慢性肾病患者冠状动脉介入治疗术前血糖水平与对比剂肾病的关系

目的 评价未确诊糖尿病的慢性肾病（CKD）患者冠状动脉介入治疗（PCI）术前血糖水平与对比剂肾病（CIN）的相关性.方法 入选331例行PCI术的未确诊糖尿病（指无糖尿病或入院前已存在糖尿病但未经诊断和治疗）肌酐清除率在15 ～ 60 ml/min的急性冠状动脉综合征（ACS）患者.根据PCI术前血糖水平将患者分为＜6.1 mmol/L,6.1～ 7.8 mmol/L,7.9 ～ 11.0 mmol/L和≥11.1 mmol/L四组.用Logistic回归分析评价PCI术前血糖水平与其他重要危险因素.CIN定义为对比剂接触后48 ～ 72 h内血清肌酐较基础值升高≥0.5 mg/dl.结果 CIN发生率随PCI术前血糖水平的增高而增加,四个从低到高血糖组的CIN发生率分别为：5.0％,9.0％,11.6％和30.0％ （P=0.004）.调整混杂因素后Logistic多元回归分析显示,PCI术前高血糖明显增加患者CIN的发生风险[与＜6.1 mmol/L组相比,三个从低到高血糖组的OR（95％CI）分别为1.91（0.65 ～5.64）,2.42（0.72 ～8.12）,11.31（2.13 ～60.03）]和6个月死亡率[与＜6.1 mmol/L组相比,三个从低到高血糖组的OR（95％ CI）分别为2.23（2.29 ～17.22）,9.52（1.53 ～59.21）,40.13（4.71 ～342.29）].结论 未确诊糖尿病并CKD的ACS患者PCI术前血糖水平与CIN及6个月死亡率密切相关,控制术前血糖水平可能会降低CIN及死亡风险.

Pre-procedural glucose levels and contrast-induced nephropathy in patients of acute coronary syndrome without established diabetes with chronic kidney disease

Objective To evaluate the relationship between pre-procedural glucose levels and the risk for contrast-induced nephropathy（CIN） in patients of acute coronary syndrome （ACS） without established diabetes with chronic kidney disease（CKD） after percutaneous coronary intervention（PCI）.Methods We evaluated 331 patients of ACS without known diabetes （regardless of per-existing diabetes） with estimated creatinine clearance （CrCl） between 15 and 60 ml/min undergoing PCI.Patients were stratified into 4 pre-procedural glucose groups：〈 6.1mmol/L,6.1-7.8 mmol/L,7.9-11.0 mmol/L and ≥ 11.1 mmol/L.Logistic regression models were used to evaluate the relationship between glucose levels and risk for CIN.CIN was defined as an increase of serum creatinine ≥0.5mg/dl from baseline within 48-72 h after the procedure.Results The incidence of CIN was increased in proportion to higher pre-procedural glucose levels,CIN rates across the 4 glucose groups from lowest to highest：5.0%,9.0%,1 1.6% and 30.0% （P =0.004）.After adjusting for confounders,elevated pre-procedural glucose increased the risk for CIN [odds ratios （95 % confidence intervals）] for 3 glucose groups （from lowest to highest）：1.91 （0.65-5.64）,2.42 （0.72-8.12）,11.31 （2.13-60.03） vs.glucose 〈 6.1 mmol/L,respectively and 6-month mortality [odds ratios （95% confidence intervals）] for 3 glucose groups （from lowest to highest）：2.23 （2.29-17.22）,9.52 （1.53-59.21）,40.13 （4.71-342.29） vs.glucose 〈 6.1 mmol/L,respectively in patients.Conclusions Elevated preprocedural glucose is associated with greater risk for CIN and 6-month mortality in patients of ACS without established diabetes with CKD after PCI,tight glycemia control may prevent CIN and even improve the clinical outcome of patients with CKD.