肾小球滤过率对造影剂肾病的早期预测价值

目的 探讨肾小球滤过率（eGFR）对行冠状动脉介入诊断和治疗患者发生造影剂肾病（CIN）的早期预测价值.方法 收集我院心内科行冠脉介入诊治术[冠状动脉造影术（CA）和（或）经皮冠状动脉介入术（PCI）]患者184例,检测患者术前（组1）、术后24 h（组2）及术后72 h（组3）血清肌酐（Scr）、尿素氮（BUN）水平,并应用MDRD公式计算三组患者的eGFR值,分析比较Scr与eGFR变化对患者肾功能受损的预测价值.结果 ①三组间BUN差异无统计学意义,Scr于术后72 h明显升高,而eGFR于术后24 h即显著下降.②以术后患者Scr较基础值升高25%诊断CIN（方法A）,组2、组3分别为28例（15.2%）、68例（37.0%）;而以eGFR＜60 ml·min-1·1.73m-2诊断CIN（方法B）,组1、组2、组3分别为44例（23.9%）、60例（32.6%）、72例（39.1%）,两种方法比较,术后24 h eGFR值降低先于Scr水平,差异具有统计学意义（P＜0.01）.③术前以eGFR＜90 ml·min-1·1.73m-2为界诊为肾功能受损者44例（31.4%）,而Scr水平虽有增高但仍在正常范围内;术前肾功能受损组CIN发病率明显高于肾功能正常组.结论 eGFR下降总是先于Scr水平变化,是早期肾功能损害及损害程度的强预测因子.介入术前计算eGFR可有效评估患者肾功能状况,术后可及早发现CIN,采取相应干预措施,有助于减少急性肾功能衰竭的发生.

Investigating the early predictive value of eGFR in CIN

Objective To probe the early predictive value of eGFR in Contrast-induced Nephropathy following Coronary intervention in patients with CHD. Methods 184 cases of patients who underwent angiography in our hospital were enroUed and their serum ereatinine （Ser）, blood urea nitrogen（BUN） were detected at preopera- tive, postoperative 24 h, postoperative 72 h, eGFR of every patients were estimated by Coekeraft-Gauh equation. The changes of Set and eGFR were observed, then analyzed and compared their predictive value to renal function. Results BUN in the above three groups had no statistical difference. Ser increased significantly at postoperative 72 h, however, eGFR has dropped obviously at postoperative 24 h. To diagnose CIN by Ser increased 25% from basic value（method A）,Goup2, group3 respectively has 28 eases（15.2%）, 68 eases（37.0%）. With eGFR〈60 ml·min^-1·1.73m……-2 diagnose of CIN （method B）, groupl, group2, group3 respectively has 44 eases （23.9%）, 60 eases（32.6%） and 72 eases（39.1%）. Comparison of two methods, group2 has significant differenee（P〈0.01 ）, but group3 has no similar result. Moreover, impaired renal function group was higher obviously than normal renal function group about incidence of CIN. Conclusion （1）44 eases patients with impaired renal function were found according the value of eGFR at preoperation, and has a clear higher incidence of CIN. （2）Detection ratio of CIN by method B was higher significantly than method A at postoperation 24 h, but there is no statistically difference at postoperation 72 h. Therefore, eGFR can be used to evaluate preoperative renal function and diagnose CIN earlier at postoperative among patients undergoing angiography in clinic, and give a early prevention of occurrence of irreversible renal damage.