对比剂剂量与肾小球滤过率比值在对比剂肾病中的预测价值

Predictive value of ratio of contrast medium volume to eGFR for contrast-induced nephropathy

目的探讨对比剂剂量（V）与估算肾小球滤过率（eGFR）的比值（V／eGFR）在经皮冠状动脉介入（PCI）诊疗中与对比剂肾病（CIN）的相关性，进一步明确对比剂剂量与eGFR的比值在对比剂肾病中的预测价值。方法将先后两次在第三军医大学大坪医院野战外科研究所心内科行PCI诊疗操作的202例冠心病患者分为第一次组和第二次组，收集病史、彩色多普勒超声心动图、肾功能检查、血常规等指标，计算V／eGFR，分析V／eGFR与CIN相关性，通过ROC曲线确立V／eGFR对CIN的预测价值。结果第一次组，CIN发病率为9．9％；第二次组，CIN发病率为17-3％。多元线性回归分析发现V／eGFR是发生CIN的最重要预测因素。第一次组中，V／eGFR〉2．895（OR：1．986，95％CI1．466±2．691，P〈0．001）为预测CIN发生的最佳值，第二次组中，V／eGFR〉2．320（OR=4．685，95％C12．783-7．885，P〈0．001）为预测cIN发生的最佳值。结论首次使用对比剂并发生CIN的患者，在再次使用对比剂时，CIN的患病率显著升高，提示V／eGFR可能是一个预NCrN更好的指标。

Objective To explore the relationship of the ratio of contrast medium volume to estimated glomerular filtration rate （eGFR） in percutaneous coronary intervention （PCI） and/or coronary angiography （CAG） with the incidence of contrast-induced nephropathy （CIN）, so as to elucidate the predictive value of the ratio for CIN. Methods A total of 202 consecutive consenting patients with coronary heart disease who were given PCI and/or CAG for twice in an interval of （457.31±246.96） d in our department during July 2008 to June 2011 were enrolled. Their medical history, color Doppler echocardiogram, renal function and blood routine examination results at the first and second time of PCI and/or CAG were collected. The ratio of contrast medium volume to eGFR （V/eGFR） at the two performance was calculated, and its correlation with CIN was analyzed. Receiver operating characteristic （ROC） curve was plotted to determine the predictive value of the ratio. Results The CIN incidence of the cohort during the first time receiving PCI and/or CAG was 9.9% （20/202）, while that during the second time was 17.33% （35/202）, with significant difference between the two performance （P 〈 0.05）. Multiple linear regression analysis showed that V/eGFR was the most significant predictive factor of CIN. For the patients who receiving PCI and/or CAG for the first time, the ratio of V/eGFR≥2.895 （OR = 1.986, 95% CI = 1.466-2.691, P 〈 0.001） was the independent predictor of CIN. In the second time, the ratio ≥2.230 （OR = 4.685, 95% CI = 2.783-7.885, P 〈 0.001） was the independent predictor. Conclusion For the patients having CIN in the first time receiving PCI and/or CAG, they are prone to CIN in the second time, suggesting that the ratio of V/eGFR might be a good predictive index of CIN.