性别对多次接触造影剂的冠心病患者发生造影剂相关肾病损伤的影响

Influence of gender in contrast-induced nephropathy by multiple contact with contrast agents in patients with coronary heart disease

目的探讨性别对多次接触造影剂的急性冠状动脉综合征(acute coronary syndrome,ACS)患者发生造影剂肾病(contrast-induced nephropathy,CIN)损伤的影响。方法选取2015年3月至2016年12月在解放军第309医院行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的ACS患者166例,检测PCI治疗前及治疗后3 d内血清肌酐浓度。根据第一次接触造影剂后是否发生CIN,将纳入患者分为CIN组(12例)和非CIN组(154例),比较两组的一般临床数据,分别计算第一次和第二次接触造影剂后CIN的发生率,并应用Logistic回归分析对各因素与CIN发生的相关性进行分析。结果与非CIN组比较,CIN组的估算肾小球滤过率(estimated glomerular filtration rate,e GFR)和血清肌酐(serum creatinine,s Cr)浓度显著增高,而左心室射血分数显著降低,差异具有统计学意义(P<0.05)。第一次接触造影剂后,166例患者中CIN的发病率为7.23%(12例),第二次CIN的发病率为12.05%(20例)。第一次接触后男性的发病率低于女性[41.6%(5/12)vs.58.33%(7/12),P<0.05],第二次男性的发病率高于女性[85.00%(17/20)vs.15.00%(3/20),P<0.05],差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,男性与CIN的发生具有显著相关性(OR=1.45,95%CI:1.42~1.78,P=0.000)。结论性别与多次接触造影剂的冠状动脉粥样硬化性心脏病患者发生造影剂相关肾病损伤具有相关性。

Objectives To investigate the influence of gender in contrast？induced nephropathy by multiple contact withcontrast agents in patients with coronary heart disease. Methods Totally 166 patients with acute coronary syndrome（ACS）undergoing percutaneous coronary intervention（PCI）were colllected from March 2015 to December 2016 in309th Hospital of PLA. Serum concentration of creatinine（sCr）was measured in patients with ACS before and threedays after PCI. According to whether suffering from contrast-induced nephropathy（CIN） for the first contact withcontrast agents,patients were divided into two groups：CIN group（12 cases）and non CIN group（154 cases）. Generalclinical data between the two groups were compared. Incidences of CIN after contact with contrast agents for the firstand second time were calculated respectively. Logistic regression analysis was used to assess the correlation betweenclinical factor and incidence of CIN. Results Compared with non CIN group,estimated glomerular filtration rate（eGFR）and concentrations of sCr of CIN group significantly increased,but left ventricular ejection fraction（LVEF）significantly decreased,between which the differences were statistically significant（P〈0.05）. Incidence of CIN was7.23%（12/166）after the first contact with the contrast agents;the incidence of CIN was 12.05%（20/166）after thesecond contact with the contrast agents. Incidence of CIN in male patients was significantly lower than that in femalepatients after the first contact with the contrast agents[41.6%（5/12）vs. 58.33%（7/12）,P〈0.05];incidence of CIN inmale patients was significantly higher than that in female patients after the second contact with the contrast agents [85.00%（17/20）vs. 15.00%（3/20）,P〈0.05],in which the differences were statistically significant（P〈0.05）. Logisticregression analysis showed that,there was significant correlation between male and incidence of CIN（OR=1.45,95%CI：1.42-1.78,P=0.000）. Conclusions There is correlation between gender and incidence of CIN in patients withcoronary heart disease after multiple exposure to contrast agent.