合并慢性肾功能不全的心绞痛患者冠状动脉介入治疗中应用血管内超声替代碘对比剂的可行性

Feasibility of iodinated contrast substituted by intravenous ultrasound during percutaneous coronary intervention for angina pectoris patients with chronic renal insufficiency

目的探讨合并慢性肾功能不全的心绞痛患者的冠状动脉介入(PCI)治疗中应用血管内超声(IVUS)替代碘对比剂的可行性。方法入选慢性肾功能不全合并不稳定性心绞痛患者51例,分为常规治疗组和IVUS指导组。常规治疗组使用碘对比剂,按照常规操作完成手术;IVUS指导组不使用碘对比剂,依据IVUS检查结果完成PCI治疗。主要终点为IVUS替代造影剂指导PCI治疗的成功率,次要终点包括患者PCI术后肾脏功能变化、并发症发生率、心绞痛缓解情况等。采用SPSS 18.0软件进行数据分析。结果51例患者中,常规治疗组30例,IVUS指导组21例。2组均成功完成PCI手术,手术成功率和操作成功率差异无统计学意义。2组术前的估算肾小球滤过率(eGFR)[(46.3±20.4)和(39.7±13.2)L/(min·1.73m^2),P=0.201]和血肌酐(SCr)[(167.2±57.4)和(156.3±44.3)μmol/L,P=0.469)差异无统计学意义。常规治疗组术后24h SCr值较术前显著升高[(210.3±100.9)和(167.2±57.4)μmol/L,P=0.002],对比剂肾病发生率显著高于IVUS指导组(37%和0%,P<0.001)。IVUS指导组术后24h SCr值比常规治疗组显著降低[(144.6±41.9)和(210.3±100.9)μmol/L,P=0.007]。结论心绞痛合并慢性肾功能不全的患者,有选择性地使用IVUS替代碘对比剂完成冠状动脉血管病变的评估和介入治疗是可行的。

Objective To investigate the feasibility of substituting iodinated contrast with intravenous ultrasound(IVUS)during the procedure of percutaneous coronary intervention(PCI)in chronic renal insufficiency patients suffering from angina pectoris.Methods A total of 51 angina pectoris patients with chronic renal insufficiency admitted in our hospital from January 2018 to December 2019 were enrolled in the study.They were randomly divided into conventional treatment group(n=30)and IVUS guidance group(n=21).Iodinated contrast was used in the conventional treatment group,and PCI was performed conventionally.For the IVUS guidance group,PCI was performed according to the results of IVUS examination,and iodine contrast was disallowed in the procedure.The primary end point was the success rate of procedure in 2 groups,and the secondary end point was the changes of renal function,incidence of complication and relief of angina pectoris.SPSS statistics 18.0 was used to analyze the data.Results PCI was successfully performed in both groups,and no significant differences were seen in the PCI and procedure success rates between them.Before the treatment,there were no statistical differences in estimated glomerular filtration rate[eGFR,(46.3±20.4)vs(39.7±13.2)L/(min·1.73m^2),P=0.201]and serum creatinine[(SCr,(167.2±57.4)vs(156.3±44.3)μmol/L,P=0.469]between the two groups.In 24h after the treatment,the conventional treatment group had obviously increased SCr level[(210.3±100.9)vs(167.2±57.4)μmol/L,P=0.002]and higher incidence of contrast-induced nephropathy(CIN)when compared with the IVUS guidance group(37%vs 0%,P<0.001).The SCr level was notably lower in the IVUS guidance group in 24h after treatment than the conventional treatment group[(144.6±41.9)vs(210.3±100.9)μmol/L,P=0.007].Conclusion In angina pectoris patients with chronic renal insufficiency,it is feasible to use IVUS instead of iodine contrast during the procedure of PCI if indications are suitable.