津和汉维两民族对比剂致急性肾损伤高危因素对比分析

Risk factors for contrast-induced acute kidney injury in Han and Uyghur populations of Tianjin and Hetian,China:a comparative study

目的:探讨新疆和田地区维吾尔族患者对比剂致急性肾损伤(contrast-induced acute kidney injury,CI-AKI)发生率、危险及影响因素是否与汉族患者存在差异,从而探讨如何降低维吾尔族患者CI-AKI发生率,改善预后。方法:回顾性分析于天津市胸科医院及新疆维吾尔自治区和田地区人民医院成功行经皮冠状动脉介入术(percutaneous coronary intervention,PCI),并于术后复查肾功能的486名患者。分别按照民族、CI-AKI有无进行分组,观察分组患者危险及影响因素间是否存在差异。并将单因素方差分析有意义指标赋值进行logistics分析。结果:和田地区维吾尔族患者CI-AKI发生率(21.10%)明显高于天津市汉族患者(8.96%)(P<0.001);对比汉族、维吾尔族总体人群及CI-AKI患者数据发现,利尿剂使用比例[1.5%vs. 10.1%,P<0.001(汉维对比);4.2%vs. 23.9%,P=0.047(汉维CI-AKI患者对比)]、N末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平[(860.58±93.89) ng/L vs.(1905.67±101.47) ng/L,P=0.024(汉维对比);(1509.70±327.69)ng/L vs.(2984.20±346.94)ng/L,P=0.019(汉维CI-AKI患者对比)]及Hs-CRP[(4.33±0.97)mg/L vs.(18.34±2.07)mg/L,P<0.001(汉维对比);(8.64±1.30)mg/L vs.(20.27±4.51)mg/L,P<0.001(汉维CI-AKI患者对比)]均存在统计学差异。同样,维吾尔族CIAKI患者与自身对照发现RAAS抑制剂使用比例(43.5%vs. 66.3%,P=0.005)、对比剂用量[(162.41±18.63)mL vs.(126.93±12.63)mL,P=0.002],左室射血分数[(48.54±6.23)%vs.(54.34±5.52)%,P<0.001]、NT-proBNP[(2 984.20±346.94)mL vs.(1 636.04±134.27)mL,P=0.018]均存在统计学差异。结论:对于维吾尔族患者,PCI增加术前RAAS抑制剂使用率、改善心功能、减少术后利尿剂引用能够降低CI-AKI发生率。

Objective:To determine whether the incidence rate and risk and influencing factors for contrast-induced acute kidney injury(CI-AKI)in Uyghur patients in Hetian of Xinjiang,China are different from those in Han patients,and to gain insights into measures that reduce the incidence and improve the prognosis of Uyghur CI-AKI patients. Methods:The clinical data of 486 patients who underwent percutaneous coronary intervention(PCI)and had postoperative renal function examination in Tianjin Chest Hospital and Hetian District People’s Hospital of Xinjiang Uygur Autonomous Region were reviewed. Patients were divided according to their ethnicity and the presence or absence of CI-AKI,and differences in risk factors and influencing factors were examined. Significant parameters identified by the one-way ANOVA were subjected to logistic analysis. Results:Uyghur patients in Hetian had a significantly higher incidence rate of CI-AKI than Han patients in Tianjin(21.10% vs. 8.96%,P<0.001). The rate of use of diuretic was significantly lower in total Han patients and Han CI-AKI patients than in total Uyghur patients and Uyghur CI-AKI patients(total patients:1.5%vs. 10.1%,P<0.001;CI-AKI patients:4.2% vs. 23.9%,P=0.047). In addition,N-terminal pro-brain natriuretic peptide(NT-proBNP)level was significantly lower in total Han patients than in total Uyghur patients[(860.58±93.89)ng/L vs.(1905.67±101.47)ng/L,P=0.024],and significantly lower in Han CI-AKI patients than in Uyghur CI-AKI patients[(1509.70±327.69)ng/L vs.(2984.20±346.94)ng/L,P=0.019]. Similarly,high-sensitivity C-reactive protein level was also significantly lower in total Han patients than in total Uyghur patients[(4.33±0.97)mg/L vs.(18.34±2.07)mg/L,P<0.001],and significantly lower in Han CI-AKI patients than in Uyghur CI-AKI patients [(8.64 ±1.30) mg/L vs.(20.27±4.51) mg/L,P<0.001]. Compared with Uyghur patients without CI-AKI,those with CI-AKI had significantly different rate of use of RAAS inhibitors(43.5% vs. 66.3%,P =0.005),dose of contrast agents [(162.41±18.63)mL vs.(126.93±12.63)mL,P=0.002],left ventricular ejection fraction [(48.54 ±6.23)% vs.(54.34 ±5.52)%,P <0.001],and NT-proBNP level[(2 984.20±346.94)mL vs.(1 636.04 ±134.27) mL,P=0.018]. Conclusion:Increasing the use of preoperative RAAS,improving cardiac function,and reducing postoperative diuretic can lower the risk of post-PCI CI-AKI in Uyghur patients.