冠脉慢性完全闭塞病变患者PCI术后造影剂肾病危险因素分析

发布时间：2018-05-20 04:30

本文选题：慢性完全性闭塞病变 + 造影剂肾病　；参考：《南方医科大学》2015年硕士论文

【摘要】：研究背景：近些年来,随着材料工程的发展和进步,大大加速了心导管术在心血管疾病的诊疗中的运用,由于心导管术应用的增加,患者接触造影剂频率及用量均有所增加,因此导致肾脏损害的情况也逐步增加。现有研究表明,医院内获得性肾功能损害中,造影剂导致的肾脏损害可约达11%[1-4]。目前造影剂肾病(Contrast-Induced Nephropathy, CIN)已成为院内获得性肾功能障碍的三大主要病因之一,尽管造影剂导致的肾功能损害为一过性的病理生理过程,但也可能延长患者临床病程以及导致临床病情复杂化,甚至成为诱因导致肾功能损害由一过性发展至永久性肾功能损害以至于需要长期肾脏替代治疗。既往研究统计发现,造影剂肾病的发生率大约在7%-15%[5],在不同人群中造影剂肾病的发生率差异较大。目的：探索慢性完全性闭塞病变(CTO)患者行冠脉造影术后造影剂肾病发生的危险因素研究人群：入选2010年5月至2013年6月于广东省人民医院行冠脉介入治疗的CTO患者共300例。入选标准：年龄18岁,慢性完全性闭塞病变患者。排除标准：(1)需长期行肾脏替代治疗或曾行肾移植；(2)PCI前2周内有造影剂接触史；(3)需行外科手术实现血运重建；(4)PCI围手术期需使用二甲双胍非甾体类抗炎药、氨基糖类抗生素、乙酰半胱氨酸等影响肾功能药物。研究方法：所有患者行PCI前及术后连续3天检测血浆肌酐水平,收集患者实验室及临床事件等基线资料。所有患者使用造影剂后均按照指南给予适当水化。造影剂肾病定义为使用造影剂后48-72小时血清肌酐值比基线值升高超过44.2umol/l或25%。根据患者是否发生CIN分为2组：CIN组与非CIN组,比较组间基线资料、CIN发生率及院内临床事件的发生率。采用回归分析校正各危险因素与CIN风险的相关性。研究结果：300例CTO患者中男性共251(83.7%)；平均eGFR为65±23ml/min; 216 (72.0%)名患者有糖尿病病史：35(11.7%)例发生CIN；院内死亡病例为3(1%),3例死亡病例均为发生CIN患者。CIN组与非CIN组间高血压病史[16(45.7) vs 98(37.0) P=0.317]、2型糖尿病[22(62.9)vs194(73.2),P=0.200]、男性比例[31(88.6)vs 220(83.0),P=0.404]、高脂血症比例[31(88.6)vs 228(86.0),P=0.682]差异均无统计学意义；CIN组患者基线估算肾小球滤过率(eGFR)及血浆白蛋白(30.9±6.3 vs 34.8±3.9,P=0.001)显著低于非CIN组(83.39±44.00 vs 76.33±22.41,P0.001)。而年龄75岁比例[7(29.0)vs54(18.6),P=0.008]、(LVEF)45%[7(29.0) vs 60(21.9),P=0.015]、贫血[16(45.7)vs62(23.6),P=0.005]患者比例在CIN组显著高于非CIN组(P值均0.05)。研究发现3例死亡病例,2例需行肾脏替代治疗病例均为CIN组患者；且CIN组需植入IABP显著高于非CIN组[4(11.4)vs 7(2.6),P=0.009]。多因素logistic回归分析发现年龄75岁(OR=1.288, CI:1.032-1.608, P=0.025)、 LVEF45% (OR=2.941, CI:1.334-6.483, P=0.007)、eGFR (OR=1.017, CI:1.003-1.030, P=0.016)与CIN发生率显著相关。结论：1.行冠脉介入诊治的CTO患者中,年龄75岁、LVEF45%、肾功能不全为CIN发生的危险因素。2.CIN发生与院内不良事件显著相关。
[Abstract]:Background: in recent years, with the development and progress of material engineering, the application of cardiac catheterization in the diagnosis and treatment of cardiovascular diseases has been greatly accelerated. Due to the increase in the application of cardiac catheterization, the frequency and amount of exposure to contrast agents have increased. Therefore, the condition of kidney damage is gradually increased. In the impairment of the renal function, the renal damage caused by contrast agent can be reduced to 11%[1-4]. current contrast agent nephropathy (Contrast-Induced Nephropathy, CIN), which has become one of the three major causes of hospital acquired renal dysfunction, although the renal impairment caused by contrast agent is an excessive pathophysiological process, but it may also prolong the patient's clinical practice. The course of the disease, the complication of the clinical condition, and even the cause of the cause of the renal function damage from one to permanent renal impairment so that long-term renal replacement therapy is required. Previous studies have found that the incidence of contrast nephropathy is about 7%-15%[5], and the incidence of contrast nephropathy in different groups is different. Study on the risk factors for