行急诊经皮冠状动脉介入治疗患者血浆大内皮素水平与术后对比剂诱导急性肾损伤的相关性分析

Relationship Between Blood Big Endothelin Level and Contrast-induced Acute Kidney Injury in Patients With Emergent Percutaneous Coronary Intervention

目的:探索行急诊经皮冠状动脉介入治疗(PCI)的患者血浆大内皮素水平与术后出现对比剂诱导的急性肾损伤(CI-AKI)的相关性。方法:选取2013-01-01到2015-06-30于阜外医院行急诊PCI的患者共1 061例纳入研究。根据大内皮素水平将患者分为大内皮素正常组(n=236)和大内皮素升高组(n=825),分析两组患者基线资料和介入操作特征,以及CI-AKI发生率和术后6个月、12个月复合终点事件(包括非致死性心肌梗死、再次血运重建、脑卒中和全因死亡)发生率,并进行Logistic分析明确CI-AKI的危险因素。结果:行急诊PCI的患者术后CI-AKI发生率为22.7%(241/1 061)。大内皮素升高组患者CI-AKI发生率和术后6个月、12个月复合终点发生率均显著高于大内皮素正常组(P值分别为0.041、0.040和0.021)。校正其他变量后,大内皮素不论作为连续性变量还是分类变量均显著增加急诊PCI患者术后CI-AKI的风险。结论:在行急诊PCI的患者中,血浆大内皮素水平升高会显著增加患者术后CI-AKI的风险。

Objective： To explore the relationship between blood level of big endothelin and contrast-induced acute kidney injury （CI-AKI） in patients with emergent percutaneous coronary intervention （PCI）. Methods： A total of 1061 consecutive patients received emergent PCI in our hospital from 2013-01 to 2015-06 were enrolled. According to blood levels of big endothelin, the patients were divided into 2 groups： Normal big endothelin group, n=236 and Elevated big endothelin group, n=825. The baseline condition, procedural features, occurrence rate of CI-AKI and composite endpoint events at 6 and 12 months post-operation were studied which including nonfatal myocardial infarction, revascularization, stroke and all-cause death. The risk factors for CI-AKI occurrence were identified by Logistic analysis. Results： The overall occurrence rate of CI-AKI was 22.7% （241/1061）. Compared with Normal big endothelin group, Elevated big endothelin group had the higher incidence of CI-AKI, increased composite endpoint events at 6 and 12 months post-operation with P=0.041, P---0.040 and P=0.021, respectively. With adjusted covariates, elevated blood level of big endothelin, no matter as a continuous variable or categorical variable had the enhanced risk of CI-AKI incidence in patients after emergent PCI. Conclusion： Elevated blood level of big endothelin may significantly increase the risk of CI-AKI in patients with emergent PCI.