Therefore,measures should be performed to prevent CIN,especially in the patients undergoing CAG.