不稳定型心绞痛患者介人术后对比剂肾病的危险因素

目的探讨不稳定型心绞痛患者冠状动脉(冠脉)介入诊断及治疗术后对比剂肾病(CIN)的发生率及危险因素。方法连续入选2007年1～8月因不稳定型心绞痛入院并接受择期冠脉介入手术的患者232例。排除标准:(1)血压<120/70 mm Hg;(2)心功能(NYHA)分级>Ⅲ级。术中使用低渗非离子型对比剂碘普罗胺。介入术后24～72 h血肌酐(Scr)较基础值增高25%或44.2 μmol/L定义为CIN。分析CIN发生率与各项危险因素的相关性。结果 CIN总发生率为14.7%。冠脉钙化、术前Scr水平≥132.6 μmol/L、内生肌酐清除率(Ccr)<60 ml/min、NYHA Ⅲ级、糖尿病及年龄≥70岁的患者CIN发生率均明显增高。多变量回归分析显示,基线Scr≥132.6μmol/L、Ccr<60 ml/min、NYHA Ⅲ级与CIN的相关性最强。结论不稳定型心绞痛患者接受冠脉介入术后CIN是常见的并发症;高龄、肾功能不全、心功能不全、糖尿病及造影发现冠脉钙化是CIN发生的危险因素。

The risk factors of contrast-induced nephropathy in patients with unstable angina pectoris underwent coronary angiography

Objective To investigate the incidence and risk factors of contrastinduced nephropathy （CIN） in patients with unstable angina pectoris who underwent coronary angiography. Methods Between January, 2007, and August, 2007, we screened all consecutive 232 patients admitted to our department with unstable angina pectoris who underwent coronary angiography （CAG） with or without percutaneous coronary intervention （PCI）. Exclusion criteria were blood pressure 〈 120/70 mm Hg, or the heart functional classification （NYHA） class IV. Low-osmolality contrast agent, Iopromide was used in all patients. CIN was defined as a relative increase of more than 25% of serum ereatine （Scr） or an absolute increase of ≥ 44. 2 μmol/L within the 72-hour period after interventional procedure. Multivariate logistic regression was used to identify correlates of CIN and clinical, as well as angiographic data Results The incidence of CIN was 14. 70%. In patients with coronary artery calcification （CAC） shown by CAG, baseline Scr≥ 132. 6 μmol/L, Ccr 〈 60 ml/min, heart function of NYHA Ⅲ, diabetic mellites, and age ≥ 70 years, the incidence of CIN was significantly higher. CIN was most strongly associated with baseline Scr≥132. 6 μmol/L, baseline Ccr 〈 60 ml/min, heart function of NYHA In. Conclusions CIN is a common complication in patients with unstable angina after exposure to intravascular contrast media. The incidence of CIN was significantly associated with aging, renal dysfunction, diabetes mellitus, and CAC shown by CAG.