ACS合并AHF患者治疗中RAAS抑制剂对CI-AKI发病的影响  

Role of RAAS inhibitors in contrast-induced acute renal injury in patients with acute coronary syndrome complicated with acute heart failure

作　　者：杜纪兵[1] 依力哈木江·艾沙 李文宇[1] 霍星宇 陈树涛[1] 丛洪良[1] 沙德尔丁·斯拉吉 Ji-bing Du;Yi Lihamujiang•Ai Sha;Wen-yu Li;Xing-yu Huo;Shu-tao Chen;Hong-liang Cong;Sha Deerding•Si La-ji(Department of Cardiology,Tianjin Thoracic Hospital,Tianjin 300051,China;Heart Diagnosis and Treatment Center,Hotan People's Hospital,Hotan,Xinjiang 848000,China)

机构地区：[1]天津市胸科医院心内科,天津300051 [2]和田地区人民医院心脏诊疗中心,新疆维吾尔自治区848000

出　　处：《中国现代医学杂志》2020年第3期107-112,共6页China Journal of Modern Medicine

摘　　要：目的探讨肾素血管紧张素醛固酮系统(RAAS)抑制剂在急性冠状动脉综合征(ACS)合并急性心力衰竭(AHF)患者经皮冠状动脉介入术(PCI)中对比剂致急性肾损伤(CI-AKI)中的作用。方法回顾性分析成功行PCI手术ACS合并AHF患者504例,并于术后24~48 h内复查肾功能。分别按照有无CI-AKI及有无应用RAAS抑制剂进行分组,对比相关观察指标,并将差异有统计学意义的观察指标进行Logistics回归分析。结果504例患者中144例(28.6%)患者发生CI-AKI。CI-AKI组RAAS抑制剂使用比例、高血压、糖尿病患病率与非CI-AKI组比较,差异有统计学意义(P<0.05)。CI-AKI组反映心脏功能超声指标LVEF、LVEDD、PAP、NT-proBNP、hs-CRP及Hcy水平与非CI-AKI组比较,差异有统计学意义(P<0.05)。将上述指标引入Logistic回归分析发现,应用RAAS抑制剂对CI-AKI影响消失。而高血压、NT-proBNP、Hcy、hs-CRP、LVEF、PAP仍为心力衰竭患者CI-AKI发生高危因素。结论对ACS合并AHF患者需行PCI治疗患者,常规应用RAAS抑制剂并不增加CI-AKI发生风险。Objective To investigate the role of RAAS inhibitors in contrast agent-induced acute kidney injury(CI-AKI)in patients with acute coronary syndrome complicated with acute heart failure undergoing percutaneous coronary intervention(PCI).Methods A retrospective analysis was made of 504 patients with acute coronary syndrome complicated with acute heart failure who underwent successful PCI and their renal function was reexamined 24 to 48 hours after operation.According to the presence or absence of CI-AKI and the presence or absence of RAAS inhibitors,the indicators were compared and the meaningful observations were analyzed by logistic regression analysis.Results CI-AKI occurred in 144 patients with acute heart failure at admission,with an incidence of 28.6%.The proportion of RAAS inhibitors in the CI-AKI group,hypertension and diabetes had statistical differences between the CI-AKI group and the non-CI-AKI group(P<0.05);there were statistical differences in the cardiac function indexes(LVEF,LVEDD,PAP,NT-proBNP,Hs-CRP and Hcy)between the CI-AKI group and the non-CI-AKI group(P<0.05).The above meaningful indicators were introduced into logistic analysis,then we found that the effect of RAAS inhibitors on CI-AKI disappeared.Hypertension,NT-proBNP,Hcy,Hs-CRP,LVEF and PAP were still risk factors for CI-AKI.Conclusion Routine use of RAAS inhibitors does not increase the risk of CI-AKI in patients with acute coronary syndrome and acute heart failure requiring PCI treatment.

关 键 词：心力衰竭 对比剂致急性肾损伤/肾疾病 RAAS抑制剂 

分 类 号：R541.6[医药卫生—心血管疾病]