冠状动脉介入诊疗患者造影剂相关急性肾损伤发生情况及其危险因素研究

Incidence of Contrast-induced Acute Kidney Injury and Its Risk Factors in PCI Treated Patients

目的探讨冠状动脉介入诊疗患者造影剂相关急性肾损伤(CI-AKI)发生情况及其危险因素。方法选择2013年3—9月在哈励逊国际和平医院接受冠状动脉造影(CAG)或经皮冠状动脉介入治疗(PCI)的患者280例,记录所有患者性别、年龄、肾功能、造影剂剂量、左室射血分数、合并症情况、急诊PCI治疗情况等,分析CIAKI的危险因素。结果 280例患者中27例患者发生CI-AKI(观察组),253例患者未发生CI-AKI(对照组),CI-AKI发生率为9.6%。两组患者性别比较,差异无统计学意义(P>0.05);两组患者年龄、CCR、糖尿病发生率、高血压发生率、心功能不全发生率、左室射血分数、造影剂剂量及急诊PCI治疗率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,肾功能不全〔OR=4.6,95%CI(3.1,5.5)〕、年龄>60岁〔OR=2.6,95%CI(1.6,3.5)〕、造影剂剂量>200 ml〔OR=3.1,95%CI(2.4,4.0)〕、心功能不全〔OR=2.3,95%CI(1.4,3.2)〕、糖尿病〔OR=2.7,95%CI(1.3,3.7)〕、高血压〔OR=1.9,95%CI(1.0,2.8)〕、急诊PCI〔OR=3.9,95%CI(2.5,5.3)〕是CI-AKI的独立危险因素(P<0.05)。结论 CI-AKI发生率为9.6%,肾功能不全、年龄>60岁、造影剂剂量>200 ml、心功能不全、糖尿病、高血压、急诊PCI是CI-AKI的独立危险因素。

Objective To investigate the incidence of contrast-induced acute kidney injury（ CI-AKI） and its risk factors in PCI treated patients. Methods From March to September in 2013,a total of 280 patients undergoing CAG or PCI were selected in the Harrison International Peace Hospital,and their gender,age,renal function,contrast agent dose,LVEF,incidence of complications,emergency PCI treatment were recorded,and the risk factors of CI-AKI were analyzed. Results In the 280 patients,27 cases occurred CI-AKI（ served as observation group）, and 253 cases did not（ served as control group）,the incidence of CI-AKI was 9. 6%. No statistically significant differences of gender was found between the two groups（ P〈0. 05）; while there were statistically significant differences of age,creatinine clearance rate（ CCR）,incidence of diabetes,incidence of hypertension, incidence of cardiac insufficiency, LVEF, contrast agent dose and emergency PCI treatment rate（ P〈0. 05）. Multivariate Logistic regression analysis showed that, renal insufficiency 〔OR = 4. 6,95% CI（ 3. 1,5. 5） 〕,aged over 60 years old 〔OR = 2. 6,95% CI（ 1. 6,3. 5） 〕,contrast agent dose over 200 ml 〔OR = 3. 1,95% CI（ 2. 4,4. 0） 〕, cardiac insufficiency 〔OR = 2. 3,95% CI（ 1. 4,3. 2） 〕, diabetes 〔OR = 2. 7,95% CI（ 1. 3,3. 7） 〕,hypertension 〔OR = 1. 9,95% CI（ 1. 0,2. 8） 〕 and emergency PCI treatment 〔OR = 3. 9,95% CI（ 2. 5,5. 3） 〕were risk factors of CI-AKI（ P〈0. 05）. Conclusion The incidence of CI-AKI was 9. 6%,renal insufficiency,aged over60 years old,contrast agent dose over 200 ml,cardiac insufficiency,diabetes,hypertension and emergency PCI treatment are risk factors of CI-AKI.