高血压前期对冠状动脉慢性完全闭塞患者行PCI治疗后造影剂肾病影响

Prehypertension increases the risk of contrast-induced nephropathy in chronic total occlusion percutaneous coronary intervention

目的探讨高血压前期对冠状动脉慢性完全性闭塞病变（CTO）患者行经皮冠状动脉介入（PCI）治疗后造影剂肾病（CIN）的影响。方法选取2010年1月至2013年12月行PCI治疗的875例CTO患者,根据患者血压分为血压正常组（n=296）,高血压前期组（n=178）及高血压组（n=401）,比较3组介入治疗后48~72 h内血清肌酐（SCr）及肾小球滤过率（eGFR）。结果在介入治疗前,各组中SCr及eGFR差异无统计学意义（P〉0.05）。在介入治疗后,高血压前期组和高血压组较血压正常组中的SCr明显升高,eGFR明显降低,差异有统计学意义（P〈0.01）。高血压前期组及高血压组中,造影剂肾病的发生率均高于血压正常组,差异有统计学意义（P〈0.05）。多变量回归分析显示高血压、高血压前期及eGFR是预测造影剂肾病的独立危险因素。结论为降低高血压前期CTO患者造影剂肾病的发生率,应在介入手术前采取适当的干预治疗。

Objective To investigate the influence of prehypertension on the development of contrast-induced nephropathy（ CIN） in patients undergoing chronic total occlusion（ CTO） percutaneous coronary intervention（ PCI）. Methods A retrospective study was performed on 875 CTO patients underwent PCI from January 2010 to December 2013. Patients were divided into the optimal BP group（ n = 296）,the prehypertension group（ n = 178）,and the hypertension group（ n = 401）. Serum creatinine（ SCr） and estimated glomerular filtration rate（ eGFR） were measured before and 48-72 hours after PCI. Results There were no differences in SCr and eGFR among the groups before PCI（ P 0. 05）; SCr increased and eGFR decreased significantly in the hypertension and prehypertension groups post-PCI（ P 0. 01）. The incidence of CIN in the prehypertension group was as high as in the hypertension group and were both significantly higher than in the optimal BP group（ P 0. 05）. Multivariate logistic regression analysis showed hypertension,prehypertension,and eGFR were independent risk factors in predicting CIN. Conclusion Screening prehypertension patients and taking appropriate prophylactic strategy before PCI may reduce the incidence of CIN.