老年冠心病患者介入治疗术后对比剂肾损伤发生率及危险因素分析

Incidence of and risk factors for contrast-induced nephropathy after percutaneous coronary intervention in elderly patients

目的探讨老年冠心病患者PCI术后对比剂肾损伤(contrast-induced nephropathy,CIN)发生情况及危险因素。方法选取行PCI的老年冠心病患者945例,按照CIN诊断标准分为CIN组150例和非CIN组795例,比较2组相关因素的差异,应用多元logistic回归分析探讨CIN危险因素。结果 945例老年患者中,150例发生CIN,CIN发生率为15.9%。2组患者年龄、心肌梗死、糖尿病、低血压、红细胞计数、血红蛋白、贫血、LVEF、术前肾小球滤过率(GFR)、对比剂剂量等比较,差异有统计学意义(P<0.01)。多元logistic回归分析,心肌梗死、糖尿病、贫血、低血压、LVEF≤45%、GFR≤60 ml/(min·1.73 m^2)、急诊PCI、对比剂剂量>200 ml是老年冠心病患者CIN的危险因素(P<0.05,P<0.01)。结论 CIN是老年冠心病患者PCI术后一种不容忽视的并发症,患者行PCI时,应引起临床医师的格外重视。

Objctive To invetigate the incidence of contrast-induced nephropathy（CIN）and identify the risk factors for CIN after PCI in elderly patients. Methods A retrospective study was conduc- ted in Tianjin Chest Hospital on 945 elderly coronary heart disease patients received PCI from jan- ery 2009 to december 2010. Acorrding to the CIN criteria, the elderly patients were divided into CIN group and non-CIN group, and logistic regression analysis was applied to determin the risk factors for CIN. Results Among the 945 elderly patients,CIN occurred in 150 patients and the in- cidence of CIN was 15.9 %. There were statistically significant differences in age, hemoglobin, red blood cells, hematocrit,anemia, systolic blood pressure, LVEF and contrast agent volume between the two groups（P〈0.01）, logistic regression analysis showed that myocardial infarction,diabetes mellitus,anemia,hypotention,LVEF≤45% ,GFR≤60 ml/（min·1.73 m2 ）, urgent PCI, contrast agent volume〉200 ml were risk factors of CIN（P〈0. 05,P〈0.01）. Conclusion CIN is a common complication after PCI in elderly patients, more attention should be paid to elderly patients with risk factors of CIN.