造影剂剂量与估计肾小球滤过率比值对高龄糖尿病患者造影剂肾病的诊断价值

The diagnostic value of the ratio of contrast medium volume to estimated glomerular filtration rate in contrast-induced nephropathy diabetics patients

目的探讨经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发病情况;评估造影剂剂量(CMV)与估计肾小球滤过率(eGFR)比值对高龄糖尿病患者造影剂肾病的诊断价值。方法回顾性分析875例在济宁医学院附属医院心内科接受PCI患者的临床资料。采用SPSS 19.0统计软件进行统计学分析,比较CIN组与非CIN组患者的各项资料,如性别、年龄、吸烟、是否低血压、左室射血分数(LVEF)、血红蛋白值、低密度脂蛋白(LDL-C)、空腹血糖、高血压和2型糖尿病病史;术前血肌酐(Scr)、eGFR;术后48h Scr、eGFR。用Logistic回归分析CIN的危险因素。结果入组患者CIN患病率4.80%(42例),男性、合并高血压病、2型糖尿病、高脂血症、吸烟、低血压、贫血、发病时心肌梗死合并休克的患病率分别为65.71%、54.86%、37.26%、22.51%、34.17%、16.80%、4.20%、8.91%。CIN与非CIN患者相比,在高龄患者(33.33%,19.33%,χ~2=4.902,P<0.05)、患有糖尿病(52.38%,36.49%,χ~2=4.317,P<0.05),吸烟(50.00%,33.37%,χ~2=4.914,P<0.05),发病时低血压(28.57%,16.21%,χ~2=4.374,P<0.05),心肌梗死伴休克(19.05%,8.40%,χ~2=5.579,P<0.05),低LVEF[(36.46±9.27)%,(43.62±3.46)%,t=2.398,P<0.05]及造影剂用量大[(154.5±95.3)m L,(115.04±49.63)m L,t=2.069,P<0.05]的患者更容易发生CIN;eGFR在CIN组明显降低[(72.50±15.06)m L/(min·1.73m^2),(108.55±21.7)m L/(min·1.73m^2),t=7.220,P<0.05]。CMV/eGFR在CIN组与非CIN组间[(2.19±1.30),(1.01±0.40),t=-3.439,P<0.05]差异有统计学意义。多因素回归分析显示高龄(年龄≥70岁,RR=5.27,P<0.05)、糖尿病(RR=9.87,P<0.05)、LVEF(RR=7.35,P<0.05)、术前eGFR(RR=4.12,P<0.05)、心肌梗死合并休克(RR=6.75,P<0.05)、CMV/eGFR(RR=13.45,P<0.05)是CIN的危险因素。ROC工作曲线显示,CMV/eGFR>1.52对于高龄糖尿病患者是否发生CIN的敏感度为72.50%,特异度为84.00%。结论PCI前评估患者的危险因素非常重要,高龄糖尿病更容易发生CIN;CMV/eGFR比值是一个独立的能够预测高龄糖尿病患者PCI后能否发生CIN的指标。

Objective To investigate the incidence of contrast-induced nephropathy (CIN ) in patients undergoing percutaneous coronary intervention(PCI)and assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate (CMV /eGFR)in super-elderly diabetic patients undergoing elective PCI who developed CIN.Methods Eight hundred and seventy-five PCI patients&nbsp;were retrospectively collected in Affiliated Hospital of Jining Medical University.Patients were divided into CIN group and non-CIN group based on the presence of CIN.Date of the two groups were compared concerning sex,age,smoking,hypotension,LVEF,hemoglobin,LDL-C,glucose,history of hypertension and type 2 diabetes,serum creatinine and eGFR pre-PCI,serum creatinine and eGFR post 48 h-PCI.Risk factors for CIN were analyzed by logistic regression statistical model.Results Among eight hundred and seventy-five patients,forty-two patients experienced CIN (4.8%).The disease incidence of male,hypertention,type 2 diabetes,hyperlipidemia,smoking,hypotentino,anemia,myocardial infarction with shock was 65.71 %,54.86%, 37.26%,22.51 %,34.1 7%,1 6.80%,4.20%,8.91 %,respectively.In the other two groups,the patients with the super-elderly (age ≥70y)(33.33%,1 9.33%,χ2 =4.902,P<0.05),type 2 diabetes(52.38%, 36.49%,χ2 =4.31 7,P =0.05),smoking (50.00%,33.37%,χ2 =4.91 4,P <0.05),with hypotention (28.57%,1 6.21 %,χ2 =4.374,P <0.05 ),myocardial infarction combined with shock (1 9.05%, 8.40%,χ2 =5.579,P<0.05),LVEF[(36.46 ±9.27)%,(43.62 ±3.46)%,t =2.398,P <0.05],and larger contrast medium volume[(154.5 ±95.3)mL,(1 1 5.04 ±49.63)mL,t =2.069,P <0.05 ]were proned to CIN.eGFR was lower in CIN [(72.50 ±1 5.06)ml/(min·1 .73m2 ),(1 08.55 ±21 .7)ml/(min·1 .73m2 ),t =7.220,P <0.05].There were significant differences between the two group in CMV/eGFR[(2.19 ±1 .30),(1 .01 ±0.40),t=-3.439,P<0.05 ].Logistic regression analysis showed that age≥70y(RR =5.27,P <0.05),type 2 diabetes(RR =9.87,P <0.05),LVEF(RR =7.35,P <0.05), pre-PCI eGFR(RR =4.1 2,P <0.05),myocardial infarction with shock(RR =6.75,P <0.05),CMV /eGFR(RR =1 3.45,P<0.05)were the risk factors for CIN.ROC analysis indicated that a CMV /eGFR of more than 1 .5 was a predictor of CIN.The sensitivity and specificity for CIN of CMV /eGFR of more than 1 .5 was 72.50% and 84.00%,respectively.Conclusions It is very important to estimate risk factors of patients before PCI.The super-elderly diabetic patients are proned to CIN.The CMV /eGFR ratio could be a valuable predictor for CIN in super-elderly diabetic patients after elective PCI.