微量清蛋白尿对冠状动脉介入诊疗术后对比剂肾病的预测作用  

Microalbuminuria as a predictor of contrast-induced nephropathy in patients undergoing coronary angiography and intervention

作　　者：王鸿珍[1] 徐文彬[2] 陶蓉[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心内科,上海200025 [2]上海交通大学医学院附属瑞金医院特需医疗保健中心,上海200025

出　　处：《内科理论与实践》2014年第3期169-173,共5页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨微量清蛋白尿(MAU)是否对冠状动脉介入诊疗术后发生对比剂肾病(CIN)的发生有预测作用。方法:筛选183例择期冠状动脉造影(CAG)术或经皮冠状动脉介入(PCI)术患者,收集其临床相关数据。所有患者分别于术前、术后48 h检测胱抑素C(Cys C),根据术前、术后Cys C变化分为CIN和非CIN 2组,分析CIN发生情况及相关危险因素。结果:CIN总发生率为9.8%(18/183)。与非CIN组比较,CIN组中年龄≥75岁老年患者、急性冠状动脉综合征(ACS)、行PCI术及存在MAU的患者明显居多,术前估算肾小球滤过率(eGFR)较低,术前血肌酐、Cys C、尿酸以及对比剂剂量/eGFR比值较高。多因素Logistic回归分析显示术前Cys C和MAU是CIN发生的独立危险因素。糖尿病患者CIN的发生率随着尿清蛋白肌酐比值(UACR)升高而显著升高。结论:术前Cys C和MAU是预测冠状动脉介入治疗术后CIN发生的主要因素。糖尿病患者的UACR水平可预测术后CIN的发生。Objective To investigate whether microalbuminuria （MAU） has the value of predicting contrast-induced nephropathy （CIN） in patients undergoing coronary angiography or percutaneous coronary intervention （PCI）. Methods A total, 183 patients were enrolled and clinical data were collected. Serum cystatin C （Cys C） was measured before and 48 h after intervention. Patients were divided into CIN and non-CIN group according to the alteration of Cys C. Results CIN occurred in 18 （9.8%） patients. Advanced age, acute coronary syndrome, PCI and MAU were significantly more common in CIN group than in non-CIN group. The baseline estimated glomerular filtration rate （eGFR） was lower, while the baseline serum ereatinine （SCr）, Cys C, uric acid and contrast dose/eGFR ratio were higher in CIN group. Multivariate analysis showed that Cys C and MAU were independent risk factors of CIN. In diabetic patients, the occurrence of CIN was in correlation with MAU level. Conclusions Preoperative MAU and eGFR value could help to identify the patients undergoing coronary angiography and intervention at risk of developing CIN. MAU level in diabetic patients may be a predictor of CIN.

关 键 词：微量清蛋白尿 胱抑素C 对比剂肾病 冠状动脉造影术 经皮冠状动脉介入术 

分 类 号：R541.4[医药卫生—心血管疾病]