高龄患者同型半胱氨酸水平与PCI术后造影剂肾病的关系

Impact of homocysteine on contrast induced nephropathy after percutaneous coronary intervention in patients at advanced age

目的探讨血浆同型半胱氨酸（Hcy）水平对高龄患者经皮冠状动脉介入治疗（PCI）术后发生造影剂肾病（CIN）的影响。方法选取2014年1月至2015年12月行经PCI的高龄患者302例（年龄≥75岁）为研究对象。1根据术前Hcy水平分为A组（55例,Hcy≤15μmol/L）、

Objective To explore the impact of plasma homocysteine（ Hcy） on contrast- induced nephropathy（ CIN） after percutaneous coronary intervention（ PCI） in patients at advanced age. Methods 1302 elderly patients undergoing PCI in our department between January2014 and December 2015 were enrolled（ age≥75）. Patients were divided into 3 groups according to the preoperative plasma Hcy level： group A（ n = 55,Hcy≤15 μmol/L）,group B（ n = 178,15 〈μmol/L Hcy 〈20 μmol/L）,group C（ n = 69,Hcy≥20 μmol/L）. The baseline data and the incidence of CIN were compared between the 3 groups. 2Patients were divided into 2 groups according to the occurrence of CIN. The baseline data and the level of Hcy between the 2 groups were compared. 3Multivariate logistic regression analysis was used to define the independent risk factors for CIN with advanced age. Results 1The incidence of CIN was significantly different between the 3 groups（ 5. 5% ︰ 9. 6% ︰ 23. 2%,P 〈0. 001）. 2The plasma Hcy level was significantly higher in CIN group compared to non- CIN group [（ 24. 0 ± 8. 0） μmol / L vs.（ 20. 2 ±6. 7） μmol / L,P = 0. 01]. 3After adjusting the confounding factors,including age,basic cardiac and renal function and diabetes,multivariate logistic regression models showed that hige Hcy was an independent risk factor for CIN（ OR = 1. 52,95% CI： 1. 39 ~ 1. 61,P = 0. 02）. Conclusion Hyperho- mocysteinemia was an independent predictive factor for CIN after PCI for patients at advanced age.