老年冠心病患者营养状况与经皮冠状动脉介入治疗后急性肾损伤的关系  

Association Between Nutritional Status and Contrast-associated Acute Kidney Injury in Elderly Coronary Artery Disease Patients Following Percutaneous Coronary Intervention

作　　者：陈海敏 刘思琦 陈烁 CHEN Haimin;LIU Siqi;CHEN Shuo(Department of Geriatric Cardiology,Guangdong Provincial Geriatrics Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Medical Record,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)广东省老年医学研究所老年心血管科,广州510080 [2]南方医科大学附属广东省人民医院(广东省医学科学院)病案室,广州510080 [3]南方医科大学附属广东省人民医院(广东省医学科学院)广东省心血管病研究所,广州510080

出　　处：《岭南心血管病杂志》2023年第6期580-584,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金项目(项目编号:A2022408)。

摘　　要：目的 明确营养不良的程度是否对老年冠状动脉粥样硬化性心脏病(冠心病)患者接受经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后造影剂相关急性肾损伤(contrast-associated acute kidney injury,CA-AKI)发生存在相关性。方法 本研究纳入2015年1~12月于广东省人民医院行冠状动脉造影术(coronary angiography,CAG)的患者。采用控制性营养状况(controlling nutritional status,CONUT)评分对患者进行营养评分,根据评分0~1分为无营养不良组,2~4分为轻度营养不良组,≥5分为中重度营养不良组。主要研究终点为PCI治疗后CA-AKI发生,定义为手术后48 h内血清肌酐浓度较基线水平增加>0.3 mg/mL或50%。营养不良水平及CA-AKI发生的相关性通过Logistics回归分析进行分析。结果 本研究共1 220例接受CAG的老年冠心病患者[年龄为(69.78±6.75)岁,71.8%为男性],其中合并轻度营养不良的共567例(46.5%),中重度营养不良的共235例(19.3%)。共有107例在CAG后出现CA-AKI,相较于无营养不良患者,轻度营养不良及中重度营养不良患者CAG后出现CA-AKI的发生率增高,差异有统计学意义(5.3%vs. 39.5%vs. 13.2%,P<0.05)。多因素Logistics回归分析表明,与无营养不良组的患者相比,轻度营养不良组患者不显著增加CAG后CA-AKI的风险(OR=1.65,95%CI:0.98~2.86,P=0.066),而中重度营养不良则与增加1.02倍的CA-AKI的风险相关(OR=2.02,95%CI:1.05~3.91,P=0.035)。结论 在接受CAG的老年冠心病患者中,营养不良较为普遍,其中中重度营养不良与CA-AKI发生风险增高显著相关。Objectives To determine the association between the severity of malnutrition and the risk of contrast-associ-ated acute kidney injury(CA-AKI)following percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD).Methods This study included patients who underwent coronary angiography(CAG)in Guang-dong Provincial Peoples Hospital from January to December 2015.The controlling nutritional status(CONUT)score was used to assess the nutritional status of patients,categorizing them into groups:scored 0-1 for no malnutrition,scored 2-4 for mild malnutrition,and scored≥5 for moderate to severe malnutrition.The primary endpoint was the occurrence of CA-AKI after CAG,defined as an increase in serum concentration of creatinine>0.3 mg/dL or 50%from baseline within 48 hours following PCI.The correlation between malnutrition levels and CA-AKI occurrence was analyzed using Logistic regression analysis.Results A total of 1220 elderly patients with CHD[mean age was(69.78±6.75)years,71.8%male]who underwent CAG were included in this study.Among them,567 individuals(46.5%)had mild malnutrition,and 235 individuals(19.3%)had moderate to severe malnutrition.CA-AKI occurred in 107 patients after CAG.Patients with mild malnutrition and moderate to severe malnutrition had higher incidence of CA-AKI compared to those without malnu-trition(5.3%vs.9.5%vs.13.2%,P<0.05).Multivariate Logistic regression analysis indicated that,compared to patients without malnutrition,mild malnutrition did not significantly increase the risk of CA-AKI after CAG(OR=1.65,95%CI:0.98-2.86,P=0.066),while moderate to severe malnutrition was associated with a 1.02-fold increased risk of CA-AKI(OR=2.02,95%CI:1.05-3.91,P=0.035).Conclusions Malnutrition is prevalent among elderly patients with CHD undergoing CAG.In this population,moderate to severe malnutrition is associated with an increased risk of CA-AKI following CAG.

关 键 词：冠状动脉疾病 老年 营养不良 血管成形术 经腔 经皮冠状动脉 急性肾损伤 

分 类 号：R541.4[医药卫生—心血管疾病]