冠心病合并糖尿病肾病患者经皮冠脉介入治疗发生急性对比剂肾损伤的研究  

作　　者：赵进[1] 李彪[1] 曾芳[1] 

机构地区：[1]暨南大学医学院附属第四医院/广州市红十字会医院心内科,广东广州510220

出　　处：《世界中医药》2016年第B06期2101-2102,共2页World Chinese Medicine

摘　　要：目的探讨冠心病合并糖尿病肾病（DN）患者行冠状动脉造影（CAG）和（或）经皮冠脉介入（PCI）诊疗后发生急性对比剂肾损伤（CI—AKI）的情况。方法：选择180例糖尿病并发冠心病患者，进行CAG和（或）经皮冠脉介入（PCt）诊疗，术后每日检测尿uKIM-1、尿微量白蛋白水平，第1、2、3、5、7天检测血肌酐（SCr）水平。结果：（1）共计合并糖尿病肾病126例，CI—AKI发病19例，相比非DN者发生率高（P=O．033）；其中CI—AKI组中大量蛋白尿者占比较非CI—AKI组高，肾功能低下者所占比例亦较非CI—AKI组高（P〈0．046）；行直接CAG和（或）PCI34例，术后发生CI—AKI8例（23．53％），较择期介入术后发生率高（P=0．018）。（2）CI—AKI组患者uKIM-1水平与SCr呈正相关（P〈0．05），其峰值出现在第2天早于Scr，与eGFR谷值相吻合，CI-AKI组峰值较第1天及非CIAKI组升高明显，P〈0.05，且高水平持续2d。结论：糖尿病肾病是CI—AKI发生的高危因素，需及早采取防治措施避免CI—AKI；uKIM-1可以作为cI—AKI更理想的早期标志物进行检测，提前识别，避免肾功能的恶化。Objective To investigate the urinary kidney injury molecule 1 （uKIM-1） and diabetic nephropathy （DN） patients underwent coronary angiography （CAG） and （or） percutaneous coronary intervention （PCI） for acute kidney injury after treatment of contrast agent （CI-AKI） relationship. Methods： To choose the 180 cases of diabetes mellitus complicated with coronary heart disease patients with CAG and （or） after percutaneous coronary intervention （PCI） in diagnosis and treatment, postoperative daily urine ukim-1 and urinary albumin levels, 1, 2, 3, 5, 7 days for measurement of serum creatinine （SCR） level. Results： （1） the total of diabetic nephropathy in 126 cases, incidence of ci-aki in 19 cases, compared to non DN incidence was high （P = 0.033）; the ci-aki group in a lot of proteinuria accounted for a relatively non ci-aki were higher, the proportion of low renal function than non ci-aki group （P〈0.046）; line direct CAG and （or） PCI in 34 cases and postoperative occurrence of ci-aki in 8 cases （23.53%）, compared with delayed intervention occurrence rate was high （P = 0.018）. （2） ci-aki group patients ukim-1 level and serum creatinine （SCR）had a positive correlation （P 〈 0.05）, the peak appeared in the 2 days earlier than SCR and EGFR and valley values coincide, peak of ei-aki group compared with day 1 and non CIAKI group significantly increased, P 〈 0.05, and the high level continued for 2 days. Conclusion： diabetic nephropathy is one of the risk factors for ci-aki, need to take early preventive measures to avoid ci-aki; ukim-1 can as ci-aki more ideal early indications for the compounds were detected, early identification, to avoid the deterioration of renal function.

关 键 词：糖尿病肾病 急性对比剂肾损害 尿肾损伤分子1 

分 类 号：R587.1[医药卫生—内分泌]