冠心病患者PCI术前血清同型半胱氨酸水平与术后对比剂肾病的相关性分析

An analysis of correlation between preoperative serum homocysteine level and postoperative contrastinduced nephropathy in coronary heart disease patients underwent percutaneous coronary intervention

目的探讨冠心病患者经皮冠状动脉介入(PCI)术前血清同型半胱氨酸(Hcy)水平与术后对比剂肾病(CIN)的相关性。方法接受PCI治疗的冠心病患者287例,21例术后72h内发生CIN(CIN组),未发生CIN 266例(非CIN组)。比较两组患者血清Hcy、肌酐(Cr)及估算的肾小球滤过率(eGFR),分析PCI术后患者发生CIN的影响因素。结果非CIN组患者术前Hcy水平低于CIN组(P<0.05),但Cr及eGFR水平比较差异无统计学意义(P>0.05);术后72h内,非CIN组Cr水平低于CIN组(P<0.05),但eGFR高于CIN组(P<0.05)。双变量相关分析显示,术前Hcy水平与术后72h内Cr呈正相关(r=0.473,P<0.01),与术后72h内eGFR呈负相关(r=-0.318,P<0.01)。Logistic回归分析显示,高龄、糖尿病、慢性肾病、高对比剂用量、Hb和左心室射血分数降低以及Cr和Hcy升高是冠心病患者PCI术后CIN发生的主要危险因素(P<0.05)。结论 PCI术前Hcy水平升高可作为冠心病患者PCI术后发生CIN的临床评价指标之一。

Objective To explore the correlation between preoperative serum homocysteine （Hcy） level and postoperative contrast-induced nephropathy（CIN） in coronary heart disease（CHD） patients undegoing percutaneous coronary intervention（PCI）. Methods A total of 287 CHD patients undergoing PCI was divided into two groups,of whom CIN within 72 hours after PCI occurred in 21 cases（group A） and CIN did not occur in 266 cases（group B）. Serum Hcy, creatinine（Cr） and estimated glomerular filtration rate （eGFR） were compared between two groups. The factors influencing CIN after PCI in the patients with CHD were analyzed. Results The preoperative serum Hcy level in group B was lower than that in group A （P〈0. 05）, but there were no significant differences in Cr level and eGFR between two groups（P〉0. 05）. The level of Cr was lower and eGFR was higher within 72 hours after operation in group B than those in group A（P〈0. 05）. Bivariate correlation analysis showed that Hcy before PCI was positively correlated with Cr after PCI（r= 0. 473,P〈0. 01） and negatively correlated with eGFR after PCI （r=- 0. 318, P〈0. 01）. Logistic regression analysis showed that aged, diabetes mellitus, chronic kidney disease, high dosage of contrast, decreased Hb and LVEF, increased Cr and Hcy were the major risk factors for CIN after PCI in the patients with CHD（P〈0. 05）. Conclusion The increase of Hcy level before PCI can be used as one of the clinical indicators to evaluate CIN after PCI in the patients with CHD.