超高龄老年患者冠状动脉介入诊疗术后发生对比剂肾病的危险因素分析  

Risk factors of contrast induced nephropathy in extreme elderly patients receiving coronary intervention

作　　者：潘慧超 伍旭升 吴献豪 万千里 陈守涛 陈小虎 刘宝宏 蒋利 

机构地区：[1]上海市同仁医院心内科,上海200050

出　　处：《中国介入心脏病学杂志》2015年第12期668-672,共5页Chinese Journal of Interventional Cardiology

基　　金：上海卫计委科研课题(20124Y02001)

摘　　要：目的探讨超高龄老年患者接受冠状动脉介入诊疗术[冠状动脉造影(CAG)、经皮冠状动脉介入治疗(PCI)]后发生对比剂肾病(CIN)的相关危险因素。方法选择2012年11月至2015年5月在上海市同仁医院心内科接受CAG、PCI的超高龄(≥80岁)患者303例,根据术后48 h内的血清肌酸酐(肌酐)水平变化分为CIN组和非CIN组,并对相关危险因素进行分析。结果 303例超高龄患者中,发生CIN者共31例(10.2%,CIN组)。两组患者的高血压分级、急诊/择期手术、冠状动脉病变支数及程度、死亡率、尿微量白蛋白等资料比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,超高龄患者的高血压分级、急诊/择期手术、病变程度、估算的肾小球滤过率(e GFR)和尿微量白蛋白是CIN发生的危险因素(均P<0.05)。结论高血压分级、急诊/择期手术、病变程度、e GFR和尿微量白蛋白是超高龄患者CAG或者PCI后CIN发生的危险因素,超高龄患者应当加强围术期综合因素管理,有效预防对比剂肾病。Objective To evaluate the associated risk factors of contrast induced nephropathy （CIN） in extreme elderly patients after coronary angiography and percutaneous coronary intervention. Methods 303 extreme elderly patients who had received coronary angiography and percutaneous coronary intervention in Shanghai Tong Ren hospital from November 2012 to May 2015 were enrolled for study. These patients were divided into the CIN group and the non-CIN group according to the serum creatinine levels within 48 h. Results Among the 303 patients CIN occurred in 31 patients and the incidence was 10. 2%. The differences in hypertension classification, primary versus elective operation, number and severity of coronary lesions, mortality rates and presence of microalbuminuria （MA） were of statistical significances between the 2 groups （ all P 〈 0. 01 ）. Multi-factor logistic analysis indicated that hypertension classification, primary or elective operation, severity of coronary lesions, levels of MA and eGFR were risk factors for CIN in extreme elderly patients （ P 〈 0. 05 ） . Conclusions Hypertension classification, primary or elective operation, severity of coronary lesions, the levels of MA and eGFR were risk factors for development of CIN in extreme elderly patients after coronary angiography and percutaneous coronary intervention. The comprehensive management of perioperative factors of this group of extreme elderly patients should be strengthened to prevent contrast induced nephropathy effectively.

关 键 词：对比剂肾病 危险因素 冠状动脉造影 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]