大剂量碘克沙醇对合并糖尿病患者冠状动脉介入术后肾功能的影响  

Effects of high-dose iodixanol on renal function in patients with diabetes undergoing percutaneous coronary intervention

作　　者：赵宁 陈再燕 王哲 徐强[2] 周音频[3] 徐中林[4] 宋耀明 晋军 黄岚 赵晓辉 ZHAO Ning;CHEN Zaiyan;WANG Zhe;XU Qiang;ZHOU Yinpin;XU Zhonglin;SONG Yaoming;JIN Jun;HUANG Lan;ZHAO Xiaohui(Department of Cardiology,the Second Affiliated Hospital of Army Medical University,PLA,Chongqing 400037,China;The 5th People’s Hospital of Chongqing,Chongqing 400062,China;The Fuling Central Hospital of Chongqing,Chongqing 408000,China;The 9th People’s Hospital of Chongqing,Chongqing 400700,China)

机构地区：[1]中国人民解放军陆军军医大学第二附属医院心内科,重庆市400037 [2]重庆市第五人民医院心内科,重庆市400062 [3]重庆市涪陵中心医院心内科,重庆市408000 [4]重庆市第九人民医院心内科,重庆市400700

出　　处：《中国动脉硬化杂志》2020年第12期1048-1053,共6页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金面上项目(81670428)。

摘　　要：目的评估大剂量碘克沙醇(>300 mL)对糖尿病患者经皮冠状动脉介入治疗(PCI)术后72 h内肾功能的影响。方法顺序筛选2015年10月—2017年12月4个中心的987例冠状动脉介入治疗术中使用大剂量(>300 mL)碘克沙醇的患者,最终204例合并糖尿病患者被纳入,进一步评价术后72 h内对比剂诱导的急性肾损伤(CI-AKI)的发生情况。结果 204例糖尿病患者使用大剂量碘克沙醇(>300 mL)对比剂诱导的急性肾损伤总发生率为3.9%(8/204)。其中碘克沙醇300~500 mL亚组和>500 mL亚组对比剂诱导的急性肾损伤发生率分别为4.3%(7/161)和2.3%(1/43);基线eGFR<60 mL/(min·1.73 m2)的患者对比剂诱导的急性肾损伤发生率为6.9%(2/29)。多因素Logistic回归分析显示,合并慢性肾功能不全、贫血、行急诊冠状动脉介入治疗术以及高Mehran评分是对比剂诱导的急性肾损伤的独立危险因素。对比剂诱导的急性肾损伤发生率与对比剂剂量的增加似乎无关。结论合并糖尿病患者使用大剂量(>300 mL)碘克沙醇后对比剂诱导的急性肾损伤发生率不高。Aim To evaluate the effects of high-dose(>300 mL) iodixanol on renal function of diabetic patients within 72 hours after percutaneous coronary intervention(PCI). Methods From October 2015 to December 2017, 987 patients who received high-dose(>300 mL) iodixanol during PCI in four centers were selected. Finally, 204 cases were enrolled in this study. The incidence of contrast-induced acute kidney injury(CI-AKI) was evaluated. Results The incidence of CI-AKI was 3. 9%( 8/204). In patients administered 300 ~ 500 m L and > 500 m L iodixanol,the incidence of CI-AKI was 4. 3%( 7/161) and 2. 3%( 1/43),respectively. In the subgroup with pre-PCI estimated glomerular filtration rate( e GFR) < 60 m L/( min·1. 73 m2),the incidence of CI-AKI was 6. 9%( 2/29). Multivariate Logistic regression analysis showed independent risk factors for CI-AKI were chronic renal failure,anemia,emergency PCI,and high Mehran score,but not contrast volume. Conclusion The administration of high-dose( > 300 m L) iodixanol in patients with diabetes undergoing PCI does not result in high incidences of post-PCI CI-AKI.

关 键 词：糖尿病 对比剂 碘克沙醇 经皮冠状动脉介入治疗 对比剂诱导的急性肾损伤 

分 类 号：R5[医药卫生—内科学]