对比剂肾病风险评估对冠脉介入诊疗术后肾功能改变的预测价值

摘要

目的 探讨对比剂肾病(CIN)风险积分对老年及老年前期冠脉介入诊疗术后CIN的预测价值.方法 对48例55～88岁缺血性心脏病(IHD)患者冠脉介入诊疗术前和术后第1、3、7天测定血清肌酐(SCr),估算肾小球滤过率(eGFR),超声测定左心室功能,应用临床CIN危险因素和CIN风险积分评估. 结果 7例符合CIN标准(CIN组).与非CIN组比较,CIN组＞75岁者及合并危险因素明显增多,CIN风险积分明显增高,基线左室射血分数(LVEF)、短轴缩短率(FS)明显偏低(均P＜0.05)；CIN风险率预测值与实际病例数相符.患者年龄与基线LVEF、FS负相关,与术后第1天SCr正相关；合并危险因素和风险积分与术后第1、3天的SCr正相关(P＜0.05或P＜0.01). 结论 高龄及伴随的心功能减低在CIN发生中具有重要意义.CIN风险积分更为准确地预测中老年IHD患者冠脉介入诊疗术后CIN的发生.%Objective To discuss the predictive value of contrast-induced nephropathy (CIN) risk score in elderly or pre-elderly patients with ischemic heart disease (IHD) undergoing coronary intervention. Methods The level of serum creatinine (SCr) of 48 patients aged 55-88 years were collected pre-operation and 1, 3, 7 d after operation to evaluate glomerular filtration rate(eGFR). Left ventricular ejection fraction (LVEF) and fraction shortening (FS) were also measured by ultrasonic cardiogram. The clinical CIN risk factors and accumulated CIN risk score were applied to predict the risk for CIN. Results Seven patients reached CIN standards(CIN group). CIN group had more patients older than 75 years and more CIN risk factors. Patients in CIN group also had significantly lower baseline LVEF, lower FS, and higher risk score of CIN compared with non-CIN group(P<0. 05). The predictive value of CIN incidence was tally with real outcome. Age of patients was in negative correlation with baseline LVEF and FS, while in positive relation with the level of SCr 1 d after operation. The number of risk factors and accumulative risk scoring were in positive relation with the levels of SCr 1 d and 3 d after operation( P <0. 05 or P <0. 01). Conclusions Older age and deteriorate of heart function play an important role in the incidence of CIN. The accumulative risk scoring tool is more accurate than multiple risk factors to predict CIN in middle aged or elderly patients with IHD undergoing percutaneous angiography.