多中心住院心内科冠状动脉造影患者造影剂肾病发生情况  

A multi-center clinical study of contrast-induced nephropathy in inpatients in cardiology department after coronary artery intervention

作　　者：张翩[1] 倪兆慧[1] 王玲[1] 何奔[2] 王肖龙[3] 邱建平[4] 郑昌柱[5] 杨光敏 朱爱国[7] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,上海200127 [2]上海交通大学医学院附属仁济医院心内科,上海200127 [3]上海中医药大学附属曙光医院心内科,上海201203 [4]上海市浦东新区公利医院心内科,上海200135 [5]上海市第七人民医院心内科,上海200137 [6]上海浦南医院心内科,上海200125 [7]上海市浦东新区人民医院肾内科,上海201200

出　　处：《中国血液净化》2010年第7期375-379,共5页Chinese Journal of Blood Purification

基　　金：浦东新区科技发展基金创新资金(PKJ2009-Y12);上海市黄浦区科研课题研究项目[(2009)HGG-R];上海市重大科研项目(08DZ1900500)

摘　　要：目的调查住院冠状动脉造影患者造影剂肾病的发病情况。方法前瞻性收集在上海浦东地区六家医院接受冠状动脉造影术(coronary angiography,CAG)病例,分析入选病例的疾病构成和造影剂肾病(contrast-induced nephropathy,CIN)在不同情况下的发病率,比较CIN组与非CIN组患者的各项资料,分析CIN患病的危险因素。结果入选患者197例,CIN发病率8.63%(17例),高龄患者(年龄≥70岁)、女性、合并2型糖尿病、心肌梗死、心功能Ⅱ级以上、使用较高剂量造影剂(≥180ml)的患者CIN发病率较高,分别为18.1%(13/72)、14.9%(10/67)、14.1%(10/71)、17.4%(4/23)、22.7%(5/22)、22.2%(8/36)(P<0.05)。发生CIN患者与非CIN患者在年龄、血红蛋白、血细胞比容、血总胆固醇、餐后2h血糖、术前肌酐清除率方面差异有统计学意义(P<0.05);多因素回归分析显示高龄(年龄≥70岁,RR=7.02,P=0.003)、心肌梗死(RR=4.67,P=0.042)、造影剂剂量≥180ml(RR=4.17,P=0.022)是CIN的危险因素。结论在心内科住院行CAG的患者中CIN的发病率不容忽视;高龄患者,合并2型糖尿病、高血压、贫血、血脂异常等危险因素的患者所占比例大。临床工作中应对高龄患者和合并糖尿病、心肌梗死、造影剂剂量较高的患者足够重视,采取合适的措施预防CIN发生。Objective To investigate the incidence and risk factors of contrast-induced nephropathy （CIN） in patients underwent coronary angiography （CAG）. Methods From April 2009 to July 2009, patients admitted to the six centers in Pudong area in Shanghai for CAG were prospectively collected. Overall incidence of CIN and the incidences under different conditions were analyzed. Patients were divided into CIN group and non-CIN group based on the presence of CIN, and the two groups were compared. Risk factors for CIN were analyzed. Results Of the 197 patients, 17 experienced CIN, and the overall incidence was 8.63%. The CIN incidences of the aged, female, patients with type 2 diabetes, myocardial infarction, heart functionII, and contrast media volume≥ 180ml were 18.1% （13/72）, 14.9% （10/ 67）, 14.1% （10/71）, 17.4% （4/23）, 22.7% （5/22）, 22.2%（8/36） （ P〈0.05）, respectively, much higher than those of nonaged, male, patients without type 2 diabetes or myocardial infarction and heart function Ⅰ～Ⅱ, and contrast media volume 〈180ml. There were significant differences in age, hemoglobin, hematocrit, cholesterol, two-hour postprandial plasma glucose, and creatinine clearance before CAG （P〈0.05） between CIN and non-CIN patients. Multivariate analysis indicated that age≥ 70 （relative ratio [RR]=7.02, P =0.003）, myocardial infarction （RR=4.67, P = 0.042）, and contrast volume≥ 180ml （RR=4.17, P =0.022） were the risk factors for CIN. Conclusion We should pay attention to the presence of CIN in hospitalized patients undergoing CAG. The incidence of CIN was higher in aged patients, and patients with type 2 diabetes, hypertension, anemia, or hyperlipidemia. Therefore, measures should be performed to prevent CIN, especially in the patients undergoing CAG.

关 键 词：冠状动脉造影 经皮冠状动脉介入 造影剂肾病 发病率 

分 类 号：R692.5[医药卫生—泌尿科学]