贫血与经皮冠状动脉介入术后对比剂诱导的急性肾损伤的关系研究  

Anemia Predicts Contrast Induced Acute Kidney Injury after Percutaneous Coronary Interventions

作　　者：陈永利[1] 姜华[1] 陈闽荔[1] 陈树涛[1] 丛洪良[1] 付乃宽[1] 

机构地区：[1]天津市胸科医院心内科,300222

出　　处：《中国全科医学》2014年第23期2722-2725,共4页Chinese General Practice

基　　金：天津市卫生局科技重点攻关项目(10KG122)

摘　　要：目的探讨贫血与经皮冠状动脉介入术(PCI)后对比剂诱导的急性肾损伤(CI-AKI)的关系。方法选取天津市胸科医院心内科2008年1月—2010年5月行PCI的冠心病患者1 500例,于PCI前及PCI后72 h内检测血肌酐水平。CI-AKI定义为PCI后72 h内测定血肌酐较术前水平增加44.2μmol/L或升高25%以上。贫血定义为血红蛋白(Hb)<110 g/L(女性)或<120 g/L(男性)。以各项临床及实验室检查指标为自变量,分别以CI-AKI及贫血为因变量,应用多元Logistic回归分析CI-AKI及贫血的危险因素。结果 1 500例行PCI患者中共有295例(19.7%)发生贫血,246例(16.4%)发生CI-AKI。贫血组与非贫血组CI-AKI发病率分别为29.2%(86/295)和13.3%(160/1 205)(P<0.05);伴有肾功能不全者中,贫血组和非贫血组CI-AKI发病率分别为39.4%(26/66)和24.6%(46/187)(P<0.05);在肾功能正常者中,贫血组和非贫血组CI-AKI发病率分别为26.2%(60/229)和11.2%(114/1 018)(P<0.05)。多元Logistic回归分析显示,贫血是PCI后发生CI-AKI的危险因素〔OR(95%CI)=1.85(1.31,2.61)〕,而高龄、肾功能不全及左心室射血分数(LVEF)≤50%是冠心病患者发生贫血的危险因素〔OR(95%CI)=1.47(1.37,1.70);1.93(1.41,2.65);1.62(1.20,2.17)〕。结论无论患者是否伴有肾功能不全,贫血均是冠心病患者PCI后发生CI-AKI的危险因素。Objective To investigate the relationship of anemia to contrast induced-acute kidney injury（ CI-AKI） after percutaneous coronary intervention（ PCI）. Methods A total of 1 500 patients from Department of Cardiology,Tianjin Chest Hospital were selected,which with coronary heart disease（CHD）underwent PCI from January 2008 to May 2010. Serum creatinine（Scr）level was determined before PCI and 72 h after. CI-AKI was defined as an absolute increase by≥44. 2μmol/L or a relative increase by≥25% in Scr within 72 hours after PCI. Anemia was defined as a level of hemoglobin（ Hb）〈120 g/L in man or 〈110 g/L in woman. Taking clinical and laboratory indicators as independent variables,CI-AKI and anemia as dependent variables,multivariate Logistic regression analysis was performed to identify risk factors of CI-AKI and anemia. Re-sUlts Among the 1 500 patients,295（19. 7%）had anemia,246（16. 4%）had CI -AKI. The CI -AKI incidences of groups anemia,non-anemia were 29. 2%（86/295）,13. 3%（160/1 205）,respectively（P〈0. 05）. CI-AKI incidences of groups anemia,non-anemia were 39. 4%（26/66）,24. 6%（46/187）,respectively,in the patients combined with renal dysfunction（P〈0. 05）,and 26. 2%（60/229）,11. 2%（114/1 018）,respectively,in those with normal renal function （P〈0. 05）. By multivariate Logistic regression analysis,anemia was a risk factor of CI-AKI after PCI〔OR（95%CI） =1. 85（1. 31,2. 61）〕,and advanced age,renal dysfunction,LVEF≤50% were risk factors of anemia in CHD patients〔OR （95%CI） = 1. 47（1. 37,1. 70）;1. 93（1. 41,2. 65）;1. 62（1. 20,2. 17）〕. ConclUsion Anemia is a risk factor of CI-AKI in CHD patients after PCI regardless of whether the patients have renal dysfunction or not.

关 键 词：贫血 肾功能不全 急性 血管成形术 经腔 经皮冠状动脉 造影剂 

分 类 号：R556[医药卫生—血液循环系统疾病] R692[医药卫生—内科学]