急性冠脉综合征患者冠脉介入术后对比剂肾损伤的危险因素

Risk factors of contrast-induced kidney injury after coronary intervention in patients with acute coronary syndrome

目的探究急性冠脉综合征(ACS)患者行冠脉介入操作后发生对比剂损伤(CI-AKI)的危险因素。方法回顾性分析2018年宣武医院全年经皮冠状动脉造影术1 007例次,资料完整的ACS患者206例次。根据KDIGO标准将患者分为对照组(非CI-AKI组)(195例)和CI-AKI组(11例)。观察指标:年龄、性别、体重指数、既往病史(高血压,糖尿病,脑血管疾病,心功能不全,高尿酸血症/痛风,慢性肾脏病)、术前尿酸、血肌酐和尿素(术前、术后48 h内或7 d内)、手术类型、病变血管数、水化和血容量。通过进行单因素和多因素分析,筛选出ACS患者PCI术后CI-AKI的危险因素。结果 206例次患者中11例次(5.34%)发生CI-AKI。单因素分析显示,年龄、术前肌酐清除率和高尿酸血症病史等差异有统计学意义(P<0.05)。多因素分析显示,急诊手术(OR=4.881)和高尿酸血症病史(OR=5.916)是CI-CKI的独立危险因素(P<0.05)。结论临床对于CI-AKI的认识不足导致CI-AKI的发病率较低且漏诊率高,PCI术后水化不足。急诊PCI和既往诊断高尿酸血症是CI-AKI的独立危险因素。与术前尿酸水平相比,既往诊断高尿酸血症对于CI-AKI的发生有更强的预测作用。

Objective To investigate the risk factors of contrast-induced acute kidney injury(CI-AKI)in patients with acute coronary syndrome after coronary intervention.Methods A retrospective and case control study was done with data analysis in 1007 cases of coronary interventions in Xuanwu Hospital in 2018,206 of which were with complete data.According to the KDIGO standard,the patients were divided into control group(n=195)and CI-AKI group(n=11).The variables to be studied included:age,gender,body mass index,previous history(hypertension,diabetes,cerebrovascular diseases,cardiac insufficiency,hyperuricemia/gout,chronic kidney disease),preoperative uric acid,serum creatinine and urea(before operation,within 48 h or 7 d after operation),type of operation,number of diseased vessels,hydration and blood volume.Through univariate and multivariate analysis,the risk factors of CI-AKI in patients with ACS after PCI were screened.Results Of the 206 cases,11(5.34%)developed CI-AKI.Univariate analysis showed that there were significant differences in age,preoperative creatinine clearance rate and hyperuricemia history(P<0.05).Multivariate analysis showed that emergency surgery(OR=4.881)and hyperuricemia history(OR=5.916)were independent risk factors of CI-CKI(P<0.05).Conclusion The lack of clinical understanding of CI-AKI leads to low incidence and high missed diagnosis rate of CI-AKI,and insufficient hydration after PCI.Emergency PCI and previous diagnosis of hyperuricemia are independent risk factors of CI-AKI.Compared with the level of uric acid before operation,the previous diagnosis of hyperuricemia has a stronger predictive effect on the occurrence of CI-AKI.