经皮冠状动脉患者体重指数与造影剂肾病的关系

发布时间：2018-04-25 05:15

本文选题：造影剂肾病 + 水化　；参考：《河北医科大学》2017年硕士论文

【摘要】：背景:随着冠脉介入治疗技术的普遍发展,造影剂在临床使用的不断增加,造影剂肾病(contrast-induced nephropathy,CIN)的发病率也随之增加,是目前医院获得性急性肾损伤的第三大原因[1]。CIN是碘造影剂在行PCI手术应用后的并发症,病死率达35%。目前临床上对于CIN暂无有效的治疗措施,术前对具有高危风险的患者进行筛查评估,正确地使用并尽量减少造影剂的使用剂量;预防性水化等干预措施,早期精确的诊疗;尽量降低CIN发生率及危害[2]。临床上经常将血清肌酐(Scr)作为CIN早期检测指标。高龄、心功能不全、贫血、糖尿病、高血压等现已证实为CIN危险因素。随着社会经济的发展,人类饮食水平的提高,肥胖已成为社会健康的重要问题,肥胖不仅是冠心病、高血压、糖尿病重要的危险因素,肥胖导致肾功能损伤称肥胖相关性肾病[3]。体重指数一直作为肥胖的诊断标准,“理想体重”作为保护因素一直被大众追捧。肥胖和CIN发生通过一个共同的炎症通路联系在一起,肥胖可能与CIN独立相关[4],也有报道肥胖引起肾小球高滤过可提高肾小管对钠的重吸收,对肾脏的保护作用可能降低CIN的发生[4]。目的:本研究将通过对体重指数分析和应用造影剂48h内肌酐值的变化来探讨体重指数与造影剂肾病的关系。方法:研究对象选择从2016年1月至2016年12月于我院行经皮冠状动脉介入治疗手术的患者,共352例,其中男性262例,女性90例,平均年龄57.94±9.45岁,平均体重72.80±10.86千克。所有入选患者进行临床资料收集,包括患者一般情况(如体重、身高、年龄、性别等)、既往病史(高血压、糖尿病、高脂血症、肾脏疾病)、用药史、体格检查等,完善实验室检查(包括血常规、凝血常规、肝功能、肾功能、电解质、血脂、血糖等)、常规心电图、胸片及心脏超声检查等其他经皮冠状动脉介入治疗术的常规术前检查。将入选的患者按体重指数分为两组,BMI24组;BMI在≥24组。记录基本特征和常规检查并给于抗凝、抗血小板聚集等常规药物治疗。两组患者术前4小时给予0.9%的生理盐水以1ml/kg/h静点,术后两组给于静脉注射20mg呋塞米并继续予1ml/kg/h的生理盐水进行水化持续24小时。于术前和术后48小时分别测量Scr。体重指数(BMI)=体重(kg)/身高^2(m)。应用SPSS19.0统计学软件对实验数据进行整理。正态分布的计量资料采用均数±标准差;非正态分布计量资料采用中位数(四分位数间距);两组间参数的比较采用独立样本t检验。分类资料用卡方检验进行比较。采用logistic回归分析筛选造影剂肾病的危险因素。以P0.05认为存在统计学差异。结果:两组基线下临床特点如性别、吸烟史、糖尿病、急性心梗、多支病变、口服他汀类、口服ACEI/ARB类、造影剂类型、射血分数、血清BNP、血红蛋白、C-反应蛋白、胆固醇、血糖、24小时出入量等方面没有统计学差异(P0.05)。在年龄、左室大小、E/e’、高血压方面存在统计学差异(P0.05)。两组造影剂肾病的发生率分别1.16%,9.02%,有统计学意义(P0.05)。Logistic回归分析显示,BNP升高、体重指数与造影剂肾病的发生相关,为CIN危险因素。体重指数判断CIN的ROC曲线面积为0.533,界值为24.1时,预测CIN的敏感性为96%,特异性为28%(95%CI:0.426-0.641;P=0.05)。结论:在水化的基础上给予小剂量呋塞米,体重指数、血清BNP与造影剂肾病发生相关,BNP升高、BMI≥24是CIN危险因素。
[Abstract]:Background: with the widespread development of coronary intervention therapy, the increase of contrast agent in clinical use, the incidence of contrast agent nephropathy (contrast-induced nephropathy, CIN) is also increasing. The third major cause of hospital acquired acute renal injury is that [1].CIN is the complication after the use of iodine contrast agent in PCI operation and the mortality rate is 3. 5%. currently has no effective treatment for CIN, screening and assessing patients with high-risk risk before operation, correctly using and minimizing the use of contrast agents, preventive hydration and other interventions, early accurate diagnosis and treatment, reducing the incidence of CIN and endangering [2]. clinically, as CIN, as CIN (Scr) as CIN Early detection index. Age, heart failure, anemia, diabetes, hypertension have now been confirmed as CIN risk factors. With the development of social economy and the improvement of human diet, obesity has become an important problem in social health. Obesity is not only an important risk factor for coronary heart disease, hypertension and diabetes, obesity is the cause of renal function damage. Obesity related nephrosis [3]. BMI has always been a diagnostic criterion for obesity. "Ideal weight" has been pursued by the public. Obesity and CIN are associated with a common inflammatory pathway. Obesity may be associated with CIN independent [4], and obesity causes glomerular high filtration to increase renal tubule to sodium. Reabsorption, the protective effect of the kidney may