造影剂引起急性肾损伤及死亡危险因素分析  

Risk factors of contrast-induced acute kidney injury and mortality

作　　者：李雪[1] 李德天[1] 张蓓茹[1] 

机构地区：[1]中国医科大学附属盛京医院肾脏内科,沈阳110004

出　　处：《中国实用内科杂志》2013年第1期42-45,共4页Chinese Journal of Practical Internal Medicine

基　　金：卫生公益性行业科研专项合作项目(201002010)

摘　　要：目的探讨冠状动脉造影(CAG)及经皮冠状动脉介入治疗(PCI)患者造影剂引起急性肾损伤的危险因素及造影剂急性肾损伤及死亡的危险因素。方法回顾性分析2007年1月至2010年12月中国医科大学附属盛京医院253例支架植入患者的临床资料。分别比较造影剂引起的急性肾损伤和非急性肾损伤患者及造影剂引起的急性肾损伤生存与死亡患者的临床特点,分析造影剂引起急性肾损伤和造影剂急性肾损伤死亡的危险因素。结果 Logistic回归分析显示,造影剂引起急性肾损伤的危险因素为高龄(≥60岁)、女性、急性心肌梗死(AMI)、术前肾小球滤过率(eGFR)<60 mL/(min.1.73 m2)、造影剂剂量(≥180 mL)、心力衰竭。COX比例风险模型显示,造影剂急性肾损伤患者死亡的危险因素为高龄(≥60岁)、术前肾小球滤过率<60 mL/(min.1.73 m2)、AMI、心力衰竭、造影剂剂量(≥180 mL)、2型糖尿病、多支血管病变(>2)。结论高龄(≥60岁)、AMI、基础肾功能差、大剂量使用造影剂、心力衰竭既是急性肾损伤的危险因素,也是死亡的危险因素。此外,2型糖尿病、多支血管病变(>2)与急性肾损伤患者死亡密切相关。女性虽然是肾损伤的危险因素,但本身并不增加患者的死亡。Objective To investigate the risk factors of contrast-induced acute kidney injury and mortality in patients who underwent coronary angiography （CAG） and pereutaneous coronary intervention （PCI）. Methods The clinical profiles of 253 patients treated with PCI in Affiliated Shengjing Hospital of China Medical University, between January 2007 and De- cember 2010 ,were retrospectively analyzed. The clinical characteristics of survival and mortality in patients with or without contrast-induced acute kidney injury as well as the risk factors of contrast-induced acute kidney injury- were analyzed. Re- suits The risk factors of contrast-induced acute kidney injury included age ≥ 60 years, female, acute myocardial infarc- tion, eGFR 〈 60 mL/（ min · 1.73 m2 ） prior to PCI, high-dose administration of contrast medium （ ≥ 180 mL） and heart dysfunction, as suggested by Logistic regression model. COX proportional hazard model showed that the risk factors of mor- tality associated with contrast-induced acute kidney injury were consisted of age ≥60 years, eGFR 〈 60 mL/（ min ·1.73 m2） piror to PCI, acute myocardial infarction, heart dysfunction, high-dose administration of contrast medium （≥ 180 mL） , type 2 diabetes mellitus and multi-vessel disease （ 〉 2）. Conclusion Elderly （ ≥60 years）, acute myocardial infarction, re- nal dysfunction, high-dose administration of contrast medium and heart dysfunction are risk factors of contrast-induced acute kidney injury and mortality following PCI. Additionally,type 2 diabetes and multi-vessel disease （ 〉 2） are closely correlated with mortality. Female is a risk factor of contrast-induced acute kidney injury yet may not increase the risk of mortality.

关 键 词：急性肾损伤 冠状动脉造影 经皮冠状动脉介入治疗 危险因素 

分 类 号：R595.3[医药卫生—内科学]