尿素氮/肌酐比值对于非ST段抬高急性冠脉综合征患者经皮冠状动脉介入治疗后对比剂肾病的预测价值

Predictive Value of Urea-Nitrogen/Creatinine Ratio for Contrast Induced Nephropathy in Patients with Non-ST-Elevation Acute Coronary Syndromeafter Percutaneous Coronary Intervention

目的尿素氮/肌酐(BUN/Cr)常作为反映患者容量状态的客观指标,现探讨冠状动脉介入治疗前BUN/Cr水平对急性冠脉综合征患者接受择期经皮冠状动脉介入治疗后发生对比剂肾病(CIN)的预测价值。方法回顾性分析于中国人民解放军总医院心血管内科行择期经皮冠状动脉介入治疗的非ST段抬高急性冠脉综合征患者1163例。根据围手术期是否发生CIN分为CIN组(n=102例)和非CIN组(n=1061例)。收集患者一般资料,基础病史以及血常规、肌酐和尿素氮等生化结果,造影结果以及超声心动图结果。采用logistic回归分析术后发生CIN的危险因素。结果1163例患者中有102例发生CIN,发生率为8.77%。与非CIN组比较,CIN组中高脂血症、高BUN/Cr的比例明显上升,心脏射血分数明显下降(P<0.05)。logistic回归分析显示术前高BUN/Cr是发生CIN的独立危险因素(OR=2.018,95%CI 1.241~3.284,P=0.005),其他的独立危险因素包括心力衰竭、高脂血症和血肌酐>177μmol/L(P<0.001,P<0.001,P<0.05)。将高BUN/Cr代入传统CIN评分系统预测CIN的AUC为0.635(95%CI 0.607~0.663,P<0.001)。结论术前高BUN/Cr(BUN/Cr≥20)是CIN的独立预测因子,有助于早期识别CIN高危患者。

Objective The urea nitrogen to creatinine ratio(BUN/Cr)is often used as an objective indicator to reflect the patient's volume status.The study investigates the predictive value of preoperative BUN/Cr level in the occurrence of contrast induced nephropathy(CIN)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A retrospective study was conducted on 1163 patients with non-ST-segment elevation ACS who underwent elective PCI in the Department of Cardiology Medicine,the General Hospital of the People's Liberation Army.According to the occurrence of CIN during the perioperative period,the patients were allocated to CIN group(n=102 cases)and non-CIN group(n=1061 cases).General data,basic medical history,angiography and echocardiography,biochemical tests including blood routine,creatinine and urea nitrogen were collected.Logistic regression was used to analyze the risk factors for CIN after operation.Results There were 102 cases of CIN among 1163 patients with the incidence of 8.77%.Compared with the non-CIN group,hyperlipidemia and high BUN/Cr ratio increased significantly in CIN group,and cardiac ejection fraction decreased significantly in CIN group(all P<0.05).Logistic regression analysis showed that preoperative high BUN/Cr level was an independent risk factor for CIN(OR=2.018,95%CI 1.241~3.284,P=0.005).Other independent risk factors for CIN included heart failure,hyperlipidemia and the level of serum creatinine>177μmol/L(P<0.001,P<0.001,P<0.05).Area under the ROC curve(AUC)of predicting the contrast induced nephropathy is 0.635 when add BUN/Cr into CIN prediction model(95%CI 0.607~0.663,P<0.001).Conclusion Preoperative high BUN/Cr ratio(BUN/Cr≥20)is an independent predictor for CIN after PCI,which is helpful for early identification of high-risk patients.