CHA_2DS_2-VASc评分对冠心病患者择期经皮冠状动脉介入治疗术后对比剂肾病的预测价值  

Predictive Value of CHA_2DS_2-VASc Score for Contrast-induced Nephropathy After Elective Percutaneous Coronary Intervention in Patients With Coronary Heart Disease

作　　者：陈飞[1] 鲁静朝[1] 杨秀春[1] 肖冰[1] 靳亚琼 刘凡[1] 崔炜[1] CHEN Fei;LU Jing-chao;YANG Xiu-chun;XIAO Bing;JIN Ya-qiong;LIU Fan;CUI Wei(Department of Cardiology,The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province,Shijiazhuang（050000）,Hebei,China)

机构地区：[1]河北医科大学第二医院心内科河北省心脑血管病研究所,河北省石家庄市050000

出　　处：《中国循环杂志》2018年第11期1049-1052,共4页Chinese Circulation Journal

摘　　要：目的:探讨CHA_2DS_2-VASc评分对冠心病患者择期经皮冠状动脉(冠脉)介入治疗术后对比剂肾病的预测价值。方法:本研究入选择期行经皮冠脉介入治疗的患者356例,按照CHA_2DS_2-VASc评分将患者分为CHA_2DS_2-VASc评分≥3分组(n=153)与CHA_2DS_2-VASc评分≤2分组(n=203)。比较分析两组基线资料及对比剂肾病、主要不良心血管事件发生率。应用Logistic回归分析和受试者工作特征曲线评估CHA_2DS_2-VASc评分对对比剂肾病的预测效果。结果:CHA_2DS_2-VASc评分≥3分组与CHA_2DS_2-VASc评分≤2分组相比,患者年龄较大,合并高血压、糖尿病者多,左心室射血分数偏低,基线血肌酐水平偏高,冠脉多支病变比例较高,对比剂用量较大,对比剂肾病发生率较高,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,CHA_2DS_2-VASc评分≥3分是对比剂肾病的独立预测因子(OR=2.152,95%CI:1.261～3.987,P=0.032)。受试者工作特征曲线分析表明,CHA_2DS_2-VASc评分≥3分预测对比剂肾病的曲线下面积为0.749,敏感度76.9%,特异度73.0%。结论:CHA_2DS_2-VASc评分对冠心病患者择期经皮冠脉介入治疗术后对比剂肾病有一定的预测价值,有助于我们识别高危患者并采取预防措施。Objectives： To investigate the predictive value of CHA2DS2-VASc score for contrast induced nephropathy（CIN） after percutaneous coronary intervention in patients with coronary heart disease. Methods： A total of 356 patients undergoing elective percutaneous coronary intervention were enrolled in this study. The patients were divided into two groups according to the CHA2DS2-VASc score： CHA2DS2-VASc score ≥ 3（n=153） and ≤ 2（n=203）. Baseline data, incidence of CIN and major adverse cardiovascular events were analyzed and compared between the two groups. The predictive effect of CHA2DS2-VASc score was analyzed with receiver operating characteristic curve（ROC） and logistic regression analysis. Results： Left ventricular ejection fraction was significantly lower, baseline serum creatinine value was significantly higher, coronary lesions were more complex, contrast agent dosage used was significantly larger and the incidence of CIN was significantly higher in patients of the CHA2DS2-VASc score ≥ 3 group than in patients of CHA2DS2-VASc score ≤ 2 group（all P values 〈0.05）. Multivariate logistic regression analysis showed that CHA2DS2-VASc score ≥ 3 was an independent predictor of CIN（OR=2.152, 95% CI： 1.261-3.987, P=0.032）. The area under the curve of ROC of CHA2DS2-VASc score ≥ 3 for predicting CIN was 0.749（sensitivity 76.9%, specificity 73.0%）.Conclusions： CHA2DS2-VASc score could predict the CIN after percutaneous coronary intervention in patients with coronary heart disease, which could help us identify the high-risk patients of CIN and take preventive measures to reduce the incidence of CIN post percutaneous coronary intervention.

关 键 词：CHA2DS2-VASc评分 冠心病 经皮冠状动脉介入治疗 对比剂肾病 

分 类 号：R54[医药卫生—心血管疾病]