造影剂肾病临床相关因素分析

摘要

Objective: To investigate the risk factors of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography and/or percutaneous coronary intervention ( PCI) . Methods: 1 793 cases of coronary angiography and/or percutaneous coronary intervention (PCI) from January 2006 to October 2011 were enrolled in this study. The incidence of the risk factors of CIN were retrospectively analyze. All these patients used the low-osmolar,nonionic contrast medium. Results; Of the 1 793 patients, 140 experienced CIN,and the overall incidence was 7. 81%. The incidence of CIN was increased with the increasing of the number of risk factors. The age, sex, diabetic mellitus, basic renal dysfunction, hydration treatment, with multi-vessel disease and contrast medium dosage in CIN patients were significantly different from those in non-CIN patients. Multi-variate analysis demonstrated that the following variables remained to be significant factors correlating with CIN: age≥70 years, diabetes mellitus, preoperative eGFR <60 mL/(min·l. 73m ) and contrast volume > 150mL. Hydration is a protective factors, can reduce the incidence of CIN. Conclusion; The incidence of CIN was 7. 81% among patients undergoing coronary angiography and/or percutaneous coronary intervention ( PCI). The incidence of CIN was increased with the increasing of the number of risk factors. Age,accompanied with diabetic mellitus,renal dysfunction and contrast medium dosage are the risk factors. Hydration can reduce the incidence of CIN.%目的:探讨冠状动脉造影(CAG)和经皮冠状动脉介入术(PCI)患者造影剂肾病(CIN)的危险因素.方法:回顾性分析北京安贞医院2006年1月至2011年10月行CAG或介入治疗患者1 793例,分析CIN发生情况及相关危险因素.所有患者均应用低渗非离子造影剂.结果:CIN总发生率为7.81％ (140/1 793),CIN发生率随危险因素的增加而增高.与非CIN患者比较,CIN患者中的老年患者(≥70岁)、女性患者、合并糖尿病、未水化治疗、多支血管病变及基础肾功能不全居多.多因素Logistic回归分析显示,年龄≥70岁、合并糖尿病、术前eGFR＜ 60mL· min-1·1.73m-2、造影剂用量＞150mL,是发生CIN的危险因素,水化是减少CIN发生的保护因素.结论:行CAG和PCI的患者CIN率为7.81％,CIN发生率随危险因素的增加而增高.其中年龄、合并糖尿病、术前肾功能不全及造影剂用量是CIN发生的危险因素,术前水化可减少CIN的发生.