PCI术中对比剂剂量与患者血肌酐、肾小球滤过率、肌酐清除率的相关性及对近中期不良事件的影响

Correlation among PCI contrast agent dose and serum creatinine,estimated glomerular filtration rate,creatinine clearance rate and adverse events in short and middle time points

目的观察经皮冠状动脉介入治疗(PCI)术中对比剂剂量与患者血肌酐(SCr)、肾小球滤过率(eGFR)水平变化及近中期不良事件的关系。方法 PCI术后患者462例按对比剂剂量分为2组,即剂量<150 ml组103例(对照组)和剂量150~300 ml组359例(观察组)。记录2组患者PCI术前及术后1周、1个月、3个月、9个月的SCr、eGFR及肌酐清除率(CCr),同时记录2组患者术后对比剂肾病(CIN)发生率,再次心肌梗死、PCI术、冠状动脉搭桥及猝死等近中期不良心血管事件(MACE)的发生情况。结果 2组患者术前、术后SCr、eGFR、CCr比较差异均无统计学意义(P>0.05)。CIN发生率:对照组5例(4.9%)低于观察组19例(5.3%)(X^2=0.031,P=0.86)。MACE发生率:对照组13例(12.6%)低于观察组41例(11.4%)(X^2=0.112,P=0.738)。eGFR是发生CIN的独立危险因素(OR=0.931,95%CI=0.910~0.952,P<0.01)。结论在对比剂使用剂量低于300 ml情况下,随着对比剂剂量的增加,其对肾功能的损伤严重程度未增加;对近中期不良事件的发生率无影响。

Objective To observe the relationship between percutaneous coronary intervention（PCI） contrast agent dose and serum creatinine（SCr）,glomerular filtration rate（eGFR） and the adverse events in the short,middle lime points.Methods According to the dose of contrast agent,462 patients after PCI were divided into 2 groups,the dose 150 ml group with 103 cases（control group） and the dose ol 150-300 ml group of 359 cases（observation group）.Recorded the SCr,eGFR and creatinine clearance rate（CCr） before and alter the operation at 1 week,1 month,3 months,9 months,also recorded contrast induced nephropathy（CIN） incidence,re-infarction alter PCI operation,main adverse cardiovascular events（MACE）such as PCI,coronary artery bypass graft and sudden death＇ s occurrence.Results There were no significant differences of preoperative and postoperative SCr,eGFR and CCr in the 2 groups of patients（P〉0.05）.The incidence of CIN：5cases（4.9%） in the control group,which was lower than the observation group of 19 cases（5.3%）（χ^2 =0.031,P =0.86）.The incidence of MACE：13 cases（12.6%） in the control group,which was lower than the observation group of 41cases（11.4%）（χ^2 = 0.1 12,P= 0.738）.eGFR is an independent risk factor lor CIN（OR =0.93 1.95%CI 0.910-0.952,P〈0.01）.Conclusion Less than 300 ml,with increasing the dose of contrast agent,the function of kidney injury severity is not increased;the near and middle term incidence of adverse events was not affected by the dose of contrast agent.