reduce the [4]. purpose of CIN. This study will explore the relationship between body mass index and contrast agent nephropathy through the analysis of body mass index and the changes in the value of creatinine in the contrast agent 48h. Methods: the subjects were selected from January 2016 to December 2016 in our hospital for percutaneous coronary intervention. A total of 352 patients were performed, of which 262 were male and 90 women, with an average age of 57.94 + 9.45 years, with an average weight of 72.80 + 10.86 kilograms. All the patients were collected for clinical data including general conditions (such as weight, height, age, sex, etc.), previous history (hypertension, diabetes, hyperlipidemia, kidney disease), history of medication, physical examination To perfect the laboratory examination (including blood routine, clotting routine, liver function, renal function, electrolyte, blood lipid, blood sugar, etc.), routine electrocardiogram, chest film and cardiac ultrasound examination, other routine preoperative examination of percutaneous coronary intervention. The selected patients were divided into two groups according to body mass index, group BMI24 and BMI in groups more than 24. The two groups of patients in the two group were given 0.9% of the normal saline 4 hours before operation, and the two groups were injected with 20mg furosemide and continued to give 1ml/kg/h saline for 24 hours after the operation. The Scr. BMI was measured before and 48 hours after the operation, respectively. BMI) = weight (kg) / height ^2 (m). Use SPSS19.0 statistics software to sort out the experimental data. The measurement data of normal distribution use mean number + standard deviation; non normal distribution data use the median (four division spacing); the two groups of parameters are compared by independent sample t test. Classification data are compared with chi square test. Logi Stic regression analysis was used to screen the risk factors for contrast nephropathy. Results: two groups of baseline clinical features such as sex, smoking history, diabetes, acute myocardial infarction, multiple branch lesions, oral administration of statins, oral ACEI/ARB, contrast agent type, ejection fraction, serum BNP, hemoglobin, C- reactive protein, cholesterol, blood sugar, 24 There were no statistical differences (P0.05). There were statistical differences in age, left ventricular size, E/e ', hypertension (P0.05). The incidence of angiographic nephropathy in two groups was 1.16%, 9.02%, respectively (P0.05).Logistic regression analysis showed that BNP increased, body mass index was associated with the occurrence of contrast nephropathy, and was a risk of CIN. Factors. When the ROC curve area of CIN was 0.533 and the boundary value was 24.1, the sensitivity of the predicted CIN was 96% and the specificity was 28% (95%CI:0.426-0.641; P=0.05). Conclusion: on the basis of the hydration, the small dose furosemide, body mass index, serum BNP and contrast agent nephropathy were related, BNP increased and BMI more than 24 was a CIN risk factor.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692;R54

【参考文献】