老年糖尿病患者经皮冠状动脉介入术后发生造影剂肾病的危险因素分析  

Analysis of Risk Factors for Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Elderly Diabetic Patients

作　　者：陈洋鸿 陈巧玲[1] CHEN Yanghong;CHEN Qiaoling(Fujian Medical University Union Hospital,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属协和医院

出　　处：《中外医学研究》2019年第36期1-4,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：福建医科大学启航基金项目（项目编号：2016QH019）

摘　　要：目的:探讨老年糖尿病患者经皮冠状动脉介入术后发生造影剂肾病的危险因素。方法:选取2018年1-12月在笔者所在医院心内科行PCI术的257例糖尿病合并急性冠状动脉综合征患者作为研究对象,根据是否存在造影剂肾病分为两组,将不存在造影剂肾病的207例作为对照组,发生造影剂肾病的50例作为观察组,比较两组的年龄、性别、体重指数(BMI)、脉压、高血压病、血糖水平、实验室数据、急诊PCI、术前用药等指标,应用Logistic回归分析筛选可能的危险因素。结果:(1)两组患者年龄、性别、体重指数(BMI)、脉压、空腹血糖、餐后2 h血糖、糖基化血红蛋白、血脂、D-二聚体、手术时间、造影剂剂量等方面比较差异无统计学意义(P>0.05);合并高血压病、eGFR、尿酸、白蛋白、血红蛋白、红细胞比容、纤维蛋白原、射血分数、急诊PCI术、术前使用他汀类和ACEI/ARB类药物等因素比较差异有统计学意义(P<0.05)。(2)多因素Logistic回归分析显示,合并高血压病(OR=4.605;95%CI:1.298,16.337;P=0.018)、术前未使用ACEI/ARB类药物(OR=0.399;95%CI:0.173,0.923;P=0.032)、急诊PCI术(OR=2.4;95%CI:1.055,5.463;P=0.037)、血尿酸升高(OR=1.005;95%CI:1.001,1.009;P=0.013)是老年糖尿病合并ACS患者PCI术后发生造影剂肾病的危险因素。结论:合并高血压病、术前未使用ACEI/ARB类药物、急诊PCI术、血尿酸升高会增加老年糖尿病合并ACS患者行PCI术后发生造影剂肾病的风险。Objective:To investigate risk factors of contrast induced nephropathy(CIN)after percutaneous coronary intervention(PCI)in elderly diabetic patients.Method:A total of 257 elderly diabetic patients with acute coronary syndrome(ACS)underwent PCI admitter in department of cardiology from January to December 2018 were involved in this study.The patients were divided into two groups according to the presence or absence of contrast induced nephropathy.A total of 207 patients without CIN were selected as control group,and 50 patients with CIN were chosen as the observation group.The age,seuality,body mass index(BMI),pulse pressure,hypertention,blood glucose level,laboratory date,emergency PCI,premedicate and so on were compared between the two groups.Multifactor logistic regression analysis was used to find risk factors of CIN.Result:(1)There was no significant difference between the two groups in the indicators such as age,sexuality,BMI,pulse pressure,fasting blood glucose,2-hour post-meal blood glucose,glycosylated hemoglobin,blood fat,D-Dimer,operation time,contrast dose(P>0.05).There was a siginiicant difference in the indicators such as hypertention,eGFR,uric acid,albumin,hemoglobin,hemetokrit,fibrinogen,ejection fraction,emergency PCI,perioperative use of statins and ACEI/ARB(P<0.05).(2)Loistic regression analysis showed that hypertention(OR=4.605,95%CI:1.298,16.337,P=0.018),perioperetive unused of ACEI/ARB(OR=0.399,95%CI:0.173,0.923,P=0.032),emergency PCI(OR=2.4,95%CI:1.055,5.463,P=0.037)and hyperuricacidemia(OR=1.005,95%CI:1.001,1.009,P=0.013)were the risk factors of CIN for elderly diabetic patients with ACS after PCI.Conclusin:The risk of CIN was increased by hypertention,perioperetive unused of ACEI/ARB,emergency PCI and hyperuricacidemia in elderly diabetes patients with acuter coronary syndrome after PCI.

关 键 词：老年糖尿病患者 经皮冠状动脉介入术 造影剂肾病 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病] R587.2[医药卫生—内科学]