颈动脉支架成形术后对比剂肾病的危险因素分析

Risk factors of contrast-induced nephropathy after carotid artery stenting

目的:探讨颈动脉狭窄患者颈动脉支架成形术(CAS)后发生对比剂肾病(CIN)的危险因素。方法:回顾性分析2021年1—12月在首都医科大学宣武医院接受CAS治疗的137例颈动脉狭窄患者的临床资料,记录人口学特征(年龄、性别、身高、体重),基础疾病史(高血压、糖尿病、肾脏病等),用药史等。观察血肌酐、血尿素氮、白蛋白、血红蛋白、红细胞比容、狭窄程度、估算肾小球滤过率(eGFR)等临床参数。符合正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验;偏态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用秩和检验;计数资料组间比较采用χ^(2)检验或Fisher确切概率法。对有关指标先做单因素分析,根据单因素分析结果选择差异具有统计学意义的指标纳入多因素Logistic回归分析。结果:137例颈动脉狭窄患者CAS术后有29例(21.2%)发生CIN。单因素分析结果显示,双侧颈动脉狭窄、术前存在未控制的高血压、血管紧张素转化酶抑制剂类药物史、糖尿病病史、胰岛素药物史、eGFR<45 mL/(min·1.73 m^(2))、体重是颈动脉狭窄患者CAS术后发生CIN的影响因素。多因素Logistic回归分析结果显示,双侧颈动脉狭窄(OR=4.724,95%CI:1.455~15.338,P=0.010)、糖尿病病史(OR=3.451,95%CI:1.345~8.858,P=0.010)、eGFR<45 mL/(min·1.73 m^(2))(OR=4.582,95%CI:1.001~20.971,P=0.050)是CAS术后发生CIN的独立危险因素。结论:有双侧颈动脉狭窄、糖尿病病史、慢性肾功能不全的颈动脉狭窄患者CAS术后更易发生CIN。

Objective:To investigate the risk factors related to the contrast-induced nephropathy(CIN)occurring after carotid artery stenting(CAS)in patients with carotid artery stenosis.Methods:The clinical data of 137 patients with carotid artery stenosis,who were treated with CAS at Xuanwu Hospital,Capital Medical University during the period from January to Decmber 2021 were retrospectively analyzed.Record demographic characteristics(age,gender,height,weight),history of underlying diseases(hypertension,diabetes,kidney disease,etc.),history of medications,etc.Observe the clinical parameters such as creatinine,blood urea nitrogen,albumin,hemoglobin,hematocrit,degree of stenosis and estimated glomerular filtration rate(eGFR).Measurement data conforming to the normal distribution were expressed as the mean±standard deviation(x±s),and the t-test was used for comparison between groups;the measurement data that does not conform to the normal distribution were expressed as the median(interquartile range)[M(Q_(1),Q_(3))],and the Rank-sum test was used for comparison between groups;the Chi-square test or Fisher exact test was used for comparison of count data between groups.Relevant variables were subjected to univariate analysis,and statistically significant indicators were selected according to the results of univariate analysis to be included in the multivariate Logistic regression analysis.Results:After CAS,a total of 29 patients(21.2%) among the 137 patients developed CIN.Univariate analysis indicated that bilateral carotid artery stenosis,uncontrolled hypertension before surgery,history of angiotensin converting enzyme inhibitor drugs,diabetes mellitus,history of insulin drugs,eGFR<45 mL/(min·1.73 m^(2)),body weight were the influencing factors associated with the occurrence of CIN after CAS in patients with carotid artery stenting;multivariate regression analysis revealed that the presence of bilateral carotid artery stenosis(OR=4.724,95%CI:1.455-15.338,P=0.010),diabetes mellitus(OR=3.451,95%CI:1.345-8.858,P=0.010)and eGFR<45 mL/(min·1.73 m^(2))(OR=4.582,95%CI:1.001-20.971,P=0.050) were the independent risk factors related to the CIN after CAS.Conclusion:Patients with the presence of bilateral carotid artery stenosis,diabetes mellitus or eGFR<45 mL/(min·1.73 m^(2)) are more likely to develop CIN after CAS.