冠状动脉介入治疗后造影剂肾病的危险因素研究

Risk factors of contrast-induced nephropathy after percutaneous coronary intervention

目的研究冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入(percutaneous coronaryintervention,PCI)治疗后发生造影剂肾病(contrast-induced nephropathy,CIN)的相关因素。方法选取广东省人民医院2008年11月至2009年12月患有冠心病并行PCI治疗的患者370例为研究对象。根据术后血清肌酐浓度变化情况分为两组,即造影剂肾病组(CIN组)58例,非造影剂肾病组(非CIN组)312例,回顾性调查分析两组患者的临床资料,分析发生造影剂肾病的相关因素。结果术后58例发生CIN,发生率为15.67%;相关分析发现年龄(r=0.193,P<0.001)、Ⅱ型糖尿病(r=0.104,P=0.045)、肾功能不全(r=0.331,P<0.001)、糖尿病肾病(r=0.150,P=0.004)、原发性高血压(高血压)(r=0.164,P=0.002)、贫血(r=0.127,P=0.015)、利尿药(r=0.300,P<0.001)的使用与CIN发生相关。Logistic回归分析发现,肾功能不全,高血压,手术前后使用利尿药为造影剂肾病的危险因素。结论肾功能不全,高血压和手术前后使用利尿药是PCI治疗后造影剂肾病的危险因素,在进行PCI治疗前应进做好预防措施。

Objectives To study the risk factors of contrast-induced nephropathy （CIN） after percutaneous coronary intervention （PCI） in patients with coronary artery disease. Methods Three hundred and seventy patients who performed PCI and had complete clinical data with medical records from November 2008 to December 2009 in Guangdong General Hospital were included in this study. The patients were divided into CIN group （n=58） and non- CIN group （n=312） according to the changes in serum creatinine after operation. We retrospectively analyzed the clinical information and adopted to logistic regression test to analyze the risk factors of CIN. Results There were 58 patients had CIN and CIN incidence rate was 15.67% in 370 patients after PCI. We found age （r=0.193, P〈0.001）, diabetes （r=0.104,P=0.045）, renal insufficiency （r=0.331, P〈0.001 ）, diabetic nephropathy （r=0.150, P=0.004）, hypertension （r=0.164, P=0.002）, anemia （r=0.127, P=0.015） and diuretic （r=0.300, P〈0.001） correlated to occurrence of CIN. Logistic regression test showed that renal insufficiency, hypertension and use of diuretic after operation were risk factors of CIN. Conclusions Renal insufficiency, hypertension and use of diuretic during operation are risk factors of CIN after PCI in patients, thus relevant preventive care should be taken during PCI.