球囊肺动脉成形术治疗慢性血栓栓塞性肺动脉高压对肾功能的作用  

The influence of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension on renal functions

作　　者：冯宇旋 王金志 李新成 张帅[2] 高倩[2] 王同生[1] 毛毅敏[1] 谢万木 翟振国[2] 黄强 FENG Yuxuan;WANG Jinzhi;LI Xincheng;ZHANG Shuai;GAO Qian;WANG Tongsheng;MAO Yimin;XIE Wanmu;ZHAI Zhenguo;HUANG Qiang(Department of Pulmonary and Critical Care Medicine,First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan Province 471000,China)

机构地区：[1]河南科技大学第一附属医院呼吸与危重症医学科,河南洛阳471000 [2]国家呼吸医学中心中日友好医院呼吸与危重症医学科

出　　处：《介入放射学杂志》2025年第2期160-165,共6页Journal of Interventional Radiology

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-12M-1-049)。

摘　　要：目的评估球囊肺动脉成形术(balloon pulmonary angioplasty,BPA)治疗慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)患者后对比剂肾病(contrast-induced nephropathy,CIN)的发生率及BPA对肾功能的影响。方法收集2018年12月至2022年5月于中日友好医院行BPA治疗的143例CTEPH患者的临床信息、血流动力学指标、BPA术前1周内及术后48~72 h内的血肌酐浓度,对比每次BPA前后血肌酐及肾小球滤过率(estimated glomerular filtration rate,eGFR)变化,评估CIN发生率及危险因素,分析首次及末次BPA治疗后的血流动力学、血肌酐及eGFR变化。结果纳入115例CTEPH患者,共行BPA 192例次,其中男性88例次,女性103例次。每次BPA使用对比剂剂量为(145.58±47.26)mL。BPA术后共有12例患者发生13例次CIN,发生率为6.8%。CIN患者的基线特征及肾功能与非CIN患者相比差异无统计学意义(P>0.05);血流动力学指标中,混合静脉血氧饱和度(mixed venous oxygen saturation,SvO_(2))在CIN患者中更低(58.58%±10.38%比66.15%±8.02%,P=0.002),其他血流动力学指标两组差异无统计学意义(P>0.05)。CTEPH患者在不同频次的BPA治疗前后血肌酐及eGFR对比差异无统计学意义(P>0.05),经数次BPA治疗后,末次肾功能指标血肌酐[(78.09±18.760)μmol/L比(82.26±21.37)μmol/L,P<0.001]和eGFR[(86.08±21.22)mL/(min·1.73 m^(2))比(82.07±22.05)mL/(min·1.73 m^(2)),P=0.007]较基线值均得到显著改善。结论BPA治疗CTEPH患者后可发生对比剂肾病,多次BPA治疗后随着临床症状及血流动力学的改善,肾功能也显著改善。Objective To assess the incidence of contrast-induced nephropathy(CIN)in patients with chronic thromboembolic pulmonary hypertension(CTEPH)after receiving balloon pulmonary angioplasty(BPA),and to evaluate the effect of the contrast agents on renal function.Methods A total of 143 CTEPH patients,who received BPA at the China-Japan Friendship Hospital of China from December 2018 to May 2022,were enrolled in this study.The clinical data,hemodynamic indicators,and serum creatinine(SC)concentrations within one week before and 48-72 h after BPA were collected.The estimated glomerular filtration rate(eGFR)was calculated according to the Modification of Diet in Renal Disease(MDRD)formula.The SC concentration and eGFR changes before and after each BPA procedure were compared.The incidence of CIN and its risk factors were evaluated,and the changes in hemodynamics,SC and eGFR after the initial and last time of BPA treatment were analyzed.Results A total of 192 BPA procedures were performed in 115 CTEPH patients,including 88 BPA procedures in males and 103 BPA procedures in females.The mean amount of contrast agent used for each BPA was(145.58±47.26)mL.After BPA,12 patients developed 13 times of CIN,with an incidence of 6.8%.There was no significant differences(P>0.05)in the baseline characteristics and SC concentration before BPA between CIN patients and non-CIN patients.In terms of the hemodynamic indexes,the mixed venous oxygen saturation(SvO_(2))in CIN patients was significantly lower than that in non-CIN patients(58.58%±10.38%vs.66.15%±8.02%,P=0.002),and no statistically significant differences(P>0.05)in the other hemodynamic indexes existed between CIN group and non-CIN group.No statistically significant differences in SC concentration and eGFR existed before and after each BPA procedure.In patients who had received several BPA procedures,significant improvements in the SC[(78.09±18.760)μmol/L vs.(82.26±21.37)μmol/L,P<0.001]and eGFR[(86.08±21.22)mL/(min·1.73 m^(2))vs.(82.07±22.05)mL/(min·1.73 m^(2)),P=0.007]

关 键 词：慢性血栓栓塞性肺动脉高压 球囊肺动脉成形术 对比剂肾病 肾功能 肾小球滤过率 

分 类 号：R543[医药卫生—心血管疾病]