术前血浆Hcy对CIN发生的预测价值  

Predictive Value of Preoperative Plasma Hcy on the Occurrence of CIN

作　　者：徐新娜[1] 任岚[1] 王继红[1] 韩昊[1] 兰永昊[1] 赵兴山[1] 孙华毅[1] XuXin-na;Ren Lan;Wang Ji-hong;Han Hao;Lan Yong-hao;Zhao Xing-shan;Sun Hua-yi(Department of Cardiology, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院心内科,北京100035

出　　处：《中国医药导刊》2016年第7期680-681,683,共3页Chinese Journal of Medicinal Guide

摘　　要：目的：探讨经皮冠状动脉介入治疗（PCI）患者术前的血浆同型半胱氨酸（Hcy）水平与对比剂肾病（CIN）发生的关系及Hcy对CIN发生的预测价值。方法：⑴368例行PCI的患者按检测术前血浆Hcy（μmol/L）水平分为3组：A组：115例，Hcy≤15；B组：218例，Hcy15～20；C组35例，Hcy≥20，观察每组CIN的发生例数。⑵368例PCI的患者按术前及术后血肌酐水平判断CIN，分为CIN组和非CIN组，比较两组血浆Hcy水平。⑶采用多因素logistic回归分析PCI患者发生CIN的危险因素。结果：⑴A组患者中有1例发生CIN（0.9%），B组患者中有8例发生CIN（3.7%），C组患者中有9例发生CIN（25.7%）。三组比较差异有统计学意义（P＜0.001）。⑵CIN组术前Hcy水平较非CIN组明显增高，P＜0.05。⑶多因素回归分析中，在校正年龄、BMI、eGFR、对比剂剂量、合并糖尿病、LVEF、血色素及白蛋白等因素后，高血浆Hcy水平使CIN的发生风险明显增加，OR=1.19，95% CI为1.02～1.41，P＜0.05。结论：高血浆Hcy水平是PCI患者发生CIN的有效预测因素。Objective: To investigate the relationship between plasma homocysteine (Hcy) level and the incidence of contrast inducednephropathy (CIN) in patients with percutaneous coronary intervention (PCI) and the predictive value of Hcy on the occurrence of CIN.Methods:⑴368 cases of PCI patients according to preoperative detection of plasma Hcy (μmol / L) level is divided into three groups: groupA: 115 cases, Hcy is less than or equal to 15; group B: 218 cases, Hcy15~20; Group C (35 cases), homocysteine (Hcy) is more than or equalto 20, the observation of each CIN cases. ⑵The 368 cases of PCI patients according to preoperative and postoperative serum creatininelevel judge CIN, divided into CIN group and non CIN group, compared two groups of plasma Hcy levels. ⑶By using multivariate logisticregression analysis of risk factors in patients with PCI CIN. Results: ⑴Group A of patients with CIN (0.9%) occurred in 1 cases, groupB patients with CIN (3.7%) occurred in 8 cases, group C patients with CIN (25.7%) occurred in 9 cases. The difference between the threegroups was statistically significant (P<0.001). ⑵The preoperative Hcy levle of CIN group than non CIN group was significantly increased,P<0.05. ⑶Multivariate regression analysis, after adjustment for age, BMI, EGFR, dose of contrast agent, with diabetes, left ventricular ejectionfraction (LVEF), hemoglobin and albumin etc. factors, high plasma Hcy level increased the CIN risk significantly. OR=1.19, CI 95%9 1.02~1.41,P<0.05. Conclusion: High plasma Hcy level is an effective predictive factor for CIN in patients with PCI.

关 键 词：对比剂肾病 同型半胱氨酸 冠状动脉介入治疗 肾功能 血肌酐 

分 类 号：R541.4[医药卫生—心血管疾病]