patients with chronic complete occlusive disease (CTO) after coronary angiography: 300 patients with CTO from May 2010 to June 2013 were enrolled in the coronary intervention treatment in Guangdong General Hospital. The criteria were: age 18, patients with slow complete occlusive disease. Exclusion criteria: (1) Long term renal replacement therapy or renal transplantation; (2) the history of contrast media exposure in the first 2 weeks of PCI; (3) the need for surgical operation to achieve revascularization; (4) the use of metformin nonsteroidal anti-inflammatory drugs, aminoglycan antibiotics, acetylcysteine and other renal functional drugs in the perioperative period of PCI. Study methods: all patients were performed before and after PCI Serum creatinine levels were measured for 3 days after 3 days, and baseline data of laboratory and clinical events were collected. All patients were given appropriate hydration after the use of contrast agents. Contrast agent nephropathy was defined as an increase in serum creatinine value of more than 44.2umol/l or 25%. at 48-72 hours after the use of contrast agents. CIN was divided into 2 according to whether the patients were divided into 2. Group CIN and non CIN group, compared with the baseline data, the incidence of CIN and the incidence of clinical events in the hospital. Regression analysis was used to correct the correlation between the risk factors and the risk of CIN. The results of the study were: 300 cases of CTO patients were 251 (83.7%); the average eGFR was 65 + 23ml/min; 216 (72%) patients had the history of diabetes: 35 (11.7%) cases. CIN was 3 (1%), and 3 cases of death were all [16 (45.7) vs 98 (37) P=0.317] in group.CIN and non CIN group, [22 (62.9) vs194 (73.2), P=0.200], [31 (88.6) vs 220 (83) in type 2 diabetes, and there was no statistical difference in the proportion of hyperlipidemia (88.6). The estimated glomerular filtration rate (eGFR) and plasma albumin (30.9 + 6.3 vs 34.8 + 3.9, P=0.001) in group CIN were significantly lower than those in non CIN group (83.39 + 44 vs 76.33 + 22.41, P0.001). The ratio of age 75 to [7 (29) vs54 (18.6), P=0.008], LVEF 45%[7 (29) The CIN group was significantly higher than the non CIN group (P value was 0.05). The study found that 3 cases of death and 2 cases of renal replacement therapy were all in group CIN, and CIN group needed to implant IABP significantly higher than non CIN group [4 (11.4) vs 7 (2.6), P=0.009]. multiple factor Logistic regression analysis found age 75 years old 1.334-6.483, P=0.007), eGFR (OR=1.017, CI:1.003-1.030, P=0.016) had a significant correlation with the incidence of CIN. Conclusion: among CTO patients with 1. lines of coronary intervention, the risk factors for CIN are 75 years old, LVEF45%, and renal insufficiency is significantly associated with adverse events in the hospital.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.3

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