造影剂肾病的相关危险因素及中医证候要素分析

发布时间：2018-06-30 09:48

本文选题：造影剂肾病 + 危险因素　；参考：《浙江中医药大学》2017年硕士论文

【摘要】：目的对造影剂肾病(contrast—media induced nephropathy,CIN)的相关危险因素及中医证候要素进行分析探讨,以便在检测前或检测过程中,尽可能的减少危险因素的出现,或者在危险因素出现的早期尽可能进行干预,利于改善预后、肾功能的恢复以及提高患者生存率等。方法通过回顾性研究的调查方法,收集2016年1月至2016年12月采用优维显、欧乃派克和安射力进行造影检查的住院患者共1424例,根据三种不同的造影剂比较其发病情况,并从中选取使用优维显进行检查的患者478例进行具体研究分析。收集这478例患者的临床资料,包括一般情况、实验室指标、中医证候、原发疾病诊断等,根据是否发生造影剂肾病分为CIN组(21例)与非CIN组(457例),比较两组组内组间差异,分析各项指标与造影剂肾病发生的相关性。结果本研究中结果显示,(1)三种不同的低渗造影剂对造影剂肾病发生的影响无明显差异,其比例约为1:1:1。(2)通过对478例使用优维显的造影患者的研究分析发现CKD患者的发病率(23.8%)较非CKD患者(3.4%)明显升高(P0.05)。(3)将CIN组与非CIN组的造影前肌酐进行比较,发现CIN组造影前肌酐明显高于非CIN组(P0.05)。再将CIN患者进行组内各项实验室指标比较发现,CIN引起的肾脏损伤短期内主要表现为血肌酐、尿素明显升高(P0.01),而对白蛋白、尿酸、血红蛋白均无明显影响(P0.05)。(4)将CIN组与非CIN组进行比较,研究显示单纯冠心病可影响CIN的发生(P0.05),高血压合并糖尿病患者较无原发疾病患者及单纯高血压患者发病率均有显著提高(P0.05),但单纯高血压患者或单纯糖尿病患者CIN的发生率无明显变化(P0.05)。通过二分类Logistic回归分析,单纯心脏病、高血压合并心脏病都是影响CIN发生的危险因素(P0.05),OR值分别为4.066(95%CI 1.273,12.988)、3.888(95%CI 1.343,11.258)。(5)CIN组与非CIN组根据中医证候要素进行分组比较后发现湿证与风证同时存在时较单独存在发病率明显升高,且瘀证比虚证的发病率高(P0.05)。结论在本研究的478例患者中CIN的发生率约为4.4%,其中CKD患者的CIN发生率较非CKD患者明显增加。在肾功能不全患者中血肌酐水平与CIN的发生存在相关性,CKD患者基础肌酐越高,越容易出现CIN。造影剂引起的急性肾损伤主要体现为血肌酐、尿素短期内明显升高,对尿酸、血红蛋白无明显影响,因此可推测尿素亦可作为早期联合判断CIN发生的指标之一。单纯冠心病、高血压合并糖尿病是CIN发生的危险因素之一。高血压合并糖尿病患者较无原发病患者及单纯高血压患者发病率均有显著提高。湿证与风证同时存在时较单独存在发病率明显升高;瘀证比虚证发生CIN可能性更大。
[Abstract]:Objective to analyze the risk factors and syndromes of contrast-media induced nephropathy (cin) in order to minimize the occurrence of risk factors before or during detection. Or intervention as early as possible in the early stages of risk factors can improve prognosis, renal function and survival rate. Methods from January 2016 to December 2016, a total of 1424 inpatients who had been examined by Uvexin, Onaipek and Anemone from January 2016 to December 2016 were collected and compared according to three different contrast agents. 478 patients who were examined with UVX were studied and analyzed. The clinical data of 478 patients were collected, including general conditions, laboratory indicators, TCM syndromes, diagnosis of primary diseases and so on. According to whether contrast agent nephropathy occurred or not, they were divided into cin group (21 cases) and non-cin group (457 cases). The differences between the two groups were compared. To analyze the correlation between various indexes and the occurrence of contrast agent nephropathy. Results the results of this study showed that (1) there was no significant difference in the effect of three different hypotonic contrast agents on the occurrence of contrast agent nephropathy. The ratio was about 1: 1: 1. (2) A study of 478 patients with urography showed that the incidence of). (was significantly higher than that of non-CKD patients (P0.05). (3). It was found that the level of creatinine in cin group was significantly higher than that in non-cin group (P 0.05). By comparing the laboratory indexes of cin patients in the group, we found that the main manifestations of renal injury caused by cin in a short period of time were serum creatinine and urea (P0.01), but in the treatment of albumin, uric acid, serum creatinine and urea were significantly increased (P0.01). There was no significant difference in hemoglobin (P0.05). (4) between cin group and non-cin group. The results showed that the incidence of cin was affected by coronary heart disease alone (P0.05). The incidence of cin in hypertensive patients with diabetes was significantly higher than that in patients without primary diseases and patients with hypertension (P0.05), but the incidence of cin in patients with hypertension or diabetes mellitus was significantly higher than that in patients with diabetes mellitus (P < 0.05). There was no significant change in the incidence rate (P0.05). By two classification logistic regression analysis, simple heart disease, Hypertension and heart disease were the risk factors of cin (P 0.05). The OR values were 4.066 (95 CI 1.273 ~ 12.988) and 3.888 (95 CI 1.343 ~ 11.258). (5). The incidence of wet syndrome and wind syndrome were significantly higher in cin group than in non-cin group according to TCM syndromes. The incidence of stasis syndrome was higher than that of deficiency syndrome (P0.05). Conclusion the incidence of cin was about 4.4 in 478 patients in this study. The incidence of cin in CKD patients was significantly higher than that in non-CKD patients. There is a correlation between serum creatinine level and the occurrence of cin in patients with renal insufficiency. The higher the level of basal creatinine in CKD patients is, the more likely it is to have CINs. Acute renal injury caused by contrast agent was mainly manifested as blood creatinine, urea increased obviously in the short term, but had no obvious effect on uric acid and hemoglobin. Therefore, it can be speculated that urea can also be used as one of the early indicators to judge the occurrence of cin. Coronary heart disease alone, hypertension with diabetes mellitus is one of the risk factors of cin. The incidence of hypertension complicated with diabetes was significantly higher than that of patients without primary disease and simple hypertension. The morbidity of dampness syndrome and wind syndrome was significantly higher than that of single syndrome, and the incidence of cin was more likely to occur in blood stasis syndrome than that in deficiency syndrome.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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