摘要
目的探讨曲美他嗪预防Mehran评分中高危患者心导管术后发生造影剂肾病的效果。方法连续性入选2018年5月至2021年5月就诊于广西北海市人民医院行心导管术的冠状动脉粥样硬化性心脏病(冠心病)患者。根据患者临床症状以及Mehran评分标准,纳入Mehran评分中高危以上(Mehran评分≥6分)的患者876例,根据患者住院期间是否服用曲美他嗪,分为曲美他嗪组(n=303)和非曲美他嗪组(n=573)。主要研究终点是造影剂肾病的发生,定义为接触造影剂后48~72 h血清肌酐浓度较基线相对升高≥25%或绝对升高≥44.2μmol/L,同时排除其他原因所致的急性肾功能损害。次要研究终点是住院期间主要复合不良临床事件,包括死亡、再发心肌梗死、再次血运重建、脑卒中或肾脏替代治疗。结果876例患者中,发生造影剂肾病的患者为89例(10.2%)。曲美他嗪治疗组造影剂肾病发生率低于非曲美他嗪治疗组,差异有统计学意义(6.9%vs.11.5%,P=0.001);而两组间主要复合不良临床事件发生率相似,差异无统计学意义(1.3%vs.2.8%,P=0.257)。多因素Logistic回归分析显示,经年龄≥75岁,基础肾功能、糖尿病等因素校正后,曲美他嗪治疗仍与低造影剂肾病发生率相关(OR=0.45,95%CI:0.12~0.96,P=0.002),而曲美他嗪治疗并未降低主要复合不良临床事件发生(OR=0.70,95%CI:0.46~1.28,P=0.104)。结论曲美他嗪治疗可以减少Mehran评分中高危患者心导管术后造影剂肾病的发生。
Objectives To investigate the effect of trimetazidine on preventing contrast induced nephropathy(CIN)in patients with moderate or high Mehran risk score after cardiac catheterization.Methods Patients with coronary heart disease who underwent cardiac catheterization in Beihai People's Hospital of Guangxi from May 2018 to May 2021 were consecutively enrolled.According to the clinical symptoms of the patients and the Mehran risk score,876 patients with moderate or high Mehran risk score(Mehran score≥6)were included.According to whether the patients treated with trimetazidine during hospitalization,they were divided into trimetazidine group(n=303)and non-trimetazidine group(n=573).The primary endpoint was the occurrence of CIN,which was defined as a relative increase of≥25% or an absolute increase of≥44.2 umol/L in serum creatinine levels within 48-72 hours after exposure to contrast media,and acute kidney injury due to other causes was excluded.The secondary endpoint was the composite of adverse clinical events during hospitalization,including death,recurrent myocardial infarction,repeat revascularization or stroke,or renal replacement therapy.Results Of the 876 patients,89(10.2%)developed CIN.The incidence of CIN in trimetazidine group was significantly lower than that in non-trimetazidine group(6.9%vs.11.5%,P=0.001).The incidence of major adverse clinical events was similar between the two groups(1.3%vs.2.8%,P=0.257).Multivariate Logistic regression analysis showed that after adjustment for age≥75 years,basic renal function,history of diabetes and other factors,trimetazidine treatment was still associated with a low incidence of CIN(OR=0.45,95%CI:0.12-0.96,P=0.002),while trimetazidine treatment did not reduce the incidence of adverse clinical events(OR=0.70,95%CI:0.46-1.28,P=0.104).Conclusions Trimetazidine treatment can reduce the occurrence of CIN after cardiac catheterization in patients with moderate or high Mehran risk score.
作者
林晓强
吴志福
王纲
詹源胜
LIN Xiaoqiang;WU Zhifu;WANG Gang;ZHAN Yuansheng(Beihai People's Hospital of Guangxi,Beihai,Guangxi 536000,China)
出处
《岭南心血管病杂志》
CAS
2023年第5期493-497,502,共6页
South China Journal of Cardiovascular Diseases
基金
北海市科技计划项目(项目编号:2019C05)。
关键词
曲美他嗪
心导管术
造影剂肾病
主要复合不良临床事件
trimetazidine
cardiac catherization
contrast induced nephropathy
adverse clinical events
