老年糖尿病患者造影剂肾病的危险因素分析

Risk factors of contrast-induced nephropathy in the elderly patients with diabetes

目的 了解行冠状动脉（冠脉）造影检查和经皮冠状动脉介入治疗（PCI）的老年糖尿病患者临床特点，并分析造影剂肾病（CIN）的危险因素。方法回顾性收集了2007年1月至2009年12月于卫生部北京医院心内科行冠脉造影和PCI术269例老年糖尿病患者的临床资料，按照是否发生CIN分为CIN组和非CIN组，对可能的危险因素进行分析，采用多元逐步Logistic回归法分析CIN的独立危险因素。结果老年糖尿病患者CIN发生率为9．3％（25／269），根据造影前肾小球滤过率估计值（e-GFR）将患者分为4组：≥90ml／min，89～60ml／min，59～30ml／min，〈29ml／min，各组CIN发生率分别为：2．2％（1／45）、4．4％（6／135）、17．3％（14／81）、50．0％（4／8）；CIN危险因素多元逐步Logistic回归分析显示，袢利尿剂使用（OR＞6．07）、术前肾功能水平（OR〉3．27）、造影剂用量（OR〉3．26）和有无慢性肾病（OR〉2．80）可进入方程（均P〈0．05）。结论老年糖尿病患者CIN发生率随着肾功能下降而升高，围术期袢利尿剂的使用、术前肾功能水平、造影剂用量和慢性肾病是老年糖尿病患者cIN的独立危险因素。

Objective To understand the clinical feature of the elderly patients with diabetes during coronary angiography, and analyze the risk factors of contrast-induced nephropathy （CIN）. Methods The clinical data of 269 elderly patients who had undergone coronary angiography and percutaneous coronary intervention（PCI） from January 2007 to December 2009 in our hospital were analyzed retrospectively. The patients were divided into two groups CIN group and non-CIN group. The possible risk factors for CIN, such as glycemic control, diabetic complication, renal function, volume of contrast medium, inflammatory state, therapy of perioperative period, past medical history were analyzed and compared between the two groups. Results In 269 elderly patients with diabetes, the incidence of CIN was 9.3% （25/269）. According to estimated glomerular filtration rate （e-GFR）, the patients were divided into four subgroup.≥90 ml/min, 89-60 ml/min, 59-30 ml/min, 〈29 ml/ min. The incidences of CIN for the subgroups were 2.2 %（ 1/45 ）, 4.4 % （ 6 / 135）, 17.3 % （ 14/81 ） and 50 %（4/8）, respectively. Multivariate logistic gradual regressive analysis showed that loop diuretic use （OR〉 6.07）, preoperative e-GFR（〈60 ml/min）（OR〉3.27）, volume of contrast medium （≥200 ml） （0R〉3.26）, chronic kidney disease（CKD） （OR〉2.80） （P=0. 001, 0. 024, 0. 015, 0. 048） were indepen-dent risk factors for CIN （P〈0.05）. Conclusions Loop diuretic use, preoperative GFR （〈60 ml/min）, volume of contrast medium （≥200 ml） and CKD are independent risk factors of CIN.