肾功能正常或轻度损害的急性冠状动脉综合征患者经皮冠状动脉介入治疗术后发生对比剂肾病的危险因素分析  

Risk Factor Analysis for Contrast-induced Nephropathy in Patients of Acute Coronary Syndrome With Normal or Slightly Impaired Renal Function After Percutaneous Coronary Intervention

作　　者：范继红[1] 胡桃红[2] 贺威[3] 靳志涛[2] 张铮[2] 丁力平[2] 高国杰[2] 杨军珂[2] 王承竹[2] 

机构地区：[1]山西医科大学第二临床医学院,山西省太原市030001 [2]中国人民解放军第二炮兵总医院心血管内科 [3]苏州大学第一临床医学院心血管内科

出　　处：《中国循环杂志》2016年第1期31-35,共5页Chinese Circulation Journal

摘　　要：目的:研究肾功能正常或轻度损害[估算肾小球滤过率(eGFR)≥60 ml/(min·1.73 m^2)]的急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后对比剂肾病的发生率,分析对比剂肾病发病的危险因素及主要不良心血管事件。方法:回顾2013-06至2015-06在第二炮兵总医院心血管内科行PCI的eGFR≥60 ml/(min·1.73 m2)的ACS患者254例。依据对比剂肾病定义[血清肌酐水平升高0.5 mg/dl(44.2μmol/L)或比基础值升高25%]分为对比剂肾病组(n=23)和非对比剂肾病组(n=231),记录所有患者的基线资料、实验室指标和手术指标,计算eGFR值。结果:254例eGFR≥60 ml/(min·1.73 m2)的ACS患者PCI术后23例发生对比剂肾病,发生率为9%。多元Logistic回归分析显示:急诊PCI(OR=0.370,95%CI:0.060~2.297)、N末端B型利钠肽原(NT-proBNP)水平(OR=4.209,95%CI:1.202~14.742)和既往未规律服用阿司匹林(OR=7.950,95%CI:1.108~57.034)是对比剂肾病发生的危险因素。结论:肾功能正常或轻度损害的ACS患者PCI术后对比剂肾病发生的危险因素是急诊PCI、NT-proBNP升高和既往未规律服用阿司匹林。Objective： To evaluate the risk factors for contrast-induced nephropathy （CIN） in patients of acute coronary syndrome （ACS） with normal or slightly impaired renal function after percutaneous coronary intervention （PCI）. Methods： A total of 254 consecutive ACS patients with normal or slightly impaired renal function received PCI in the Second Artillery General Hospital from 2013-06 to 2015-06 were retrospectively studied. All patients had eGRF〉60 ml （minol.73 m^2） and they were divided into 2 groups： CIN group, the patients with serum creatinine increased by 0.5mg/dl （44.2 μmol/L） or elevated to 25% higher than the baseline, n=23; Non-CIN group, n=231. The basic condition with laboratory tests, operative indexes were recorded and eGRF value were calculated in all patients. Results： There were 9% （23/254） patients suffered from CIN after PCI. Multivariate regression analysis indicated that emergent PCI （OR=0.370, 95% CI 0.060-2.297）, increased plasma level of NT-proBNP （OR=4.209, 95% CI 1.202-14.742） and without pre-operative aspirin administration （OR=7.950, 95% CI 1.108-57.034） were the clinical risk factors for post-operative C1N occurrence. Conclusion： Emergent PCI, higher plasma level of NT-proBNP and no pre-operative aspirin administration were the risk factors for CIN occurrence in ACS patients with normal or slightly impaired renal function after PCI.

关 键 词：对比剂肾病 急性冠状动脉综合征 冠状血管造影术 危险因素 

分 类 号：R541[医药卫生—心血管疾病]