急性冠状动脉综合征合并心力衰竭患者的肾功能状况及冠状动脉介入治疗术后对比剂肾病的发生情况分析  

Incidence of Renal Insufficiency and Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome Complicated With Heart Failure

作　　者：朱佳璐 高传玉 王宪沛 晏娟娟 张优 王山 ZHU Jialu;GAO Chuanyu;WANG Xianpei;YAN Juanjuan;ZHANG You;WANG Shan(Department of Cardiology,Zhengzhou University People's Hospital,Zhengzhou(450003),Henan,China)

机构地区：[1]郑州大学人民医院心血管内科,河南省郑州市450003 [2]河南省心血管病流行病学中心,河南省郑州市450003

出　　处：《中国循环杂志》2019年第4期337-342,共6页Chinese Circulation Journal

摘　　要：目的:分析合并心力衰竭(HF)的急性冠状动脉综合征(ACS)患者的肾功能状况及经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的发生情况。方法:前瞻性连续纳入563例诊断为ACS的住院患者,根据临床诊断分为心功能正常组(n=379)及HF组(n=184)。比较心功能正常组和HF组肾功能不全的患病率及PCI使用对比剂后CIN的发生率。采用多因素Logistic回归分析来评估HF是否为CIN的独立危险因素。肾功能不全定义为:估算肾小球滤过率<60 ml/(min·1.73 m^2)。CIN定义为:暴露于碘化对比剂后48～72 h血肌酐水平≥0.5 mg/dl(≥44μmol/L)或较基线升高≥25%。结果:HF组中肾功能不全患病率为30.11%,明显高于心功能正常组(8.44%,P<0.001)。HF组PCI术后CIN发生率明显高于心功能正常组(5.98%vs 2.37%, P<0.05);射血分数降低型、射血分数中间值、射血分数保留型HF患者中CIN发生率分别为6.45%、5.56%、5.98%,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,HF(OR=2.867,95%CI:1.003～8.191,P<0.05)是PCI术后CIN发生的独立预测因子。结论:ACS合并HF患者中肾功能不全患者比例及PCI术后CIN发生率均较高,HF是PCI术后CIN发生的独立预测因子。Objectives: To observe the incidence of renal dysfunction and contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) complicating with heart failure (HF). Methods: A total of 563 consecutive patients diagnosed with ACS were enrolled prospectively. Patients were divided into two groups: normal heart function group (n=379) and HF group (n=184). The incidence of renal insufficiency (RI) and CIN after PCI was compared between HF patients and patients with normal heart function. Multivariate logistic regression analysis was used to evaluate whether HF was an independent risk factor for CIN. RI was defined as estimated glomerular filtration rate <60 ml/(min·1.73 m^2). CIN was defined as serum creatinine (Cr)≥0.5 mg /dl or increase of 25% at 48-72 h after exposure to iodized contrast agent. Results: RI was diagnosed in 30.11% patients with HF, which was significantly higher than normal heart function group (8.44%, P<0.001). Incidence of CIN was significantly higher in HF patients than in patients with normal heart function (5.98% vs 2.37%, P<0.05). CIN incidences were similar in HF patients with reduced EF, mid-range EF and preserved EF (6.45% vs 5.56% vs 5.98%, P>0.05). Multivariate logistic regression analysis indicated that HF (OR=2.867, 95%CI: 1.003-8.191, P<0.05) was an independent predictor for CIN after PCI. Conclusions: Patients with ACS and HF face increased incidence of RI and CIN after PCI, HF serves as an independent predictor of CIN after PCI in this patient cohort.

关 键 词：急性冠状动脉综合征 心力衰竭 肾功能 对比剂肾病 

分 类 号：R54[医药卫生—心血管疾病]