对比剂剂量与估算的肾小球滤过率比值对冠状动脉介入术后对比剂肾病的预测价值  

The ratio of contrast medium volume to estimated glomerular filtration rate as a predictor of contrast-induced nephropathy developed after undergoing CAG and /or PCI

作　　者：何海燕[1] 李文华[2] 余亚仁 陈静[2] 王琳[2] 

机构地区：[1]江苏省徐州医学院研究生院,221000 [2]徐州医学院附属医院心内科

出　　处：《中国临床研究》2014年第6期647-649,共3页Chinese Journal of Clinical Research

摘　　要：目的探讨对比剂剂量(CMV)与估算的肾小球滤过率(eGFR)比值(CMV/eGFR)对行冠脉诊疗介入术后对比剂肾病(CIN)的早期临床预测价值。方法连续收集徐州医学院附属医院心血管内科于2013年3月至9月195例行CAG术和/或PCI术的患者临床资料,于术前3 d内及术后24、48 h静脉采血3 ml,用于血肌酐(Scr)检测,以适合中国人的改良形式肾脏病饮食调整研究(modification of diet in renal disease,MDRD)公式计算eGFR,并计算CMV/eGFR。应用受试者工作特征曲线(ROC)评价分析CMV/eGFR的比值对CIN发生的敏感性和特异性。结果 195例患者中术后有13例(6.7%)发生CIN,当CMV/eGFR值<2.46,CIN发生率为2.6%(4/152),而当CMV/eGFR≥2.46,CIN发生率为20.9%(9/43)。CIN组与非CIN组患者在对比剂用量[(176.46±67.15)ml vs(105.31±43.05)ml,P<0.01],以及CMV/eGFR(2.94±1.28 vs 1.77±0.82,P<0.01)方面有统计学差异。ROC曲线表明取CMV/eGFR预测CIN的临界点为2.46,当>2.46时,其特异度为81.3%,灵敏度为76.9%。结论 CMV/eGFR对于冠脉诊疗介入术后患者发生CIN具有良好的早期预测价值。Objective To explore the early clinical predictive value of the ratio of contrast medium volume （CMV） to estimated glomerular filtration rate （eGFR） （CMV/eGFR） for contrast-induced nephropathy （CIN） developed after coronary intervention procedure for diagnosis and/or treatment. Methods The clinical data of consecutive 195 patients underwent coronary angiography （CAG） and/or percutaneous coronary intervention （PCI） in the department of cardiology of the hospital affiliated to Xuzhou Medical College between March 2013 and September 2013 were collected. Collecting 3 ml of venous blood within 3 d before operation and 24 h, 48 h after operation, the serum creatinine （Scr） was detected. The eGFR was calculated by the modified formula suitable for Chinese derived from modification of diet in renal disease （MDRD） formula, and then CMV/eGFR was calculated. The sensitivity and specificity of CMV/eGFR for predicting development of CIN were assessed and analyzed by the receiver-operating characteristic curve （ROC）. Results The CIN after interventional procedure was seen in 13 out of 195 cases （6. 7% ）. The CIN occurrence rate was 2.6% for CMV/eGFR 〈 2.46 , while it was 20.9% for CMV/eGFR≥ 2.46. There were significant differences between CIN group and no-CIN group in CMV [ （176.46 ± 67. 15 ） ml vs （ 105.31 ±43.05） ml,P 〈0.01） ]and CMV/eGFR （2.94± 1.28 vs 1.77 ±0.82,P 〈0.01）. The analysis of ROC curve shows that for CMV/eGFR 〉 2.46, the specificity and sensitivity were 81.3% and 76.9%, respectively. Conclusions The CMV/eGFR has a favorable early predictive value for the diagnosis of CIN in patients underwent coronary intervention procedure.

关 键 词：冠状动脉造影术 经皮冠状动脉介入 对比剂肾病 

分 类 号：R816.2[医药卫生—放射医学]