高尿酸血症与慢性肾脏疾病患者经皮冠状动脉介入治疗后对比剂肾病的相关性

摘要

目的 探讨高尿酸血症(HUA)与慢性肾脏疾病患者经皮冠状动脉介入治疗(PCI)后对比剂肾病(CIN)的相关性.方法 连续入选2011年3月至2012年5月在广东省人民医院心内科行PCI的慢性肾脏疾病患者446例.根据血清尿酸水平,将患者分为HUA组(205例)和非HUA组(241例).HUA定义为男性血尿酸＞420 μmol/L及女性血尿酸＞357 μmol/L；CIN定义为接触对比剂后48 ～ 72 h内,血清肌酐绝对值升高≥44.2 μmol/L或较基础值升高≥25％,并排除其他原因导致的肾损害.前瞻性观察两组患者的CIN发生率及院内临床事件.采用多因素logistic回归分析HUA与CIN的相关性.结果 在446例患者中,74例(16.6％)患者发生CIN,HUA组的CIN发生率高于非HUA组[23.9％ (49/446)比10.4％(25/446),P=0.000].发生CIN患者的病死率高于未发生CIN的患者[14.9％(11/74)比1.3％ (5/372),P=0.000].与非HUA组比较,HUA组肾脏替代治疗、急性心力衰竭、需要使用主动脉内球囊反搏、术后低血压的比例较高(P＜0.01或P＜0.05).多因素logistic回归分析显示,HUA(OR=1.9,95％ CI:1.1 ～3.5,P=0.037)、年龄＞75岁(OR =3.2,95％ CI:1.8 ～5.7,P=0.000)、急诊PCI(OR =2.9,95％ CI:1.6 ～5.1,P=0.000)和贫血(OR=2.1,95％ CI:1.2 ～3.8,P=0.012)是CIN的独立危险因素.结论 HUA是慢性肾脏疾病患者PCI术后发生CIN的独立危险因素.%Objective To investigate the relationship between hyperuricemia and contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).Methods A total of 446 consecutive patients with CKD undergoing PCI in Guangdong general hospital were enrolled in this study.Patients were divided into hyperuricemic group (n =205) and normouricemic group (n =241).Hyperuricemia was defined as serum uric acid ＞ 420 μmol/L for male,＞357 μmol/L for female.CIN was defined as ≥44.2 μmol/L or ≥25％ increase from baseline Serum creatinine within 48-72 hours after contrast medium exposure,and that was not attributable to other causes.In hospital incidences of CIN and the major adverse cardiac events were compared between the two groups.The relationship between the incidence of CIN and hyperuricemia was evaluated by multivariate logistic regression analysis.Results CIN occurred in 16.6％ (74/446) of patients,and incidence of CIN was significantly higher in the hyperuricemic group than in the normouricemic group [23.9％ (49/446) vs.10.4％ (25/446),P =0.000].Patients who developed CIN had higher in hospital mortality [14.9％ (11/74) vs.1.3％ (5/372),P =0.000].Need for renal replacement therapy,acute heart failure,intraaortic balloon pump use and the hypotension after PCI were significantly higher in the hyperuricemic group compared with normouricemic group (P ＜ 0.01 or P ＜ 0.05).Multivariate analysis indicates that hyperuricemia (OR =1.9,95 ％ CI:1.1-3.5,P =0.037),age ＞ 75 years (OR =3.2,95 ％ CI:1.8-5.7,P =0.000),emergent PCI (OR =2.9,95 ％ CI:1.6-5.1,P =0.000) and anemia (OR =2.1,95 ％ CI:1.2-3.8,P =0.012) were predictors of CIN in patients with CKD.Conclusion Hyperuricemia is the independent risk predictor of CIN in patients with CKD undergoing PCI.