术前血糖水平对急诊冠状动脉介入治疗后造影剂肾病发生率的影响

Impact of pre-operative blood glucose level on incidence of contrast-induced nephropathy in urgent coronary interventions： analysis of 745 cases

目的了解术前血糖水平对行急诊冠状动脉介入治疗术的急性sT段抬高型心肌梗死患者造影剂肾病发生率的影响。方法2008年10月至2012年5月期间在首都医科大学附属北京安贞医院接受急诊冠状动脉介入治疗术的急性ST段抬高型心肌梗死患者共745例，所有患者均应用低渗非离子造影剂。测定介入治疗前和术后第1、2、3天肾功能，了解造影剂肾病（CIN）发生的独立危险因素，分析血糖水平对CIN发生率的影响。结果745例患者中，男性530例，女性215例，发生CIN共156例，发病率为20．9％；CIN组中年龄、糖尿病、高敏C反应蛋白（hs—CRP）、血糖、左室射血分数（LVEF）及再灌注时间方面，同t^CIN组比较差异有统计学意义（P〈0．05）；CIN组患者全因死亡率、心源性死亡率、恶性心律失常发生率增加（P〈0．05）；多因素logistic回归分析显示，血糖水平、hs．CRP、LVEF是CIN发生的独立危险因素。血糖水平采取四分法，显示和CIN的发生率密切相关。结论术前的血糖水平和急诊冠状动脉介入治疗的急性心肌梗死患者CIN的发生密切相关，是CIN独立危险因素，增加急性心肌梗死患者住院期间死亡率。

Objective To determine the effect of pre-operative blood glucose level on the incidence of contrast-induced nephropathy （CIN） in patients with ST-segment elevation myocardial infarction undergoing urgent percutaneous coronary interventions （PCI）. Methods A total of 745 ST-segment elevation myocardial infarction patients undergoing urgent coronary interventions in our department from October 2008 to May 2012 were enrolled in this study. All patients received low osmolar nonionic contrast media. Renal function was evaluated by serum creatinine concentration at baseline and each day for the following 3d to analyze the effect ofpre-operative glucose level on the incidence of CIN. Results Among the 745 patients （530 males and 215 females）, there were 156 patients having CIN, with an incidence of 20.9%. There was no significant difference in the age, diabetes mellitus, high sensitivity C-reactive protein （hs-CRP）, blood glucose level, left ventricular ejection fraction （LVEF）, and reperfusion time between the CIN and non-CIN groups （P 〈 0.05）. The patients from the CIN group had significantly higher risk of in-hospital all-cause mortality, cardiac death, and arrhythmias （P 〈 0.05）. Multiple logistic regression analysis showed that blood glucose, hs-CRP, and LVEF were independent risk factors for CIN. Elevated glucose level as variables categorized into quartiles were independently correlated with the development of CIN （P 〈 0.05）. Conclusion Elevated pre-operative glucose level has a close correlation with the development of CIN in patients with ST-segment elevation myocardial infarction undergoing urgent PCI, and increases in-hospital mortality as an independent risk factor for C1N.