肾功能相对正常的急性冠脉综合征患者PCI术后不同定义的对比剂肾病发生率和近期预后

Incidence and in-hospital outcomes of contrast-induced nephropathy based on different definitions in patients with acute coronary syndrome and relative normal renal function

目的：评估不同定义的对比剂肾病对于肾功能相对正常（eGFR≥60ml/min/1.73m2）的急性冠脉综合征（急性非ST段抬高型心肌梗死＋急性ST段抬高型心肌梗死）患者PCI术后对比剂肾病（contrast-induced nephropathy,CIN）危险因素、发生率以及住院期间预后的影响。方法：选取肾功能相对正常的ACS患者232例。依据对比剂肾病定义分为CIN25%组（PCI术后血清肌酐增加≥25%）和CIN0.5组（PCI术后血清肌酐绝对值增加≥0.5mg/dl）组,计算所有患者的eGFR值、GRACE积分及Mehran积分,应用多元回归分析评估CIN和住院不良事件（再梗死＋急性左心力衰竭＋死亡）的风险。结果：CIN25%组和CIN0.5组发生率分别为12.1%和5.6%,GRACE积分〉140是CIN25%组的独立危险因素（OR=5.22,95%CI 2.39~11.36,P=0.001）,CIN0.5组是住院期间不良事件的独立危险因素（OR=4.84,95%CI1.42~16.54,P=0.012）。结论：肾功能相对正常的ACS患者合并GRACE积分高时PCI术前及术后应予以充分的预防CIN措施,当术后肌酐绝对值升高≥0.5mg/dl是应警惕住院期间不良心脏事件的发生。

Objective：To evaluate the incidence,risk factors,and in-hospital prognosis of contrast-induced nephropathy based on the different definitions in patients with acute myocardial infarction and relative normal kidney function.Method：The study population included all 232 consecutive patients from May 1,2013 to March 28,2014.We calculated estimated glomerular filtration rate,GRACE risk score and Mehran risk score.The CIN was defined according to 2definitions：CIN25%（increases in serum creatinine≥25%）and CIN0.5（increases in serum creatinine≥0.5mg/dl）.The risk of CIN and in-hospital cardiac events was assessed using multivariable logistic regression.Result：CIN25% occurred in 28（12.1%）patients,13（5.6%）patients developed CIN0.5.Global Registry of Acute Coronary Events（GRACE）risk score〉140was an independent factor of CIN25%（OR=5.22,95%CI2.39-11.36,P=0.001）,CIN0.5was an independent factor of in-hospital cardiac events（mortality,reinfarction and heart failure）（OR=4.84,95%CI1.42-16.54,P=0.012）.Conclusion：Patients admitted with acute coronary syndrome and relative normal renal function with high risk according to GRACE score are at high risk of developing CIN.In these groups,the effective measure to prevent CIN would be recommended before and after PCI.Also,increases in serum creatinie≥0.5mg/dl should alert us to a high rate of in-hospital cardiac events（death,reinfarction,and heart failure）.