碘克沙醇与碘海醇/碘普罗胺对经皮冠状动脉介入治疗术后对比剂肾病发生率及远期预后的影响  

Effect of Iodixanol versus Iohexol/Iopromide for the incidence of contrast induced nephropathy after percutaneous coronary intervention and long-term prognosis

作　　者：杜梦阳 姜琳 唐晓芳 高展[1] 袁晋青[1] DU Meng-yang;JIANG Lin;TANG Xiao-fang;GAO Zhan;YUAN Jin-qing(Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,National Center for Cardiovascular Disease,Beijing 100037,China)

机构地区：[1]国家心血管病中心,北京协和医学院中国医学科学院,阜外医院心内科,北京100037

出　　处：《中国介入心脏病学杂志》2021年第10期558-563,共6页Chinese Journal of Interventional Cardiology

基　　金：国家重点研发计划项目(2016YFC1301300)。

摘　　要：目的比较碘克沙醇与碘海醇/碘普罗胺对经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)发生率及其远期预后的影响。方法选择2013年1-12月在中国医学科学院阜外医院接受PCI术的符合标准的6167例患者作为研究对象。根据所用对比剂的类型,将患者分为碘克沙醇组(1709例)、碘海醇组(1284例)和碘普罗胺组(3174例)。通过Cox回归分析研究碘克沙醇与碘海醇、碘普罗胺与CIN发生率、PCI术后2年全因死亡率的关系。结果碘克沙醇组、碘海醇组和碘普罗胺组的CIN发生率分别为1.9%、3.5%和1.6%。logistic多因素分析表明,与碘克沙醇相比,碘海醇的使用显著增加了CIN的发生率(OR 2.114,95%CI 1.104~3.714,P=0.009),而与碘克沙醇相比,碘普罗胺没有增加CIN的发生率(OR 1.128,95%CI 0.665~1.912,P=0.656)。Cox多因素回归分析显示,与碘克沙醇相比,碘海醇和碘普罗胺的使用均不会影响患者的2年全因死亡率(HR 1.914,95%CI 0.920~3.983,P=0.083;HR 1.069,95%CI 0.593~1.927,P=0.825)。结论与碘克沙醇相比,碘海醇对比剂会显著增加PCI术后CIN的发生率,而碘普罗胺不会。但是碘海醇和碘普罗胺与碘克沙醇相比均对2年全因死亡率没有显著影响。Objective To compare the effect of Iodixanol versus Iohexol/Iopromide for contrast induced nephropathy(CIN)after percutaneous coronary intervention(PCI)and longterm prognosis.Methods Total of 6167 patients who underwent interventional therapy in Fuwai Hospital from January to December,2013 were enrolled in the cohort according to the exclusion criteria.According to the type of contrast agent used,the patients were divided into Iodixanol(1709 cases),Iohexol group(1284 cases),Iopromide group(3174 cases).Correlation between contrast exposure and contrast induced nephropathy and 2-year outcomes after PCI were analyzed based on Cox regression.Results The incidence of CIN was 1.9%,3.5%,and 1.6%in the Iodixanol group,Iohexol group and Iopromide group,respectively.The logistic multivariate analysis showed that the use of Iohexol significantly increased the incidence of CIN compared with Iodixanol(OR 2.114,95%CI 1.104-3.714,P=0.009),while Iopromide did not increase the incidence of CIN compared with Iodixanol(OR 1.128,95%CI 0.665-1.912,P=0.656).Multivariate Cox regression analysis showed that the use of Iohexol and Iopromide did not af fect the incidence of 2 years all-cause mortality compared with Iodixanol(HR 1.914,95%CI 0.920-3.983,P=0.083;HR 1.069,95%CI 0.593-1.927,P=0.825,respectively).Conclusions Compared with Iodixanol,Iohexol contrast could signifi cantly increase while Iopromide dose not increase the incidence of CIN after PCI.Iohexol and Iopromide have no signifi cant ef fect on 2-year all-cause mortality compared with Iodixanol.

关 键 词：碘克沙醇 碘海醇 碘普罗胺 等渗对比剂 低渗对比剂 

分 类 号：R543.3[医药卫生—心血管疾病]