经皮冠状动脉介入术后造影剂肾病的发生率及危险因素分析

Incidence and Risk Factors of Contrast Induced Nephropathy after Percutaneous Coronary Intervention

目的分析经皮冠状动脉介入(PCI)术后造影剂肾病(CIN)的发生率及危险因素。方法回顾性分析2017年1月至2019年7月在武汉大学人民医院心血管内科住院并行急诊或择期PCI术的256例急性冠状动脉综合征患者的临床资料,收集患者临床资料、既往病史、入院病情等,按照CIN的标准分为CIN组和非CIN组,分析CIN的发生率及危险因素。结果在纳入的256例患者中,25例发生CIN,CIN发生率为9.76%。CIN组的心功能不全(Killip≥Ⅲ级)、心房颤动及重复造影<7 d患者比例明显高于非CIN组[36.0%(9/25)比12.6%(29/231)、20.0%(5/25)比7.8%(18/231)、36.0%(9/25)比14.7%(34/231)](P<0.05);术后48 h,CIN组的血肌酐水平高于非CIN组[(136±57)μmol/L比(98±37)μmol/L],预估肾小球滤过率水平低于非CIN组[(50±18)mL/(min·1.73 m^(2))比(71±22)mL/(min·1.73 m^(2))](P<0.01)。二元Logistic回归分析结果显示,心功能不全(Killip≥Ⅲ级)、重复造影<7 d是CIN的独立危险因素(P<0.05)。结论心功能不全(Killip≥Ⅲ级)、重复造影<7 d是CIN发生的独立危险因素,因此造影前应先改善心功能,造影时间间隔超过1周更安全。

Objective To analyze the incidence and risk factors of contrast induced nephropathy(CIN)after percutaneous coronary intervention(PCI).Methods Retrospective analysis of 256 patients with acute coronary syndrome hospitalized in the Department of Cardiology for concurrent emergency or selective PCI in Renmin Hospital of Wuhan University from Jan.2017 to Jul.2019 was done.The clinical data,medical history and admission condition were collected,and according to the standard of CIN,they were divided into a CIN group and a non-CIN group.The incidence and risk factors of CIN were analyzed.Results Among the 256 patients included,25 cases had CIN,and the incidence was 9.76%.The proportion of patients with cardiac insufficiency(Killip≥gradeⅢ),atrial fibrillation and repeated angiography<7 d in the CIN group was significantly higher than that in the non-CIN group[36.0%(9/25)vs 12.6%(29/231),20.0%(5/25)vs 7.8%(18/231),36.0%(9/25)vs 14.7%(34/231)](P<0.05).48 hours after operation,the serum creatinine level in the CIN group was higher than that in the non-CIN group[(136±57)μmol/L vs(98±37)μmol/L];the level of estimated glomerular filtration rate in the CIN group was lower than that in the non-CIN group[(50±18)mL/(min·1.73 m^(2))vs(71±22)mL/(min·1.73 m^(2))](P<0.01).Binary Logistic regression analysis showed that cardiac insufficiency(Killip≥gradeⅢ)and repeated angiography<7 d were independent risk factors for CIN.Conclusion Cardiac insufficiency(Killip≥gradeⅢ)and repeated angiography<7 d are independent risk factors for CIN.Therefore,the cardiac function should be improved before angiography,and the angiography time interval of more than one week is safer.