冠状动脉介入治疗诱发造影剂肾病的危险因素及预后

Risk Factors and Prognosis of Contrast-induced Nephropathy Induced by Coronary Intervention

目的冠心病患者通过冠状动脉介入治疗后,对引发患者产生造影剂肾病的潜在因素进行分析,并对预后情况进行研究。方法选取该院在2015年1月—2018年1月,这一期间内收治的患者随机抽取出300例患者,根据患者是否出现造影剂肾病将小组进行划分,划分成观察组和对照组,观察组由出现造影剂肾病的11例患者所组成,而对照组则由余下的没有出现造影剂肾病的289例患者所组成,对两组患者进行比较,从而分析可能引发造影剂肾病的潜在因素,并对预后情况进行研究。结果通过多因素分析发现,引发造影剂肾病的潜在因素有3种,①造影剂的使用剂量与造影剂肾病的发作有密切关系,观察组患者使用的造影剂剂量为:(270.68±70.58)mL,而对照组患者使用的造影剂剂量为(240.19±40.57)mL,两组剂量之间差异有统计学意义(t=6.254 8,P<0.05);②是否存在既往糖尿病史与造影剂肾病的发作密切相关,造影剂肾病的发生概率20.83%(5/24),非糖尿病患者发生造影剂肾病的概率为2.10%(6/276),差异有统计学意义(χ~2=16.258 4,P<0.05);③是否存在肾功能不全既往史与造影剂肾病的发作密切相关,造影剂肾病的发生概率为25.0%(2/8),而非肾功能不全患者发生造影剂肾病的概率为2.05%(6/292),差异有统计学意义(P<0.05)。观察组患者发生心源性死亡有3例,心梗死亡有1例,对照组患者心源性死亡有23例,心梗死亡有6例。结论造影剂剂量、糖尿病、肾功能不全是潜在因素,术后应该对患者密切观察。

Objective To analyze the underlying factors of contrast-induced nephropathy in patients with coronary heart disease after coronary intervention, and to study the prognosis. Methods From January 2015 to January 2018, patients in our hospital were randomly selected from 300 patients. The patients were divided into observation group and control group according to whether the patient had contrast nephropathy. The observation group consisted of 11 patients with contrast-induced nephropathy, while the control group consisted of the remaining 289 patients without contrast-induced nephropathy. The two groups were compared to analyze the potential factors that may cause contrast nephropathy and study the prognosis. Results Multivariate analysis revealed that there were three potential factors for causing contrast nephropathy. 1.The dose of contrast agent was closely related to the onset of contrast nephropathy. The dose of contrast agent used in the observation group was(270.68 ±70.58)mL. The contrast agent dose used in the control group was(240.19±40.57)mL, there was a significant difference between the two groups(t=6.254 8,P<0.05);2.whether the history of previous diabetes was closely related to the onset of contrast nephropathy, the incidence of contrast-induced nephropathy was 20.83%(5/24), and the probability of developing contrast-enhanced renal disease in non-diabetic patients was 2.10%(6/276). The difference was statistically significant(χ^2=16.258 4,P<0.05) 3.The existence of a history of renal insufficiency is closely related to the onset of contrast-induced nephropathy. The probability of occurrence of contrast-induced nephropathy was 25.0%(2/8), and the probability of developing contrast-enhanced kidney disease in non-renal dysfunction patients was 2.05%(6/292), the difference was significant and statistically significant(P<0.05).There were 3 cases of cardiac death in the observation group and 1 case of myocardial infarction. There were 23 cases of cardiac death in the control group and 6 cases of myocardial infarction. Conclusion Contrast dose, diabetes, and renal insufficiency are potential factors, and should be closely observed after surgery.