【摘要】 目的探讨经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发病情况;评估造影剂剂量(CMV)与估计肾小球滤过率(eGFR)比值对高龄糖尿病患者造影剂肾病的诊断价值。方法回顾性分析875例在济宁医学院附属医院心内科接受PCI患者的临床资料。采用SPSS 19.0统计软件进行统计学分析,比较CIN组与非CIN组患者的各项资料,如性别、年龄、吸烟、是否低血压、左室射血分数(LVEF)、血红蛋白值、低密度脂蛋白(LDL-C)、空腹血糖、高血压和2型糖尿病病史;术前血肌酐(Scr)、eGFR;术后48h Scr、eGFR。用Logistic回归分析CIN的危险因素。结果入组患者CIN患病率4.80%(42例),男性、合并高血压病、2型糖尿病、高脂血症、吸烟、低血压、贫血、发病时心肌梗死合并休克的患病率分别为65.71%、54.86%、37.26%、22.51%、34.17%、16.80%、4.20%、8.91%。CIN与非CIN患者相比,在高龄患者(33.33%,19.33%,χ~2=4.902,P<0.05)、患有糖尿病(52.38%,36.49%,χ~2=4.317,P<0.05),吸烟(50.00%,33.37%,χ~2=4.914,P<0.05),发病时低血压(28.57%,16.21%,χ~2=4.374,P<0.05),心肌梗死伴休克(19.05%,8.40%,χ~2=5.579,P<0.05),低LVEF[(36.46±9.27)%,(43.62±3.46)%,t=2.398,P<0.05]及造影剂用量大[(154.5±95.3)m L,(115.04±49.63)m L,t=2.069,P<0.05]的患者更容易发生CIN;eGFR在CIN组明显降低[(72.50±15.06)m L/(min·1.73m~2),(108.55±21.7)m L/(min·1.73m~2),t=7.220,P<0.05]。CMV/eGFR在CIN组与非CIN组间[(2.19±1.30),(1.01±0.40),t=-3.439,P<0.05]差异有统计学意义。多因素回归分析显示高龄(年龄≥70岁,RR=5.27,P<0.05)、糖尿病(RR=9.87,P<0.05)、LVEF(RR=7.35,P<0.05)、术前eGFR(RR=4.12,P<0.05)、心肌梗死合并休克(RR=6.75,P<0.05)、CMV/eGFR(RR=13.45,P<0.05)是CIN的危险因素。ROC工作曲线显示,CMV/eGFR>1.52对于高龄糖尿病患者是否发生CIN的敏感度为72.50%,特异度为84.00%。结论PCI前评估患者的危险因素非常重要,高龄糖尿病更容易发生CIN;CMV/eGFR比值是一个独立的能够预测高龄糖尿病患者PCI后能否发生CIN的指标。更多还原

【Abstract】 Objective To investigate the incidence of contrast-induced nephropathy( CIN) in patients undergoing percutaneous coronary intervention( PCI) and assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate( CMV / eGFR) in super-elderly diabetic patients undergoing elective PCI who developed CIN. Methods Eight hundred and seventy-five PCI patients were retrospectively collected in Affiliated Hospital of Jining Medical University. Patients were divided into CIN group and non-CIN group based on the presence of CIN. Date of the two groups were compared concerning sex,age,smoking,hypotension,LVEF,hemoglobin,LDL-C,glucose,history of hypertension and type 2 diabetes,serum creatinine and eGFR pre-PCI,serum creatinine and eGFR post 48 h-PCI. Risk factors for CIN were analyzed by logistic regression statistical model. Results Among eight hundred and seventy-five patients,forty-two patients experienced CIN( 4. 8%). The disease incidence of male,hypertention,type 2diabetes,hyperlipidemia,smoking,hypotentino,anemia,myocardial infarction with shock was 65. 71%,54. 86%,37. 26%,22. 51%,34. 17%,16. 80%,4. 20%,8. 91%,respectively. In the other two groups,the patients with the super-elderly( age ≥70y)( 33. 33%,19. 33%,χ~2= 4. 902,P < 0. 05),type 2 diabetes( 52. 38%,36. 49%,χ~2= 4. 317,P = 0. 05),smoking( 50. 00%,33. 37%,χ~2= 4. 914,P < 0. 05),with hypotention( 28. 57%,16. 21%,χ~2= 4. 374,P < 0. 05),myocardial infarction combined with shock( 19. 05%,8. 40%,χ~2= 5. 579,P < 0. 05),LVEF[( 36. 46 ± 9. 27) %,( 43. 62 ± 3. 46) %,t = 2. 398,P < 0. 05],and larger contrast medium volume [( 154. 5 ± 95. 3) m L,( 115. 04 ± 49. 63) m L,t = 2. 069,P < 0. 05] were proned to CIN. eGFR was lower in CIN [( 72. 50 ± 15. 06) ml /( min · 1. 73m~2),( 108. 55 ± 21. 7) ml/( min·1. 73m~2),t = 7. 220,P < 0. 05]. There were significant differences between the two group in CMV/eGFR[( 2. 19 ± 1. 30),( 1. 01 ± 0. 40),t =- 3. 439,P < 0. 05 ]. Logistic regression analysis showed that age≥70y( RR = 5. 27,P < 0. 05),type 2 diabetes( RR = 9. 87,P < 0. 05),LVEF( RR = 7. 35,P < 0. 05),pre-PCI eGFR( RR = 4. 12,P < 0. 05),myocardial infarction with shock( RR = 6. 75,P < 0. 05),CMV /eGFR( RR = 13. 45,P < 0. 05) were the risk factors for CIN. ROC analysis indicated that a CMV / eGFR of more than 1. 5 was a predictor of CIN. The sensitivity and specificity for CIN of CMV / eGFR of more than 1. 5was 72. 50% and 84. 00%,respectively. Conclusions It is very important to estimate risk factors of patients before PCI. The super-elderly diabetic patients are proned to CIN. The CMV / eGFR ratio could be a valuable predictor for CIN in super-elderly diabetic patients after elective PCI.更多还原