冠心病患者造影剂相关急性肾损伤后使用肾素-血管紧张素系统抑制剂对远期预后的影响

Effect of renin-angiotensin system inhibitor on long-term prognosis after contrast-as-sociated acute kidney injury in patients with coronary heart disease

目的探讨冠心病患者造影剂相关急性肾损伤(CA-AKI)后使用肾素-血管紧张素系统抑制剂(RASI)对远期预后的影响。方法共纳入1526例自2008年1月—2018年12月在广东省人民医院行冠状动脉造影确诊为冠心病且术后出现CA-AKI的患者,根据是否服用RASI分为RASI组(n=984)和非RASI组(n=542)。主要终点是远期全因死亡。比较两组患者的基线临床资料。使用Kaplan-Meier方法和COX回归分析评估RASI对远期预后的影响。结果RASI组使用β受体阻滞剂、他汀类药物的比例高于非RASI组(P<0.01)。在4.75(2.82,6.67)年的随访期间,有332例患者死亡,全因死亡率为21.76%。Kaplan-Meier生存分析显示,RASI组患者的死亡率低于非RASI组患者(P=0.001)。单因素和多因素COX回归分析显示出院后接受RASI治疗与全因死亡呈显著负相关(P=0.001,P=0.034),RASI是远期全因死亡的独立保护因素。结论RASI是冠心病患者CA-AKI后远期预后的独立保护因素,长期使用RASI治疗可减少冠心病合并CA-AKI患者的全因死亡。

Aim To investigate the effect of renin-angiotensin system inhibitor(RASI)on long-term prognosis in patients with coronary heart disease(CHD)after contrast-associated acute kidney injury(CA-AKI).Methods A total of 1526 patients with CHD diagnosed by coronary angiography and postoperative CA-AKI in Guangdong Provincial People's Hospital from January 2008 to December 2018 were included in this study.They were divided into RASI group(n=984)and non-RASI group(n=542)according to whether they took RASI or not.The primary end point was longterm all-cause death.Baseline clinical data were compared between the two groups.Kaplan-Meier method and COX regression analysis were used to evaluate the effect of RASI on long-term prognosis.Results The proportion ofβ-receptor blockers and statins used in the RASI group was higher than that in the non-RASI group(P<0.01).During the median follow-up period of 4.75 years(quartile 2.82 years,6.67 years),332 patients died,and the all-cause mortality was 21.76%.Kaplan-Meier survival analysis showed that the mortality of RASI group was lower than that of non-RASI group(P=0.001).Univariate and multivariate COX regression analysis showed that RASI treatment after discharge was significantly negatively correlated with all-cause death(P=0.001,P=0.034),and RASI was an independent protective factor for long-term all-cause death.Conclusions RASI is an independent protective factor for the long-term prognosis of CHD patients after CA-AKI.Long-term use of RASI therapy can reduce the all-cause death in patients with CHD and CA-AKI.