急性冠脉综合征患者经皮冠状动脉介入治疗后发生对比剂肾病的影响因素研究

Influencing Factors of Contrast- induced Nephropathy in Acute Coronary Syndrome Patients Treated by Percutaneous Coronary Intervention

目的探究急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗后发生对比剂肾病的影响因素。方法选取2012年5月—2014年5月武汉大学人民医院心内科收治的ACS患者260例,均行经皮冠状动脉介入治疗,其中58例患者治疗后发生对比剂肾病,作为观察组;另202例患者治疗后未发生对比剂肾病,作为对照组。回顾性分析两组患者的实验室检查结果〔血肌酐、尿酸、血糖、血红蛋白(Hb)、白细胞计数(WBC)、红细胞分布宽度(RDW)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、超敏C反应蛋白(hs-CRP)〕、介入治疗情况(手术时间、造影剂使用量、支架长度、支架直径及慢性完全闭塞病变发生率),分析发生对比剂肾病的影响因素。结果两组患者血糖、WBC、TC、TG、LDL-C、HDL-C比较,差异无统计学意义(P>0.05);观察组患者血肌酐、尿酸及hs-CRP水平均高于对照组,RDW大于对照组,Hb低于对照组(P<0.05)。两组患者手术时间、支架长度以及支架直径比较,差异无统计学意义(P>0.05);观察组患者造影剂使用量、慢性完全闭塞病变发生率高于对照组(P<0.05)。多因素Logistic回归分析结果显示,血肌酐水平升高〔OR=1.268,95%CI(1.004,1.025)〕、RDW增大〔OR=2.517,95%CI(1.687,3.826)〕及hs-CRP水平升高〔OR=1.314,95%CI(1.125,1.542)〕是ACS患者经皮冠状动脉介入治疗后发生对比剂肾病的独立危险因素(P<0.05)。结论血肌酐水平升高、RDW增大及hs-CRP水平升高是ACS患者经皮冠状动脉介入治疗后发生对比剂肾病的危险因素,因此临床需注意监测ACS患者介入治疗后血肌酐、RDW及hs-CRP水平,及时调控以预防对比剂肾病的发生。

Objective To explore the influencing factors of contrast-induced nephropathy in acute coronary syndrome patients treated by percutaneous coronary intervention. Methods From May 2012 to May 2014,a total of 260 acute coronary syndrome patients were selected in the Department of Cardiology,People′s Hospital of Wuhan University,all of them receivedpercutaneous coronary intervention,thereinto 58 cases with contrast -induced nephropathy were served as observation group, while other 202 cases without contrast-induced nephropathy were served as control group. Laboratory test results（ including Scr, UA,blood glucose, Hb, WBC, RDW, TC, TG, LDL-C, HDL-C and hs-CRP ） and therapeutic conditions of PCI （operation duration,contrast medium usage,stent length,stent diameter and incidence of chronic total occlusion）of the two groups were retrospectively analyzed to figure out the influencing factors of contrast - induced nephropathy. Results No statistically significant differences of blood glucose,WBC,TC,TG,LDL-C or HDL-C was found between the two groups （P〉0. 05）,while Scr,UA and hs-CRP levels of observation group were statistically significantly higher than those of control group,RDW of observation group was statistically significantly wider than that of control group,Hb of observation group was statistically significantly lower than that of control group （ P 〈0. 05 ）. No statistically significant differences of operation duration,stent length or stent diameter was found between the two groups （ P 〉0. 05 ）, while contrast medium usage and incidence of chronic total occlusion of observation group were statistically significantly higher than those of control group （ P〈0. 05）. Multivariate Logistic regression analysis showed that,increased Scr level〔OR=1. 268,95%CI（1. 004,1. 025）〕, increased RDW〔OR =2. 517,95%CI（1. 687,3. 826）〕and increased hs-CRP level〔OR =1. 314,95%CI（1. 125, 1. 542）〕were independent risk factors of contrast - induced nephropathy in acute coronary syndrome patients treated by percutaneous coronary intervention（P 〈0. 05）. Conclusion Increased Scr level,increased RDW and increased hs-CRP level are independent risk factors of contrast-induced nephropathy in acute coronary syndrome patients treated by percutaneous coronary intervention,which should be closely monitored to prevent the onset of contrast-induced nephropathy.