急性心肌梗死患者行急诊冠状动脉介入治疗后对比剂肾病的临床研究  

Contrast-induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

作　　者：徐验[1] 衣为民[1] 龙娟[1] 罗颖[1] 张怡清[1] 胡伟[1] 郭文玉[1] 

机构地区：[1]深圳市孙逸仙心血管医院心内科,广东深圳518020

出　　处：《南昌大学学报（医学版）》2012年第5期43-47,共5页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)后对比剂肾病(CIN)的发生率、相关因素以及对预后的影响。方法选择186例接受急诊PCI的急性ST段抬高心肌梗死患者,测定其术前和术后48～72h内的血清肌酐水平(Scr),记录患者临床资料及住院期间发生的主要不良事件。CIN定义为术后48～72h内Scr升高>25%,或绝对值升高≥44.2μmol·L-1(0.5mg·dL-1)。结果 186例患者中有34例发生CIN(CIN组),152例为非CIN(非CN组),CIN发生率为18.3%。CIN组患者年龄较非CIN组更大(P<0.05),CIN组肾功能不全、左室射血分数(LVEF)<40%、合并心力衰竭(Killip≥Ⅱ级)的患者明显多于非CIN组(P<0.01),所有心源性休克患者均发生了CIN;CIN组术前使用他汀类药物的患者比例低于非CIN组(P<0.05)。Logistic多因素回归分析显示,肾功能不全(基线肌酐清除率<60mL·min-1)、使用主动脉内球囊反搏(IABP)、心源性休克、术前他汀治疗与CIN的发生有关。CIN组患者的住院时间较非CIN组延长,住院期间主要不良事件发生率增高(P<0.05或P<0.01)。结论 CIN是急诊PCI患者的常见并发症,可能增加住院期间不良事件的发生率。肾功能不全和血流动力学不稳定是CIN的危险因素,术前他汀治疗是减少CIN发生的预测因素。Objective To investigate the incidence,clinical predictors and in-hospital outcome of contrast-induced nephropathy（CIN） in patients who underwent primary percutaneous coronary intervention（PCI） for acute myocardial infarction（AMI）.Methods Serum creatinine（Scr） concentration was measured before and 48-72 hours after PCI in 186 patients with acute ST-segment elevation myocardial infarction.Clinical characteristics and adverse events were observed during hospitalization.CIN was defined as an increase in serum creatinine of 〉25% or ≥44.2 μmol·L-1（0.5 mg·dL-1）from baseline within 48-72 hours following the procedure.Results Among the 186 patients,34（18.3%） developed CIN.Patients with CIN were more likely to be older（P〈0.05） and had higher incidences of pre-existing renal insufficiency,left ventricular ejection fraction（LVEF）〈40%,heart failure（Killip’s class≥2）than those without CIN（P〈0.01）.All patients with cardiogenic shock developed CIN at admission.The percentage of patients who received pretreatment with statin in CIN group was lower than that in non-CIN group（P〈0.05）.Multivariate Logistic regression analysis revealed that renal insufficiency（baseline Cr clearance〈60 mL·min-1）,implantation of intra-aortic balloon pump（IABP）,cardiogenic shock and statin pretreatment were correlated with CIN.CIN group had longer hospital stay and more adverse events than non-CIN group（P〈0.05 or P〈0.01）.Conclusion CIN frequently complicates primary PCI and is associated with higher incidence of in-hospital adverse events in patients with AMI.Pre-existing renal dysfunction and hemodynamic instability are the independent risk factors for CIN.Statin pretreatment is a predictor of decresed risk of CIN.

关 键 词：心肌梗死 急性 造影剂 肾功能衰竭 急性 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]