冠心病患者经皮冠状动脉介入术后发生造影剂肾病的危险因素

Risk factors for contrast-induced nephropathy after percutaneous coronary intervention in patients with no chronic kidney disease

目的探讨行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗的冠心病患者术后造影剂肾病(contrast-induced nephropathy,CIN)发生的危险因素。方法冠心病患者342例均行PCI治疗,其中58例PCI后发生CIN者为CIN组,284例未发生CIN者为对照组。比较2组一般资料、术前实验室检测指标、冠状动脉病变特征、造影剂应用情况及术后并发症发生率、院内病死率,多因素logistic回归分析PCI后发生CIN的危险因素。结果CIN组年龄>75岁比率(29.3%)、急诊PCI比率(65.5%)、术前合并心力衰竭比率(29.3%)、低白蛋白血症比率(70.7%)、院内病死率(12.1%)及术前收缩压[(134±18)mm Hg]、CIN评分[(7.8±3.6)分]、血肌酐[(86.5±12.9)μmol/L]均高于对照组[12.3%、34.9%、7.4%、54.2%、2.8%、(127±17)mm Hg、(6.4±3.2)分、(76.3±11.6)μmol/L](P<0.05),左室射血分数(left ventricular ejection fraction,LVEF)[(52±15)%]、估算肾小球滤过率[(78.6±23.1)mL/(min·1.73m^2)]低于对照组[(59±17)%、(89.3±25.9)mL/(min·1.73m^2)](P<0.05);CIN组置入支架数[(1.7±0.9)枚]较对照组[(2.2±1.3)枚]少,支架总长度[(35.7±16.9)mm]较对照组[(49.3±26.5)mm]短,造影剂剂量[(215.6±46.3)mL]较对照组[(196.3±39.8)mL]大(P<0.05),2组性别比例、合并高血压比率、造影剂接触时间等比较差异无统计学意义(P>0.05);多因素logistic回归分析结果显示,年龄>75岁(OR=1.903,95%CI:1.106~3.614,P=0.002)、急诊PCI(OR=2.613,95%CI:1.361~3.394,P=0.006)、术前LVEF<45%(OR=3.496,95%CI:1.846~6.431,P=0.043)、术前合并心力衰竭(OR=3.724,95%CI:2.841~6.421,P=0.049)、造影剂剂量>200mL(OR=3.391,95%CI:2.601~6.732,P=0.006)为PCI后发生CIN的危险因素。结论高龄(>75岁)、急诊PCI、术前左心室收缩功能降低(LVEF<45%)、合并心力衰竭及造影剂剂量>200mL可增加冠心病患者PCI后CIN发生风险。

Objective To explore the risk factors for contrast-induced nephropathy(CIN)after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods Totally 342 patients with CHD were divided into 58 patients with CIN after PCI(CIN group)and 284 patients with no CIN(control group).The general data,laboratory indexes before PCI,features of coronary arterial lesions,contrast consumption,complication incidence after PCI,and hospital fatality were compared between two groups.Multivariate logistic regression was used to analyze the risk factors for CIN after PCI.Results In CIN group,the percentages of patients with age>75 years(29.3%),primary PCI(65.5%),heart failure before PCI(29.3%),hypoalbuminemia(70.7%)and hospital fatality(12.1%),as well as systolic blood pressure before PCI((134±18)mm Hg),CIN score(7.8±3.6),and serum creatinine level((86.5±12.9)μmol/L)were significantly higher than those in control group(12.3%,34.9%,7.4%,54.2%,2.8%,(127±17)mm Hg,6.4±3.2,(76.3±11.6)μmol/L)(P<0.05),while left ventricular ejection fraction((52±15)%)and estimated glomerular filtration rate((78.6±23.1)mL/(min·1.73 m^2))in CIN group were significantly lower than those in control group((59±17)%,(89.3±25.9)mL/(min·1.73 m^2))(P<0.05).CIN group received fewer stents(1.7±0.9)in shorter length((35.7±16.9)mm),and larger volume of contrast((215.6±46.3)mL)than control group(2.2±1.3,(49.3±26.5)mm,(196.3±39.8)mL)(P<0.05),and there were no significant differences in the sex ratio,proportion of patients with hypertension and contrast-exposure time between two groups(P>0.05).Multivariate logistic regression analysis showed that age>75 years(OR=1.903,95%CI:1.106-3.614,P=0.002),primary PCI(OR=2.613,95%CI:1.361-3.394,P=0.006),left ventricular ejection fraction<45%before PCI(OR=3.496,95%CI:1.846-6.431,P=0.043),complication of heart failure(OR=3.724,95%CI:2.841-6.421,P=0.049),and contrast comsumption>200 mL(OR=3.391,95%CI:2.601-6.732,P=0.006)were the risk factors for CIN after PCI.Conclusion The old age(>75 years),primary PCI,left ventricular dysfunction before PCI(left ventricular ejection fraction<45%),heart failure and contrast volume>200 mL might increase the risk for CIN after PCI in patients with CHD.