急性冠脉综合征患者血同型半胱氨酸水平对经皮冠状动脉介入术后造影剂肾病发生的相关研究  

The effect study of homocysteine on contrast-induced nephropathy after percutaneous coronary intervention patients

作　　者：王海峰[1] 王玉慧[1] 陈建华[1] 吕彦辉[1] 罗东雷[2] 周江[2] Wang Haifeng;Wang Yuhui;Chen Jianhua;Lyu Yanhui;Luo Donglei;Zhou Jiang(Department of Nephrology,Central Hospital of Chengde,Chengde 067000,China;Department of Cardiology,Central Hospital of Chengde ,Chengde 067000,China)

机构地区：[1]承德市中心医院肾内科,067000 [2]承德市中心医院心内科,067000

出　　处：《国际泌尿系统杂志》2019年第1期117-120,共4页International Journal of Urology and Nephrology

摘　　要：目的探讨不同血清同型半胱氨酸水平的急性冠脉综合征患者经皮冠状动脉介入治疗后造影剂肾病的发生率及相关影响因素。方法选取2016年8月至2017年6月在本院心内科行经皮冠状动脉介入治疗的299例急性冠脉综合征患者。据入院时血清同型半胱氨酸水平分为两组(A组Hcy<15μmol/L,B组Hcy≥15μmol/L),比较不同的血清同型半胱氨酸水平急性冠脉综合征患者行经皮冠状动脉介入术后造影剂肾病发生率,分析其影响因素。结果299例患者发生造影剂肾病24例,发生率为8.0%,A组患者196例,发生造影剂肾病11例,发生率5.61%;B组患者103例,发生造影剂肾病13例,发生率12.62%,两组之间比较差异有统计学意义(P=0.039)。两组之间比较术前血肌酐、血尿酸、γ-谷氨酰转肽酶差异有统计学意义(P<0.05),术前年龄、血糖、甘油三酯、胆固醇、血白蛋白等差异无统计学意义。多因素Logistic回归分析显示血清同型半胱氨酸≥15μmol/L(OR=1.060,95%CI:1.014~1.107,P=0.009),术前血肌酐(OR=1.039,95%CI:1.014~1.064,P=0.002)、γ-谷氨酰转肽酶(OR=1.032,95%CI:1.005~1.060,P=0.022)是发生造影剂肾病的危险因素。结论术前同型半胱氨酸水平≥15μmol/L、血肌酐升高、γ-谷氨酰转肽酶升高使急性冠脉综合征患者经皮冠状动脉介入治疗术后造影剂肾病发生风险增加。Objective To explore the impact of homocysteine(Hcy)on contrast-induced nephropathy(CIN) after percutaneous coronary intervention(PCI) in patients with acute coronary syndrome(ACS). Methods Two hundred and ninety-nine patients underwent PCI in the cardiology department of our hospital were enrolled in this study. Patients were divided into group A(Hcy<15μmol/L)and group B(Hcy≥15μmol/L)according to HCY level to investigate the influence of the incidence of CIN after PCI and its influencing factors. Results CIN occurred in 24(8.0%)of 299 enrolled patients, and the incidence of CIN in group B(12.62%)was significantly increased compared with that in the group A(5.61%)(P=0.039). Statistically significant differences were found in preoperative blood creatinine, preoperative uric acid, gamma-glutamyl transpeptidase.There was no statistical difference between preoperative age blood glucose triglyceride cholesterol blood albumin and so on. Multivariate logistic regression analysis found that Hcy≥15μmol/ L(OR=1.060, 95%CI: 1.014-1.107, P=0.009), preoperative blood creatinine(OR=1.039, 95%CI: 1.014-1.064, P=0.002)andγ-glutamyltransferase(OR=1.032, 95%CI: 1.005-1.060, P=0.022)were found of risk factors of CIN. Conclusions Serum homocysteine, preoperative blood creatinine and γ-glutamyltransferase may increase the occurrence of CIN after PCI in patients with ACS.

关 键 词：肾疾病 冠状动脉疾病 造影剂 血管成形术 经腔 经皮冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病] R692[医药卫生—内科学]