二氧化碳结合力与急诊冠状动脉介入治疗后对比剂性急性肾损害的关系  

Relationship between carbon dioxide combining power and contrast-induced acute kidney injury in patients with ST segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention

作　　者：冉鹏[1] 杨峻青[1] 杨旭希[1] 周颖玲[1] 谭宁[1] 何谊婷 李光[1] 孙硕[1] 刘勇[1] 谢年谨[1] 陈纪言[1] 

机构地区：[1]广东省心血管病研究所广东省医学科学院广东省人民医院心内科,广州510080 [2]广东省佛山市顺德区人民医院心内科

出　　处：《中华心血管病杂志》2014年第7期551-556,共6页Chinese Journal of Cardiology

摘　　要：目的：探讨二氧化碳结合力（CO2-CP）与急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）后对比剂性急性肾损害（CI-AKI）的关系。方法回顾性分析2012年3月至2013年8月在广东省人民医院行急诊PCI的174例STEMI患者的临床资料。按术前CO2-CP水平的三分位间距，将患者分为3组：T1组（ CO2-CP＜22.62 mmol/L）、T2组（ CO2-CP 22.62～24.30 mmol/L）、T3组（ CO2-CP＞24.30 mmol/L）。比较3组之间的基线资料、CI-AKI发生率、院内病死率及血液透析率。 CI-AKI定义为使用对比剂后48 h内血清肌酐较基线水平升高26.4μmol/L或升高50％。采用单因素 logistic 回归分析筛选 CI-AKI 的危险因素，采用 logistic 回归分析 CO2-CP 与CI-AKI的关系。采用受试者工作特征（ ROC）曲线评估CO2-CP预测CI-AKI的最佳界值。结果共25例患者（14.4％）发生 CI-AKI。 T1、T2和T3组CI-AKI 的发生率分别为27.6％（16/58）、5.3％（3/57）和10.2％（6/59）（P＝0.002），院内病死率分别为10.3％（6/58）、0和1.7％（1/59）（P＝0.010），血液透析率分别为5.2％（3/58）、0、1.7％（1/59）（P＝0.168）。单因素logistic 回归分析显示，CO2-CP ＜22.00 mmol/L 与 CI-AKI 的发生率相关（ OR ＝6.767，95％CI：2.731～16.768， P ＜0.001）；多因素logistic回归分析显示，CO2-CP＜22.00 mmol/L是发生CI-AKI的独立危险因素（ OR＝5.835，95％CI：1.800～18.914， P＝0.003）。 ROC曲线显示， CO2-CP界值为22.00 mmol/L时，其预测CI-AKI的敏感度为64.0％，特异度为79.1％，曲线下面积为0.714。结论 STEMI患者术前CO2-CP水平与急诊PCI后CI-AKI相关，CO2-CP＜22.00 mmol/L者发生CI-AKI的风险增加。Objective To study the relationship between carbon dioxide combining power （ CO2-CP） and contrast-induced acute kidney injury （ CI-AKI） in patients with ST segment elevation myocardial infarction and undergoing percutaneous coronary intervention.Methods We retrospectively analyzed 174 patients admitted to our hospital from March 2012 to August 2013 with ST segment elevation myocardial infarction and underwent emergency percutaneous coronary intervention.Patients were divided into three tertiles according to pre-operative CO2-CP： T1 （CO2-CP 〈22.62 mmol/L）,T2（CO2-CP 22.62 -24.30 mmol/L）, T3（CO2-CP〉24.30 mmol/L）.Baseline clinical data, CI-AKI incidence, in-hospital mortality and dialysis rate were compared among groups.An increase in serum creatinine of 〉26.4 μmol/L and/or 〉50%from baseline within 48 hours after contrast exposure was defined as CI-AKI.Univariate logistic regression analysis was used to identify the risk factors of CI-AKI.The relationship between CO 2-CP and CI-AKI was assessed by multivariate logistic regression analysis.Receiver operating characteristic curve was used to identify the optimal cutoff of the CO 2-CP for predicting CI-AKI.Results CI-AKI occurred in 25（14.4%） patients, and lower CO2-CP was related to higher incidence of CI-AKI （27.6% （16/58） in group T1, 5.3%（3/57） in group T2, 1.7 % （1/59） in group T3, P=0.002） and higher in-hospital mortality （10.3%（6/58） vs.0 and 1.7%（1/59）, P=0.010）.Dialysis rate was similar among 3 groups （5.2%（3/58）vs.0 and 1.7%（1/59）, P=0.168）.The incidence of CI-AKI was significantly associated with CO2-CP〈22.00 mmol/L in univariate analyses （ OR=6.767,95%CI 2.731-16.768, P〈0.001）.After adjusting for potential confounding risk factors , CO2-CP 〈22.00 mmol/L remained significantly associated with the incidence of CI-AKI （OR=5.835,95%CI 1.800-18.914, P=0.003） in multivariate logistic regression.ROC analysis revealed that the optimal cutoff of CO 2-CP to predict CI-AKI was 22.0

关 键 词：肾病 对比剂 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] R692[医药卫生—内科学]