造影剂肾病对冠状动脉粥样硬化性心脏病患者短期预后的影响

Impact of contrast-induced nephropathy on short-term prognosis of patients with coronary heart disease

摘要:

目的  初步评价造影剂肾病对冠状动脉粥样硬化性心脏病（简称冠心病）患者短期临床预后的影响。方法  回顾性纳入自2010年1月-2014年12月期间于该院心血管内科住院并接受经皮冠状动脉内支架植入术的冠心病患者755例，并进行12个月随访。将所有纳入患者分为造影剂肾病组和非造影剂肾病组，并对其临床特点及12个月随访临床不良事件进行比较。结果  755例患者中，男性466例，女性289例，发生造影剂肾病51例（6.8%）；与非造影剂组患者比较，造影剂肾病组有更多的高龄患者、吸烟患者、糖尿病患者以及急性心肌梗死伴休克患者，差异有统计学意义（P <0.01）。平均Syntax积分在造影剂肾病组为（33.6±10.6）分，非造影剂肾病组为（22.1±6.8）分；造影剂肾病组患者LVEF为（38.5±8.87）%，非造影剂肾病组患者为（42.76±4.35）%，两组比较差异有统计学意义（P <0.01）。12个月随访的主要不良事件率在造影剂组患者中明显高于非造影剂组患者，差异有统计学意义（P <0.05）。多因素Logistic回归分析显示，造影剂肾病是冠心病患者12个月主要不良事件的独立危险因素。结论  造影剂肾病的发生可应用于预测冠心病患者的短期预后。

Abstract:

 Objective To evaluate the impact of contrast-induced nephropathy (CIN) on short-term prognosis of patients with coronary heart disease. Methods Total 755 patients with coronary heart disease who received percutaneous coronary intervention from January 2010 to December 2014 were involved in this study, and major adverse cardiovascular events (MACEs) of 12 month were recorded. All subjects were divided into CIN and non-CIN group, the characteristics and MACEs were compared between these two groups. Results There were 466 males and 289 females, among those 51 cases (6.8%) had CIN. Compared with non-CIN group, the patients in CIN group were much older, and had more active smokers, diabetes, acute myocardial infarctions and cardiac shocks, and the differences were significant. The SYNTAX score was (33.6 ± 10.6) in CIN group, and (22.1 ± 6.8) in non-CIN group. Left ventricular ejection fraction was (38.5 ± 8.87)% in CIN group, and (42.76 ± 4.35)% in non-CIN group, and the difference was significant (P < 0.01). The MACEs of 12 months was significantly higher in CIN group than that in non-CIN group (P < 0.05). The multiple Logistic regression analysis revealed that CIN was the independent risk factor of poor prognosis in patients with coronary heart disease. Conclusions CIN could be applied to predict short-term prognosis of patients with coronary heart disease.