冠状动脉慢性完全性闭塞病变患者经皮冠状动脉介入治疗后造影剂肾病危险因素分析

Risk factors of contrast-induced nephropathy in patients with chronic total occlusion who underwent percutaneous coronary intervention

目的 探讨冠状动脉慢性完全性闭塞病变（chronic total occlusion,CTO）患者行经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后造影剂肾病（contrast-induced nephropathy,CIN）发生的危险因素。方法 入选广东省人民医院300例行PCI治疗的CTO患者,分为CIN组及非CIN组。比较两组间基线资料及院内临床事件的发生率。采用Logistic回归分析校正各危险因素与CIN风险的相关性。结果 300例CTO患者中35（11.7%）例发生CIN。CIN组与非CIN组间原发性高血压患者比例、2型糖尿病患者比例、男性比例、高脂血症患者比例比较,差异均无统计学意义（P〉0.05）。CIN组基线估算肾小球滤过率（e GFR）显著低于非CIN组,差异有统计学意义（P〈0.05）。而年龄〉75岁、左心室射血分数（LVEF）〈45%、低蛋白血症、贫血患者比例在CIN组显著高于非CIN组,差异有统计学意义（P〈0.05）。多因素Logistic回归分析发现年龄〉75岁（OR=1.288,95%CI：1.032~1.608,P=0.025）、LVEF〈45%（OR=2.941,95%CI：1.334~6.483,P=0.007）、估算肾小球滤过率（OR=1.017,95%CI：1.003~1.030,P=0.016）与CIN发生率显著相关。结论 行PCI诊治的CTO患者中,年龄〉75岁、左心室射血分数〈45%、肾功能不全为CIN发生的危险因素。

Objectives To investigate the risk factors of contrast-induced nephropathy（CIN） in patients with coronary chronic total occlusion（CTO） who underwent percutaneous coronary intervention（PCI）. Methods Totally 300 patients with CTO receiving PCI were recruited from Guangdong General Hospital. The patients were divided into CIN group and non-CIN group. Baseline characteristics and in-hospital clinical events were compared between the two groups. Logistic regression was used to investigate the risk ractors of CIN. Results All the 300 patients with CTO were recruited and 35（11.7%） of them developed CIN. Proportions of hypertension, type 2 diabetes mellitus, males and dyslipidemia were not significantly different between CIN group and non-CIN group（P〉0.05）. Patients in CIN group were much more likely with lower estimated glomerular filtration rate（e GFR） at baseline（P〈0.05）, and proportions of patients with age〉 75 years, left ventricular ejection fraction（LVEF） 〈45%, hypoproteinemia and anemia were significantly higher in CIN group than in non-CIN group（P〈0.05）. Logistic regression analysis found that age〉75 years（OR=1.288, 95%CI ： 1.032-1.608, P=0.025）, LVEF45%（OR=2.941, 95%CI ： 1.334-6.483, P=0.007）, e GFR（OR =1.017, 95% CI ： 1.003-1.030, P =0.016） were strongly correlated with CIN incidence. Conclusions Age 〉75years, LVEF〈45% and renal inadequacy are the risk factors of CIN in patients with CTO after coronary intervention.