冠脉介入治疗中对比剂肾病发生的临床研究

Contrast-induced nephropathy in patients underwent percutaneous coronary intervention: a clinical study

目的:探讨经皮冠状动脉介入(PCI)治疗患者对比剂肾病(CIN)的发病率及危险因素。方法:选择2011年5月至2014年5月在韶关市第三人民医院接受PCI的180例患者作为研究对象,以术后72 h内血清肌酐(SCr)较术前升高25%或升高44.2μmo L/L(0.5 mg/d L)作为CIN的诊断标准,分析CIN的发病率及危险因素。结果:180例患者中年龄≥65岁者69例(38.3%),合并高血压124例(69.44%)、糖尿病62例(58.33%),术前e GFR<60 m L/min者85例(56.67%),服用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂106例(58.89%)、利尿剂19例(10.56%)、二甲双胍9例(5.00%)、他汀类药物163例(90.56%),对比剂用量≥150 m L者65例(36.11%)。180患者中14例(7.8%)发生CIN,CIN组与非CIN组患者在年龄≥65岁、对比剂用量≥150 m L等方面有明显差异(P<0.05)。Logistic多因素回归分析显示,年龄≥65岁、术前e GFR<60 m L/min、对比剂用量≥150 m L是CIN的独立危险因素,他汀类药物未能减少对围手术期对比剂的发生。结论:PCI患者的CIN发病率较高,年龄≥65岁、术前e GFR<60m L/min和对比剂用量≥150 m L是其独立危险因素。

Objective： To investigate the incidence and the rick factors of contrast-induced nephropathy（ CIN） in patients underwent percutaneous coronary intervention（ PCI）. Method： A total of 180 cases underwent PCI between May 2011 and May 2014 was included as the subjects in the study. The diagnostic criteria of CIN was identified if the serum creatinine（ SCr） increased 25% or 44. 2 μmol / L（ 0. 5 mg / d L） after 72 h of the operation compared with baseline. The incidence and the rick factors of CIN were analyzed. Results： In 180 patients,69 ≥ 65 years old（ 38. 3%）,124 with complicated hypertension（ 69. 44%）,62 with diabetes mellitus（ 58. 33%）,85 with preoperative e GFR 60 ml / min（ 56. 67%）,106 received angiotensin converting enzyme inhibitor or angiotensin receptor blocker（ 58. 89%）,19 received diuretics（ 10. 56%）,9 received metformin（ 5%）,163 received statins（ 90. 56%）,65 received volume of contrast medium ≥ 150 ml（ 36.11%）. Among180 patients,CIN occurred in 14 cases（ 7. 8%）. There were significant differences between CIN group and non-CIN group in terms of age ≥65 years old and volume of contrast medium ≥150 mL（ P 0. 05）.Logistic regression analysis showed that age ≥65 years old,e GFR 60 mL / min,and volume of contrast medium≥150 mL were independent risk factors of CIN,whereas statins failed to reduce the occurrence of perioperative CIN. Conclusion： The incidence of CIN in patients underwent PCI was highe. The age≥65 years and the volume of contrast medium ≥ 150 ml are the independent risk factors of CIN.