应用g-I/eGFR比值预测急性ST段抬高心肌梗死急诊冠状动脉介入术后对比剂肾病的风险

目的探讨g-I/eGFR比值与急诊冠脉介入治疗术后发生对比剂肾病(contrast induced nephropathy,CIN)风险之间的关系,旨在建立一种更简捷合理的预测方法,减少急诊冠脉介入术后CIN的发生。方法回顾性分析2009年1月至2011年3月在北京大学第一医院因急性ST段抬高心肌梗死(ST-segmentel evation myocardial infarction,STEMI)接受急诊冠状动脉介入治疗手术的患者130例,记录术前血肌酐水平、术中对比剂用量、术后48～72h血肌酐水平,计算g-I/eGFR比值及对比剂肾病发生情况。使用SPSS13.0软件对资料进行分析,应用Mann-Whitney U检验了解CIN与各因素间的关系,应用Binary Logistic回归分析对可能影响肾功能的诸多因素进行分析。结果 130例患者中,发生对比剂肾病25例,发生率为19.2%。CIN和非CIN患者在术前及术后血肌酐、g-I/eGFR比值、使用主动脉内球囊反搏方面的差异具有统计学意义。基础肾病、Killip分级>I级、g-I/eGFR比值均与CIN的发生关系密切,其Exp(B)分别为7.742(95%CI0.932～64.301)、3.733(95%CI1.258～11.077)和0.031(95%CI0.002～0.557)。其中g-I/eGFR比值与CIN发生呈负相关(B=-3.476)。结论在急性STEMI行急诊PCI的患者中,基础肾病、心功能不全是CIN发生的危险因素,g-I/eGFR比值与CIN在本研究中呈负相关。

Feasibility of the ratio between dose in gram iodine and eGFR (g-I/eGFR) to assess the risk of CIN in patients with acute STEMI after emergent PCI

Objective To discuss the usefulness of the ratio of g-I/eGFR to assess the risk of contrast induced nephropathy ( CIN) in patients who were subjected acute ST-segment elevation myocardial infarction ( STEMI) after emergent PCI so that the minimal dose of contrast medium could be determined and the risk of developing CIN could be avoided. Methods 130 patients with acute STEMI were enrolled retrospectively from September 2009 to March 2011 in Peking University 1st Hospital. All patients underwent emergent percutaneous coronary intervention ( PCI) . We measured the serum creatinine before and after the operation,recorded the volume of contrast medium used during the operation,and calculated the ratio between dose in gram iodine and eGFR( g-I/eGFR) . All statistical analyses were performed with SPSS13. 0. To identify the correlations between CIN and the clinical and laboratory parameters,a univariate analysis was done using the Mann-Whitney U test. A binary Logistic regression analysis was used to assess the correlation among the variants. Results CIN occurred in 25 patients out of 130 patients with an incidence of 19. 2% . In patients with and without CIN,there is significant difference in serum creatinine before and after PCI,g-I/eGFR,the use of intra-aortic balloon pump ( IABP) . On binary Logistic regression ,the history of nephropathy [Exp( B) = 7. 742( 95% CI 0. 932 - 64. 301) ],Killip class > grade Ⅰ [Exp( B) = 3. 733 ( 95%CI 1. 258 - 11. 077) ],g-I/eGFR [Exp( B) = 0. 031( 95% CI 0. 002 - 0. 557) ] are most closely related to the occurance of CIN. However,the ratio of g-I/eGFR is negatively associated with the occurance of CIN ( B = - 3. 476) . Conclusions In patients with acute STEMI undergoing emergent PCI,the history of nephropathy and cardiac function are main risks of the occurance of CIN. In our study,the ratio of g-I/eGFR is negatively associated with the occurance of CIN.