应激性高血糖和急诊冠状动脉介入治疗后造影剂肾病的相关性研究

目的 了解应激性高血糖对行急诊冠状动脉介入治疗术的非糖尿病急性心肌梗死患者造影剂肾病(CIN)发生情况的影响.方法 2008年10月至2011年5月在首都医科大学附属北京安贞医院接受急诊冠状动脉介入治疗术的非糖尿病急性心肌梗死患者共318例,患者均应用低渗非离子造影剂.根据入院血糖水平分为应激性高血糖组(63例)及非应激性高血糖组(255例),分析应激性高血糖与CIN的关系.结果 318例患者中,发生CIN共60例(18.9％),其中应激性高血糖组中CIN 18例(28.6％),其发生率明显高于非应激性高血糖组[16.5％(42/255)],差异有统计学意义(P＜0.05).应激性高血糖组与非应激性高血糖组患者血中白细胞计数、高敏C反应蛋白及左心室射血分数差异有统计学意义[(10.4±2.8)×109/L比(9.6±2.5)×109/L,(9±5)mg/L比(7±3)mg/L,(47±15)％比(51±14)％,均P＜0.05];应激性高血糖组再灌注时间长于非应激性高血糖组[(5.7±1.8)h比(4.5 ±2.1)h,P＜0.05].Logistic多因素回归分析显示,应激性高血糖是CIN发生的独立危险因素(OR=1.59,95％置信区间为1.32～1.86;P＜0.05).结论 应激性高血糖是行急诊冠状动脉介入治疗术的非糖尿病急性心肌梗死患者CIN发生的独立危险因素.

Clinical study on relationship between stress hyperglycemia and contrast-induced nephropathy in urgent coronary interventions

Objective To analyze the effect of stress hyperglycemia on the incidence of contrast-induced nephropathy （CIN）in patients undergoing urgent percutaneous coronary interventions without diabetes mellitus （DM）. Methods All 318 patients undergoing urgent coronary interventions were enrolled from October 2008 to May 2011. All patients received low-osmolality nonionic contrast agent. Serum creatinine concentration （Cr） at baseline and each day for the following three days were measured. Based on the admission glucose levels, 318 patients were divided into stress hyperglycemia group and non-stress hyperglycemia group. Univariate and Multivariate analysis were used to analyze the relationship between stress hyperglycemia and CIN. Results Among 318 patients, CIN occurred in 60 patients and the incidence of CIN was 18.9 %. The stress hyperglycemia group had higher incidence of CIN than nonstress hyperglycemia group[28.6% （18/63） vs 16.5% （42/255）, P 〈0.05]. The white blood cell level, high sensitive C reactive protein and left ventricular ejection fraction showed significant differences between stress hyperglycemia group and non-stress hyperglycemia group[ （ 10.4 ± 2.8）× 10^9/L vs （9.6 ± 2. 5） × 10^9/L, （9 ±5）mg/L vs （7 ±3）mg/L, （47 ± 15）% vs （51 ± 14）%, all P〈0.05]. Reperfusion time in stress hyperglycemia group was longer than that in non-stress hyperglycemia group [ （5.7 ± 1.8 ） h vs （4.5 ± 2.1 ） h, P 〈 0.05 ]. Multivariate analysis showed stress hyperglycemia was an independent risk factor of CIN （ OR = 1.59, 95% CI 1.32-1.86 ; P 〈 0.05）. Conclusion Stress hyperglycemia is an incidence risk factor of CIN in patients undergoing urgent percutaneous coronary interventions without DM.