老年患者冠状动脉造影术后对比剂肾病发生率及危险因素分析

The morbidity of contrast-induced nephropathy after coronary angiography in elderly people and its risk factors

目的了解老年患者在冠状动脉造影术后对比剂肾病（CIN）的发生率和主要危险因素。方法回顾分析2011年1月至2012年12月在北京医院心内科行冠状动脉造影和（或）介入治疗的老年患者1627例，术后发生CIN患者45例为CIN组，非CIN组1582例，分析两组患者的基线资料，应用多因素Logistic回归分析确定发病危险因素。结果CIN发生率为2．8％（45／1627）。非CIN组和CIN组患者年龄〉70岁[56．9％（900例）比80．0％（36例）]、估算的肾小球滤过率〈60ml·min^-1·1．73m^-2[28．9％（457例）和53．3％（24例）]、使用利尿剂[15．5％（245例）比31．1％（14例）]、低收缩压〈100mmHg（1mmHg=0．133kPa，5．4％（85例）和6．7％（3例）]比较，差异有统计学意义（P〈0．05或P〈0．01）。以年龄〉70岁、估算的肾小球滤过率〈60ml·min^-1·1．73m^-2、使用利尿剂、低收缩压为变量行多因素Logistic回归分析，结果显示年龄〉70岁、估算的肾小球滤过率〈60ml·min^-1·1．73m^-2、使用利尿剂是发生CIN的独立危险因素（0R值分别为2．21、1．93和1．97，均P〈0．05）。结论老年患者是发生CIN的高危人群，主要的危险因素为年龄、基础肾脏功能和应用利尿剂。

[Abstract] Objective To investigate the morbidity of contrast-induced nephropathy （CIN） after coronary angiography in elderly people and its major risk factors. Methods We conducted a retrospective observational study to analyze the patients who underwent coronary angiography and/or angioplasty in Beijing Hospital from January 2011 to December 2012. 1 627 patients were enrolled in this study and divided into CIN group （n=45） and non-CIN group （1 582）. Clinical baseline data in the two groups were analyzed, and the risk factors were determined by multivariate Logistic regression analysis. Results The incidence of CIN was 2.8% （45/1 627）. Between the two groups with or without CIN, there were differences in age〉70 years, estimated glomerular filtration rate （eGFR） 60 ml ·min^-1· 1.73 m^-2, use of diuretic, low blood pressure 〈100 mmHg （56.9% （900 cases） vs. 80.0% （36 cases）, 28.9% （457 cases） vs. 53.3% （24 cases）, 15.5% （245 caseg） vs. 31. 1% （14 cases）, 5.4% （85 cases） vs. 6.7% （3 cases）, respectively, P〈0.05 or 0.01]. Multivariate logistic regression analysis showed that age〉70 years, eGFR %60 ml · min^-1· 1.73 m^ 2, and use of diuretic were the independent risk factors for CIN （OR =2.21, 1.93, 1.97, respectively, all P〈0.05）. Conclusions The elderly people have the high risk for CIN after coronary angiography, and the major risk factors include age, basal renal function and use of diuretic.