肾动脉阻力指数对2型糖尿病患者经皮冠脉介入术后造影剂致急性肾损伤的预测价值

Predictive value of renal artery resistance index on contrast-induced acute kidney injury in patients with type 2 diabetes mellitus after percutaneous coronary intervention

目的探讨肾动脉阻力指数(RRI)对2型糖尿病(T2DM)患者经皮冠脉介入术(PCI)治疗后造影剂致急性肾损伤(CI-AKI)的预测价值。方法选择2020年1~9月就诊于江西省萍乡市人民医院的100例行PCI治疗的T2DM患者作为研究对象,根据CI-AKI诊断标准,分为CI-AKI组(n=30)和非CI-AKI组(n=70)。比较两组基线资料、血肌酐(Scr)水平及RRI,并分析T2DM患者PCI治疗后发生CI-AKI的影响因素,绘制受试者工作特征(ROC)曲线判断造影剂剂量、肾动脉收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、Scr水平、RRI对CI-AKI的诊断价值。结果单因素分析结果提示,CI-AKI组和非CI-AKI组的造影剂剂量、PSV、EDV比较,差异有统计学意义(P<0.05);CI-AKI组术后24 h、术后48 h的Scr水平及术后24 h的RRI高于非CI-AKI组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果提示,造影剂剂量(β=0.048,OR=1.050,95%CI=1.031~1.069)、PSV(β=-0.301,OR=0.832,95%CI=0.803~0.982)、EDV(β=-0.356,OR=0.625,95%CI=0.531~0.878)、Scr水平(β=0.063,OR=1.065,95%CI=1.042~1.090)、RRI(β=2.999,OR=20.063,95%CI=1.204~334.228)是T2DM患者行PCI治疗后发生CI-AKI的相关影响因素(P<0.05);绘制ROC曲线结果显示,造影剂剂量、PSV、EDV、Scr、RRI检测T2DM患者PCI治疗后发生CI-AKI得到的曲线下面积(AUC)分别为0.880、0.928、0.971、0.878、0.925,各指标的敏感度分别为97.0%、97.1%、95.7%、98.6%、97.2%,均高于90.0%,但RRI的特异性最高,为96.7%,因此,RRI检测CI-AKI的预测价值较高。结论造影剂剂量较大、PSV、EDV、Scr水平及RRI是T2DM患者PCI治疗后发生CI-AKI的影响因素,而RRI可更好地预测CI-AKI,早期检测RRI对T2DM行PCI治疗后CI-AKI的早期诊断及临床诊疗具有重要价值。

Objective To explore the predictive value of renal artery resistance index(RRI)on contrast-induced acute kidney injury(CI-AKI)in patients with type 2 diabetes mellitus(T2DM)after percutaneous coronary intervention(PCI).Methods A total of 100 cases of T2DM patients who underwent PCI treatment in Pingxiang People′s Hospital from January 2020 to September 2020 were selected as the research objects.According to CI-AKI diagnostic criteria,they were divided into a CI-AKI group(n=30)and a non-CI-AKI group(n=70).The baseline data,serum creatinine(Scr)levels and RRI between the two groups were compared,and the influencing factors of CI-AKI in patients with T2DM after PCI were analyzed,the receiver operating characteristic(ROC)curve was drawn to judge the value of contrast agent dose,peak systolic velocity(PSV)of renal artery,end diastolic velocity(EDV),Scr levels and RRI in the detection of CI-AKI.Results The results of univariate analysis showed that there were statistical significant differences in compared contrast dose,PSV and EDV between CI-AKI group and non CI-AKI group(P<0.05);the levels of Scr at 24 h and 48 h after operation and RRI at 24 h after operation in CI-AKI group were higher than those in non CI-AKI group(P<0.05);the results of Logistic multivariate analysis showed that the dose of contrast medium(β=0.048,OR=1.050,95%CI=1.031-1.069),PSV(β=-0.301,OR=0.832,95%CI=0.803-0.982),EDV(β=-0.356,OR=0.625,95%CI=0.531-0.878),Scr level(β=0.063,OR=1.065,95%CI=1.042-1.090),RRI(β=2.999,OR=20.063,95%CI=1.204-334.228)were the related influenccing factors of CI-AKI in T2DM patients after PCI(P<0.05).ROC curve was drawn,and the results showed that contrast agent dose,PSV,EDV,Scr,RRI detected the area under the curve(AUC)of patients with T2DM after PCI were 0.880,0.928,0.971,0.878 and 0.925,respectively,the sensitivity of each index were 97.0%,97.1%,95.7%,98.6%and 97.2%respectively,all higher than 90.0%,but the specificity of RRI was the highest(96.7%),therefore,the predictive value of RRI in detection of CI-AKI was higher.Conclusion Higher dose of contrast agent,PSV,EDV,Scr level and RRI are the influencing factors for the occurrence of CI-AKI after PCI in T2DM patients,among them,RRI can better predict CI-AKI.Early detection of RRI has important value for the early diagnosis and clinical diagnosis and treatment of CI-AKI after PCI treatment for T2DM.