贫血与慢性肾脏病患者经皮冠状动脉介入术后对比剂肾病的关系

The correlation of anemia and contrast-induced nephropathy in patients with chronic kidney diseaseundergoing percutaneous coronary intervention

目的探讨贫血与慢性肾脏病（CKD）患者经皮冠状动脉介入术（PCI）后发生对比剂。肾病（CIN）的关系。方法连续收集2010年10月至2012年12月于广东省人民医院住院拟行PCI的CKD患者292例，根据术前血红蛋白水平将患者分为贫血组（男性〈130g/L，女性〈120g/L）（101例）和非贫血组（191例），分析两组患者的临床特点、CIN发生率及其他院内不良事件。采用多因素logistic回归分析探讨贫血与CIN的关系。结果292例患者中，CIN的发生率达9．9％（29／292）；其中贫血组17．8％（18/101），显著高于非贫血组5．8％（11/191）（X^2=10．747，P=0．001）。与非贫血组相比，贫血组中需要肾脏替代治疗、主动脉球囊反搏术（IABP）治疗、机械通气和急性心力衰竭发作的比例较高（分别是4．0％比0．0％，P=0．006；9．9％比1．O％，P〈0．001；3．0％比0．0％，P=0．017；5．9％比1．0％，P=0．015）。多因素logistic回归分析显示，经过年龄〉75岁、基础肾功能、糖尿病史等因素校正后，贫血仍与CIN显著独立相关（OR=2．7，95％CI1．2～6．3，P=0．017）。结论贫血是CKD患者行PCI后发生CIN的危险因素，加强对术前贫血的认识与治疗，可能对减少这些患者发生CIN具有重要的意义。

Objective To investigate the correlation of anemia and contrast-induced nephropathy （CIN） in patients with chronic kidney disease （CKD） undergoing percutaneous coronary intervention （PCI）. Methods A total of 292 patients with CKD undergoing PCI admitted to Guangdong General Hospital from October 2010 to December 2012 were consecutively enrolled in this study. Anemia was defined as hemoglobin 〈 130 g/L in male and 〈 120 g/L in female. All patients were divided into the following two groups by their preoperative hemoglobin： anemic group （n = 101 ） and non-anemic group （n = 191 ）. The incidence of CIN and other major adverse cardiac events in hospital were evaluated. The correlation between CIN and anemia was evaluated by multivariate logistic regression analysis. Results The incidence rates of CIN were 9. 9% （29/292） in all subjects, 17.8% （ 18/101 ） in the anemic group and 5.8% （ 11/191 ） in the non-anemic group. Compared with the non-anemic group, more patients in the anemic group required renal replacement therapy and intra-aortic balloon pump therapy, mechnical ventilation and manifested as acute heart failure （4.0% vs0.0%, P=0.006; 9. 9% vs 1.0%, P〈0.001; 3.0% vs 0.0%, P= 0. 017 ; 5.9% vs 1.0%, P =0. 015 ; respectively）. Adjusted for age 〉75 years, basic renal function and the history of diabetic mellitus in the logistic regression analysis, anemia remained as a significant and independent risk predictor for CIN in patients with CKD （ OR = 2. 7, 95% CI 1.2-6.3, P = 0. 017 ） . Conclusions Pre-proeedure anemia is a significant and independent predictor of CIN in patients with CKD undergoing PCI. Caution and treatment for the pre-proeedure anemia could be very useful for the prevention of CIN in those patients.