冠状动脉介入术患者对比剂肾病的相关危险因素分析

摘要

Objective: To investigate the incidence and the rick factors of contrast-induced nephropathy ( CIN ) in patients undergoing coronary angiography ( CAG) and percutaneous coronary intervention ( PCI) . Methodology: From October 2010 to April 2011,a total of six hundred and seventy two cases undergoing CAG and PCI wert recruited. CIN is identified if the serum creatinine is increased by 25% or 44.2 μmol/L (0.5 mg/dl) of the baseline at 48 hours post procedure. The incidence and the rick factors of CIN were analyzed. Results;Of six hundred and seventy two patients, 292 cases (43. 5% ) were aged over 3=65 588 (87. 5% ) had coronary heart disease,461 (68. 6% )had hypertension, 144 (21. 4% ) had diabetes mellitus,30 (4. 5% ) had SCr more than 110 μmol/L before procedure,42 (6. 3% ) had anemia, 344 (51. 2% ) took ACEI,95 (14. 1% ) took diuretics,39 (5. 8% ) took metformins,and 237 cases (35. 3% ) had the volume of contrast media 3=200 ml. Among the 672 patients,CIN occurred in 55 patients and the incidence of CIN was 8. 2%. There were significant differences between CIN and non-CIN patients in terms of ages over 65, coronary heart disease,the volume of contrast meida 2≥200 ml. Diuretics(P <0. 05). Logistic regression analysis showed that age 3=65,and the voluem of contrast media 3≥200 ml were independent risk factors of CIN. Conclusion: The incidence of CIN in patients undergoing CAG and PCI was higher. The age 3=65 and the volume of contrast meida 3=200 ml were independent risk factors of CIN.%目的:研究冠状动脉造影(CAG)和经皮冠状动脉介入治疗(PCI)患者对比剂肾病(CIN)的发病率及危险因素. 方法:选择2010年10月至2011年4月南京军区南京总医院接受CAG和PCI的患者672例,以术后48h血清肌酐(SCr)较术前升高25％或升高44.2 μmol/L(0.5 mg/dl)作为CIN的诊断标准,分析CIN的发病率及危险因素. 结果:672例患者中,年龄≥65岁者292例(43.5％),冠心病588例(87.5％),高血压461例(68.6％),糖尿病144例(21.4％),术前SCr≥110 μmol/L者30例(4.5％),贫血42例(6.3％),服用血管紧张素转换酶抑制剂344例(51.2％),利尿剂95例(14.1％),二甲双胍39例(5.8％),对比剂用量≥200 ml者237例(35.3％).672患者中55例(8.2％)发生CIN,发生CIN者与非CIN者在年龄≥65岁、冠心病、对比剂用量≥a200 ml及利尿剂等方面有明显差异(P＜0.05).Logistic多因素回归分析显示,年龄≥65岁、对比剂用量≥200 mL是CIN的独立危险因素. 结论:在CAG和PCI患者的CIN发病率较高,年龄≥65岁和对比剂用量≥200 mL是其独立危险因素.