冠状动脉造影及介入治疗致造影剂肾病的危险因素分析

Analysis of risk factors of contrast-induced nephropathy in patients undergoing coronary angiography or non-emergent percutaneous coronary intervention

目的观察不稳定型心绞痛患者在冠状动脉造影(coronary angiography,CAG)或非急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)前后肾功能的变化以及造影剂肾病(contrast-induced nephropathy,CIN)的发生率,探讨CIN的危险因素。方法不稳定型心绞痛患者500例,在手术前后行水化治疗的基础上,测定不同时间胱抑素C(Cystatin C,Cys C)、血清肌酐(serum creatinine,SCr)及肾小球滤过率(estimated glomerular filtration rate,eGFR),计算CIN发生率并分为CIN组及非CIN组,评估CIN组手术前后肾功能变化。比较2组的临床特点,对其进行CIN危险评分(Mehran评分系统),分析CIN发生的危险因素。结果 500例入选患者中72例发生了CIN,发生率为14.4%。CIN组年龄、入院时Cys C和SCr水平、造影剂用量、糖尿病比例、高血压比例、病变严重程度比例、Mehran评分高于非CIN组,eGFR低于非CIN组,差异均有统计学意义(P<0.05)。CIN组手术后Cys C和SCr水平呈先升高再降低趋势,eGFR水平呈先降低后升高趋势,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,入院Cys C水平、入院eGFR水平、糖尿病病史、造影剂用量及Mehran评分是CIN的危险因素。结论即使预防性应用水化治疗,CIN发病率仍然很高。将Cys C及SCr结合有利于提高CIN的检出率。造影剂用量、糖尿病病史、基础肾功能不全及Mehran评分是CIN的独立危险因素,其中Mehran评分相关性最好,可于术前推广应用。

Objective To observe the renal functional variance before and after coronary angiography（CAG）or non-emergent percutaneous coronary intervention（PCI）in patients with unstable angina,to determine the incidence rate of contrast-induced nephropathy（CIN）and to discuss the risk factors.Methods Five hundred patients with unstable angina enrolled into the study.Cystatin C（Cys C）,serum creatinine（SCr）and estimated glomerular filtration rate（eGFR）were collected before and after CAG or non-emergent PCI at different time points on the basis of the treatment of hydration to estimate the incidence of CIN.The patients were divided into CIN group and non-CIN group,and the changes of renal function before and after operation in group CIN were evaluated.The clinical characteristics of the two groups were compared,and the risk factors of the occurrence of CIN were analyzed by CIN risk score（Mehran scoring system）.Results CIN occurred in 72 of 500patients,and the incidence was 14.4%.The factors of age,baseline Cys C level,baseline SCr level,the dosage of contrast medium,hypertensionhistory,diabetic history,severity of coronary lesions,Mehran scores of CIN group were higher than that of non-CIN group,and baseline eGFR level were lower than that of non-CIN group.The difference was statistically significant（P〈0.05）.The level of Cys C and SCr in patients with CIN after operation showed a trend of first increasing and then decreasing and the eGFR level was decreased and then increased.The difference was statistically significant（P〈0.05）.The results of multivariate Logistic regression analysis showed that：baseline Cys C level,baseline eGFR level,diabetic history,the dosage of contrast medium,and Mehran scores were the risk factors of CIN.Conclusion The incidence of CIN is still high,even with the preventive use of the treatment of hydration.The detection rate will be increased if Cys C and SCr are combined.Diabetes history,baseline renal dysfunction,the dosage of contrast medium and Mehran score are independent risk factors for CIN,and the most relevant risk factor is Mehran score,which can be applied before operation.