非酒精性脂肪肝与急诊PCI术后对比剂肾病的相关性

The relationship between nonalcoholic fatty liver disease and contrast-induced nephropathy in patients with acute myocardial infarction undergoing percutaneous coronary intervention

目的探讨非酒精性脂肪肝（NAFLD）与急性心肌梗死（AMI）患者急诊经皮冠状动脉介入治疗（PCI）术后对比剂肾病（CIN）发生的相关性。方法连续入选我院2014年3月至2016年5月行急诊PCI患者的临床资料。根据超声诊断结果,将患者分为NAFLD组和非NAFLD组。CIN定义为应用对比剂48~72 h内血清肌酐较基础值升高≥44.2μmol/L,或较基础值升高≥25%。分析两组患者基线资料、术前和术后尿素氮、血肌酐、估算的肾小球滤过率（e GFR）、对比剂用量、冠状动脉病变特点,并采用多因素Logistic回归分析AMI患者PCI术后发生CIN的危险因素。结果 261例AMI患者急诊PCI术后有43（16.5%）例发生CIN。NAFLD组发生CIN的比例显著高于非NAFLD组[23.93%（28/117）比10.42%（15/144）,P=0.003]。院内不良事件比较,NAFLD组急性心力衰竭发生比例较高（P〈0.05）。多因素Logistic回归分析显示,NAFLD（OR=2.18）、糖尿病（OR=2.42）、对比剂用量（OR=2.44）是PCI术后发生CIN的危险因素。结论 NAFLD可能增加AMI患者急诊PCI术后发生CIN的风险。

Aim To investigate the relationship between nonalcoholic fatty liver disease（NAFLD） and contrastinduced nephropathy（CIN） in patients with acute myocardial infarction（AMI） undergoing percutaneous coronary intervention（PCI）. Methods A total of 261 consecutive patients with acute myocardial infarction undergoing PCI in our hospital from March 2014 to May 2016 were enrolled in this study. Patients were divided into NAFLD group（n = 117） and non-NAFLD group（n = 144） based on the diagnosis of B-mode ultrasound. CIN was defined as≥44.2 μmol/L or ≥25%increase from baseline serum creatinine within 48 ～ 72 hours after contrast medium exposure,and that was not attributable to other causes. The following data were recorded： the baseline measurements,blood urea nitrogen,serum creatinine levels before PCI and 1,2 and 3 days after PCI,estimated glomerular filtration rate（eG FR）,the contrast volume and coronary pathological features after PCI. Risk factors for CIN were determined by multivariate Logistic regression analysis. Results CIN occurred in 16.5%（43/261） of patients,and incidence of CIN was significantly higher in the NAFLD group than that in the non-NAFLD group [23.93%（28/117） vs. 10.42%（15/144）,P = 0.003]. Compared with adverse eventsin the hospital,the incidence of acute heart failure in NAFLD group was higher（P〈0.05）. Multivariate Logistic regressive analysis showed that NAFLD（OR = 2.18）,diabetes（OR = 2.42）,contrast volume（OR = 2.44） were risk factors for the incidence of CIN. Conclusion NAFLD is the independent risk predictor of CIN in patients with AMI undergoing PCI.