摘要
目的探讨心功能不全对糖尿病合并肾功能不全患者行冠脉介入诊治术后发生对比剂所致急性肾功能损害(CIAKI)的影响。方法纳入2008年12月-2011年10月全国53家中心的2型糖尿病(T2DM)合并慢性肾脏病(CKD)2、3期患者2998例,其中心功能正常患者2533例,合并心功能不全患者465例。监测两组患者人口学特征、术前肾功能及术后发生CIAKI的情况。结果两组术前年龄、性别、高危因素等基线资料差异无统计学意义(P>0.05)。心功能正常组有70例患者术后72h内Scr较基线升高≥44.2μmol/L(0.5mg/dl)或Scr较基线升高≥25%,CIAKI发生率为2.8%,而心功能不全组有22例发生CIAKI,发生率为4.7%,明显高于心功能正常组,差异有统计学意义(P=0.03)。介入诊治术后30d随访发现,两组全因死亡差异无统计学意义(P=0.23)。多因素分析显示,瑞舒伐他汀是CIAKI发生的保护因素,急性冠脉综合征、心功能不全、贫血、肾功能不全是CIAKI发生的危险因素。结论冠脉介入诊治术前合并心功能不全患者术后发生CIAKI的风险高于心功能正常患者。术前充分评估高危患者的心功能并给予有效治疗,待心功能改善后再行冠脉介入治疗可减少CIAKI的发生。
Objective To evaluate the influence of cardiac insufficiency on contrast-induced acute kidney injury（CIAKI） after percutaneous coronary intervention（PCI） in patients with diabetes mellitus（DM） complicated with mild to moderate renal insufficiency（MMRI）. Methods From Dec. 2008 to Oct. 2011, 2998 patients, with type 2 DM and concomitant chronic kidney diseases（CKD） from 53 hospitals in China, were enrolled in the present study. Out of them, 2533 patients showed normal cardiac function（NYHA=1） and 465 patients suffered from cardiac insufficiency（NYHA1）. The demographic characteristics, preoperative renal function and postoperative incidence of CIAKI in the two groups were monitored. Results No significant difference was found between two groups（P〉0.05） in preoperative baseline data（age, sex, high risk factors, etc.）. The incidence of CIAKI was significantly higher in NYHA1 group than in NYHA=1 group（4.7% vs 2.8%, P=0.03）. During a 30 day follow-up, the incidence of all-cause mortality was not significantly different between two groups（P〉0.05）. Multiple factors analysis found that rosuvastatin was the protective agent for CIAKI, and acute coronary syndrome, cardiac insufficiency, anemia and renal insufficiency were the risk factors for CIAKI. Conclusion For PCI, the risk of postoperative incidence of CIAKI is higher in patients with preoperative cardiac insufficiency than in those with normal cardiac function. The incidence of CIAKI may be reduced obviously by meticulous preoperative assessment of heart function in high-risk patients, giving effective treatment and performing PCI after cardiac function is improved.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2015年第9期727-732,共6页
Medical Journal of Chinese People's Liberation Army
基金
国家科技重大专项课题(2012ZX09303016-002)
辽宁省科技攻关项目(2013225089)~~
关键词
心力衰竭
糖尿病
急性肾损伤
造影剂
heart failure
diabetes mellitus
acute kidney injury
contrast media
