RAAS抑制剂在对比剂致维吾尔族患者急性肾损伤中的作用  

The role of RAAS blockers in acute kidney injury induced by contrast agent in Uygur patients

作　　者：李文宇[1] 依力哈木江·艾沙 阿达莱提·阿卜力孜 沙德尔丁·斯拉吉 杜纪兵[1] LI Wen-yu;YI Lihamujiang·AI Sha;A Daliti·Abulizi;SHA Deerding·SI Laji;DU Ji-bing(Tianjin Chest Hospital, Tianjin Institute of Cardiovascular Diseases, Tianjin 300051, China;People’s Hospital of Hetian District, Xinjiang Uygur Autonomous Region)

机构地区：[1]天津市胸科医院,天津市心血管病研究所,300051 [2]新疆维吾尔自治区和田地区人民医院

出　　处：《天津医药》2019年第5期517-520,共4页Tianjin Medical Journal

基　　金：天津市卫生局科技基金(2013KZ080)

摘　　要：目的探讨对比剂致维吾尔族患者急性肾损伤(CI-AKI)发生率、危险因素及肾素-血管紧张素-醛固酮系统(R AAS)抑制剂在其中是否发挥影响作用。方法回顾性分析新疆维吾尔自治区和田地区人民医院心脏诊疗中心成功行经皮冠状动脉介入治疗(PCI)手术,并于24~ 48h后复查肾功能的218例维吾尔族患者的临床资料。按照有无CI-AKI分为CI-AKI组(n= 46)及对照组(n= 172),观察2组患者一般资料,分析CI-AKI的危险因素及RAAS抑制剂在其中的作用。结果 218例患者中发生CI-AKI46例(21.1%)。 CI-AKI组中高血压患病率、对比剂用量、低密度脂蛋白胆固醇(LDL-C)水平、N末端B型脑钠肽前体(N T-proBNP)水平、高敏C反应蛋白(hs-CRP)水平高于对照组;RAAS抑制剂使用比例、左室射血分数(LVEF)水平、高密度脂蛋白胆固醇(H DL-C)水平、血红蛋白(H B)水平低于对照组(P<0 .05)。 CI-AKI组及对照组术前肌酐清除率差异无统计学意义。术前CI-AKI组肌酐水平低于对照组,但术后CI-AKI组肌酐水平较术前明显增加(P<0 .05)。术前2组间尿素氮水平差异无统计学意义,但术后CI-AKI组尿素氮水平明显增加。多因素Logistic分析发现对比剂用量增加、高NT-proBNP及hs-CRP水平仍为维吾尔族患者发生CI-AKI的危险因素,使用RAAS抑制剂是保护因素。结论对于维吾尔族拟行PCI治疗患者,术前使用RAAS抑制剂,改善术前心功能,减少术中对比剂用量能够降低CI-AKI发生风险。Objective To investigate the incidence and risk factors of contrast agent-induced acute kidney injury (CI- AKI) in Uygur patients, and the role of RAAS inhibitors thereof. Methods Data of 218 Uygur patients underwent percutaneous coronary intervention (PCI) and detected renal function after 24-48 hours in the cardiac diagnosis and treatment center of People′s Hospital of Hetian District, Xinjiang were retrospectively analyzed. Patients were divided into CI-AKI group (n=46) and the control group (n=172). Clinical data, risk factors and the role of RAAS inhibitors in CI-AKI were observed in two groups. Results In 218 patients, 46 (21.1%) were found CI-AKI. The prevalence of hypertension, dosage of contrast agent, LDL-C, NT-proBNP and hs-CRP levels were higher in CI-AKI group than those of the control group. RAAS inhibitor use ratio, LVEF, HDL-C and HB levels were lower in CI-AKI group than those in the control group. There was no significant difference in preoperative creatinine clearance between CI-AKI group and control group. The creatinine level before operation was lower in CI-AKI group than that in control group, but the level of creatinine increased significantly after operation in CI-AKI group (P<0.05). There was no significant difference in the level of urea nitrogen before operation between the two groups, but the level of urea nitrogen increased significantly after operation in CI-AKI group (P<0.05). Multivariate logistic analysis showed that the increased dosage of contrast agent, high NT-proBNP and hs-CRP levels were risk factors for CI-AKI in Uygur patients, and RAAS inhibitors were protective factors for reducing the occurrence of CI-AKI in Uygur patients. Conclusion For Uyghur patients undergoing PCI, preoperative use of RAAS inhibitor, improved the preoperative cardiac function and reduced intraoperative contrast agent dosage can reduce the incidence of CI-AKI.

关 键 词：造影剂 肾功能衰竭 急性 维吾尔族 对比剂致急性肾损伤 RAAS抑制剂 

分 类 号：R692.5[医药卫生—泌尿科学]