经皮冠状动脉介入治疗后两种对比剂诱发的急性肾损伤诊断标准的应用比较

目的:评估两种对比剂诱发的急性肾损伤(CI-AKI)诊断标准在行经皮冠状动脉介入治疗(PCI)患者的临床特征及术后不良事件相关性差异。方法:回顾性分析2013年1月至12月于我院行PCI的患者共10394例。比较欧洲泌尿生殖放射学会CI-AKI诊断标准血清肌酐绝对值升高≥44.2μmol/L(0.5 mg/dl),或较基线值升高≥25%,简写为CI-AKI 25%标准]和改善全球肾病预后组织CI-AKI诊断标准血清肌酐绝对值升高≥26.5μmol/L(0.3 mg/dl),或较基线值升高≥50%,简写为CI-AKI 50%标准]诊断的CI-AKI发生率及与PCI后2年内主要心脑血管不良事件(MACCE,包括死亡、心肌梗死、血运重建、支架内血栓、脑卒中的复合终点事件)发生风险的差别。结果:10394例患者中,采用CI-AKI 25%标准诊断的CI-AKI为936例(9.0%),而采用CI-AKI 50%标准诊断的CI-AKI患者为206例(2.0%),P<0.001。与CI-AKI 50%标准诊断的CI-AKI患者相比,CI-AKI 25%标准诊断的CI-AKI患者,其估算的肾小球滤过率(eGFR)更高,而术前血清肌酐更低,慢性肾脏病(CKD)1期的患者比例较高(P均<0.05)。在随访期间,共有1240例(11.9%)患者发生MACCE。CI-AKI 25%标准和CI-AKI 50%标准诊断的患者的MACCE发生率差异无统计学意义(9.9%vs.11.7%,P=0.463)。COX多因素回归分析显示两种CI-AKI诊断标准确定的CI-AKI均不是MACCE的独立预测因素(P>0.05)。结论:为避免在肾功能正常的患者中过度定义CI-AKI,CI-AKI 50%标准更适用于临床中筛选出肾功能损伤高危的患者;两种标准诊断的CI-AKI均与PCI后2年MACCE的发生无显著相关。

Prevalence of Contrast-induced Acute Kidney Injury and Outcome Among Patients Post Percutaneous Coronary Intervention:Clinical Impact of Two Different Definitions of Contrast-induced Acute Kidney Injury

Objectives:The purpose of this study was to evaluate the clinical characteristics and postoperative adverse events between the contrast-induced acute kidney injury(CI-AKI)patients after percutaneous coronary intervention(PCI)defined by two diagnostic criteria.Methods:From January 2013 to December 2013,10394 patients undergoing PCI in Fuwai Hospital were analyzed retrospectively.CI-AKI were diagnosed according to two different definitions:the CI-AKI 25%definition from guidelines for contrast media from the European Society of Urogenital Radiology in 2003,an increase in serum creatinine ≥25% or ≥44.2μmol/L(0.5 mg/dl)from baseline within 48 hours after PCI.The CI-AKI 50% definition according to Kidney Disease Improving Global Outcomes(KDIGO)in 2012,an increase in serum creatinine ≥50% from baseline or an increase ≥26.5μmol/L(0.3 mg/dl)from baseline.The incidence of CI-AKI and the risk of major adverse cardio-cerebrovascular events(MACCE)in 2-year follow-up were compared between patients defined by the two CI-AKI definitions after PCI.Results:A total of 10394 patients were enrolled.There were 936 cases(9.0%)CI-AKI according to CI-AKI 25% definition and 206 cases(2.0%)CI-AKI according to CI-AKI 50% definition(P<0.001).Compared with the CI-AKI patients diagnosed with CI-AKI 50% definition,the CI-AKI patients diagnosed with CI-AKI 25% definition had higher estimated glomerular filtration rate(eGFR),higher proportion of patients with chronic kidney disease(CKD)stage 1 and and lower serum creatinine levels before PCI(P<0.05).During follow-up,1240(11.9%)cases of MACCE happened.There was no significant difference in the incidence of MACCE(9.9%vs.11.7%,P=0.463)in CI-AKI patients diagnosed according to CI-AKI 25% definition or CI-AKI 50% definition.Cox multivariate regression analysis showed that the CI-AKI determined by the two criteria were not independent predictors of MACCE(P>0.05),while left ventricular ejection fraction,PCI history,diabetes history,hypertension history,SYNTAX score and IABP use were independent predictors of MACCEs within 2 years post PCI(P<0.05).Conclusions:The CI-AKI 50% definition is more suitable for screening patients with high risk of renal function injury,while avoiding over-definition of CI-AKI post PCI.CI-AKI determined by the two criteria are not independent predictors of MACCEs within 2 years after PCI.Left ventricular ejection fraction,PCI history,diabetes history,hypertension history,SYNTAX score and IABP use are independent predictors of MACCE within 2 years after PCI.