两种对比剂诱发的急性肾损伤诊断标准在冠状动脉介入术后患者中的应用比较  

Comparison of diagnostic criteria of 2 different acute renal injury induced by contrast agents in patients after percutaneous coronary intervention

作　　者：王若蒙 张拓[1] 张维峰[1] 孙士群[1] 王志敬 张湘 沈玲红[1] 何奔[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200127 [2]上海市浦东新区周浦医院急诊科

出　　处：《中国介入心脏病学杂志》2017年第1期7-12,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金会(81600518);上海卫生和计划生育委员会(20164Y0111)

摘　　要：目的比较两种对比剂诱发的急性肾损伤诊断标准与行冠状动脉介入术患者的临床特征及术后不良事件相关性的差异。方法回顾性分析2013年7月至2014年12月于上海交通大学医学院附属仁济医院心脏中心行冠状动脉造影术(CAG)或经皮冠状动脉介入治疗(PCI)的患者共1063例。分别采用欧洲泌尿生殖放射学会对比剂肾病(CIN)诊断标准和改善全球肾病预后组织(KDIGO)诊断标准对冠状动脉介入术后对比剂诱发急性肾损伤(CI-AKI)的患者进行诊断。比较两种诊断标准与冠状动脉介入术后12个月内主要不良事件(MAEs)发生风险的相关性。结果 KDIGO诊断标准下,CI-AKI患者23例(2.2%),而采用CIN诊断标准,CI-AKI患者93例(8.7%),两种诊断标准比较差异有统计学意义(P<0.001)。KDIGO诊断标准下的CI-AKI患者,随着Mehran评分危险分级的增加,患者所占比例呈现逐渐增加的趋势,而在CIN诊断标准中则呈现相反的趋势。在12个月随访过程中,有61例(5.7%)患者发生MAEs,但两种诊断标准下CI-AKI患者的MAEs发生率比较,差异无统计学意义(P>0.05)。多元logistics回归分析显示:CIN诊断标准预测MAEs为OR6.69,95%CI 3.55~12.61,P<0.001;KDIGO诊断标准预测MAEs为OR 8.38,95%CI 2.28~30.72,P=0.001。结论采用KDIGO诊断标准和CIN诊断标准诊断冠状动脉介入术后CI-AKI的发病率存在明显差异。相较于CIN诊断标准,KDIGO诊断标准可能与行冠状动脉介入术患者的高危特征以及术后MAEs的发生更为相关。Objective To compare two different diagnostic criteria of acute kidney injury induced by contrast media in patients receiving coronary artery intervention, and differences in their correlation with postoperative adverse events. Methods A retrospective analysis of 1063 cases received coronary angiography （CAG） or pereutaneous coronary intervention （PCI） in the Heart Center of Renji Hospital from July 2013 to December 2014 was made. Postoperative Contrast-Induced Acute Kidney Injury （CI-AKI） was diagnosed following coronary intervention by using Contrast-Induced Nephropathy （CIN） standards and Kidney Diseases Improving Global Outcomes （KDIGO） standard respectively. The correlation between the two diagnostic criteria and major adverse events （MAEs） risk within 12 months after coronary artery intervention treatment was compared. Results Using the diagnostic criteria of KDIGO, the incidence of CI- AKI was 2. 2%, but according to the diagnostic criteria of CIN, the incidence of CI-AKI was 8.7% （P 〈 0. 001 ）. In patients diagnosed with KDIGO standard, the proportion of CI -AKI appeared to gradually increase along with the increase in chronic kidney disease （CKD） grades or CI-AKI dangerous stages, while in patients diagnosed with CIN standard, there was an opposite trend. During the 12 months of follow-up, MAEs occurred in 61 patients, the rate of 5.7%. Multiple logistics regression showed that CIN criteria forcasted MAEs with odds ratio = 6.69, 95% confidence interval, 3.55 - 12.61 （P 〈 0.001 ） , while KDIGO criteria forcasted MAEs with odds ratio = 8. 38, 95% confidence interval, 2. 28 - 30. 72 （ P = 0. 001 ）. Conclusions An obvious difference exists in postoperative incidence of CI-AKI following coronary intervention between the KDIGO diagnostic criteria and CIN diagnostic criteria. Compared with CIN criteria, KDIGO criteria may be more related to the high-risk features of patients given coronary artery intervention treatment and their postoperative adverse events. Further c

关 键 词：对比剂 急性肾损伤 冠状动脉造影 经皮冠状动脉介入治疗 

分 类 号：R692[医药卫生—泌尿科学] R541.4[医药卫生—外科学]