糖化血红蛋白水平与不稳定性心绞痛择期冠状动脉介入术后对比剂肾病关系的研究

Relationship between glycated hemoglobin and contrast-induced nephropathy after selective percutaneous coronary intervention in patients with unstable angina pectoris

目的探讨糖化血红蛋白（Hb A1c）与不稳定心绞痛（UA）择期冠状动脉介入治疗（PCI）患者术后发生对比剂肾病（CIN）的关系。方法选取2015年1月~2015年10月于北京安贞医院诊断UA并行择期PCI患者420例患者,根据Hb A1c水平分为实验组（Hb A1c≥6.5%,n=118）和对照组（Hb A1c〈6.5%,n=302）两组,比较两组患者术前及术后36 h血肌酐水平、内生肌酐清除率（Ccr）水平及CIN发生率,分析Hb A1c水平与不稳定性心绞痛患者择期PCI术后发生CIN的关系。结果实验组患者24.4%患者发生CIN,对照组患者0.67%发生CIN,实验组较对照组CIN发生率明显增高（P〈0.05）。二元Logistic回归分析显示Hb A1c水平≥6.5%是UA患者择期PCI术后发生CIN的独立危险因素（OR=5.711;95%CI：2.475~13.785,P=0.000）。结论不稳定心绞痛行择期冠状动脉介入治疗患者Hb A1c≥6.5%术后CIN发生率将明显升高。

Objective To discuss the relationship between glycated hemoglobin（Hb Alc） and contrastinduced nephropathy（CIN） after selective percutaneous coronary intervention（PCI） in patients with unstable angina pectoris（UAP）. Methods UAP patients treated with selected PCI（n=420） were chosen from Jan. 2015 and Oct. 2015, and the divided, according to the level of Hb Alc, into test group（Hb A1c≥6.5%, n=118） and control group（Hb A1c6.5%, n=302）. The levels of creatinine（Cr） and endogenous creatinine clearance rate（CCr）, and incidence of CIN were compared between 2 groups before and 36 h after PCI. The relationship between Hb A1 c level and CIN after PCI was analyzed. Results The incidence of CIN was 24.4% in test group and 0.67% in control group（P0.05）. The results of binary Logistic analysis showed that Hb A1 c level≥6.5% is the independent risk factor in UAP patients after selected PCI（OR=5.711; 95%CI： 2.475-13.785, P=0.000）. Conclusion The incidence of CIN increases significantly in UPA patients with Hb A1 c level≥6.5% after selected PCI.