摘要
目的探讨对比剂肾病(contrast-induced nephropathy,CIN)在非选择性患者中的发病率及其危险因素,以及等渗对比剂碘克沙醇的肾安全性。方法共入选532例接受冠状动脉介入诊疗术的患者,测定患者术前1周内任一天及术后48h的肾功能。以术后48h血肌酐(serum creatinine,SCr)较术前升高25%或升高44.2μmol/L(0.5mg/dL)为CIN的诊断标准,分析对比剂对肾功能的影响。用Logistic多因素回归分析CIN发生的危险因素。结果(1)532例患者中29例发生CIN,发病率为5.5%;(2)术前估计肾小球滤过率(estimate glomerular filtration rate,eGFR)<45mL/min的患者CIN发病率显著高于eGFR≥45mL/min的患者(17.5%比4.5%,P=0.002);(3)532例患者中,427例使用低渗对比剂,105例使用等渗对比剂碘克沙醇,低渗对比剂组术前平均eGFR显著高于等渗对比剂组(81.4±27.6mL/min比62.5±22.8mL/min,P=0.000),两者CIN发病率差异无统计学意义(5.6%比4.8%,P=0.797);(4)Logistic多因素分析显示,术前使用利尿剂、术前eGFR<45mL/min、对比剂用量≥500mL是CIN的独立危险因素。结论冠状动脉介入诊疗术后CIN在非选择性患者中的发病率为5.5%。在术前eGFR<45mL/min的患者中CIN的发病率显著升高。等渗对比剂碘克沙醇对肾的安全性可能略优于低渗对比剂。术前使用利尿剂、术前eGFR<45mL/min、对比剂用量≥500mL是CIN的独立危险因素。
Objective To evaluate the incidence of contrast-induced nephropathy （CIN） in nonselected patients undergoing coronary angiography and intervention, and to investigate, the clinic risk factors of CIN as well as the renal safety of isosmolar iodixanol. Methods A total of 532 patients undergoing diagnostic coronary angiography or percutaneous coronary intervention were enrolled. Serum creatinine （SCr） was measured at any time within a week before the procedure and 2 days （48 hours） post procedure. The definition of CIN is the increase of serum creatinine of 44. 2 μmol/L （0. 5 mg/dL） or 25% of the baseline at 48 hours after the use of contrast media. The effects of contrast media on renal function in patients undergoing coronary intervention were investigated and predictors of CIN were determined using logistic regression test. Results （ 1 ） Among the 532 patients, CIN occurred in 29 patients and the incidence of CIN in non-selected patients was 5.5%. （2） The incidence of CIN was significantly higher in patients with baseline eGFR 〈45 mL/min compared with those patients whose baseline eGFR ≥45 mL/min （17.5% vs. 4. 5%, P = 0. 002）. （3） A total of 427 patients were given low-osmolality contrast media （LOCM） and 105 patients were given iso-osmolality contrast media （IOCM）. The average baseline eGFR in patients provided with LOCM was significantly higher than those with IOCM （ P = 0. 000） but there was no significant difference concerning the incidence of CIN in patients given LOCM compared with those given IOCM （ 5.6% vs. 4. 8% ,P = O. 797 ）. （4） Identified by logistic regression, diuretics intake before procedure, basic eGFR 〈 45 mL/min, and volume of contrast-meida more than 500 mL were independent risk factors of CIN. Conclusions The incidence of CIN in oatients undergoing coronary intervention is higher in oatients with basic eGFR 〈45 mL/min than those with eGFR ≥45 mL/min. The renal safety of isosmolar iodixanol may be higher than LOCM. The independent risk factors of CIN are diuretics intake before procedure, basic eGFR 〈 45 mIZmin, and volume of contrast-meida more than 500 mL.
出处
《中国介入心脏病学杂志》
2009年第3期153-156,共4页
Chinese Journal of Interventional Cardiology
