尿pH值与慢性肾脏疾病患者对比剂肾病的关系

目的 探讨尿pH值与慢性肾脏疾病（chronic kidney disease,CKD）患者经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗或冠状动脉造影术（coronary angiography,CAG）后对比剂肾病（contrast-induced nephropathy,CIN）的相关性.方法 回顾性分析2009年9月至2012年8月在广东省人民医院行择期PCI治疗或CAG的CKD患者453例的临床资料.按术前尿pH值水平将患者分为2组：尿pH值≥6组（n=254例）,尿pH值＜6组（n=199例）.比较两组之间的基线资料、CIN发病率、院内病死率及血液透析率.采用单因素Logistic 回归分析筛选CIN的危险因素,采用多因素Logistic回归分析尿pH值＜6与CIN的关系.结果 共52例患者（11.5％）发生CIN;尿pH值≥6组,尿pH值＜6组CIN的发病率分别5.5％ （14/254）、19.1％（38/199）,两组比较差异有统计学意义（P＜0.001）;院内病死率分别为0和1.5％ （3/199）,两组比较差异无统计学意义（P=0.050）;血液透析率分别为0.4％（1/254）和1.5％（3/199）,两组比较差异无统计学意义（P=0.209）.单因素Logistic回归分析显示,尿pH值＜6与CIN的发病率相关（OR =4.406,95％CI：2.124-7.708,P＜0.001）;多因素Logistic回归分析提示,尿pH值＜6是CIN的独立危险因素（OR =3.267,95％CI：1.674-6.374,P=0.001）.结论 CKD患者术前尿pH值＜6与择期PCI或CAG术后CIN相关,尿pH值＜6增加发生CIN的风险.

Relationship between urinary pH and contrast-induced nephropathy in patients with chronic kidney disease

Objectives To study the relationship between urinary pH and contrast-induced nephropathy （CIN） in patients with chronic kidney disease（CKD） after elective percutaneous coronary intervention （PCI） or coronary angiography （CAG）.Methods We conducted an retrospective and observational study in 453 CKD patients receiving elective PCI or CAG in Guangdong General Hospital between September 2009 and August 2012.Patients were divided into two groups according to preoperative urinary pH level：urinary pH＜6 group （n=199） and urinary pH ≥6 group （n=254）.Baseline clinical data,CIN incidence,in-hospital mortality and dialysis were compared between the two groups.Univariate analysis was used to identify the risk factors of CIN.The relationship between urinary pH ＜6 and CIN was assessed by multivariate Logistic regression.Results CIN occurred in 52（11.5％） patients.Incidence of CIN in urinary pH ≥ 6 group was significantly lower than that in urinary pH＜6 group 5.5％ （14/254） vs.19.1％ （38/199）,P＜0.001].No significant difference was observed regarding in-hospital death 0 vs.1.5％ （3/199）,P=0.050] and dialysis 0.4％ （1/254） vs.1.5％ （3/199）,P=0.209] between the two groups.Incidence of CIN was significantly associated with urinary pH＜6 in univariate analysis （OR =4.406,95％ CI：2.124-7.708,P＜0.001）.After adjusting potential confounding variables,multivariate Logistic regression indicated that urinary pH＜6 was an independent risk factor of CIN （OR=3.267,95％CI：1.674-6.374,P=0.001）.Conclusions Urinary pH＜6 is related to CIN in patients with CKD after elective PCI or CAG.Urinary pH＜6 predicts a higher risk of CIN.