肾功能相对正常的急性冠脉综合征患者PCI术后不同定义的对比剂肾病发生率和近期预后

吴河; 张丰富; 叶飞; 尤威; 毛建华

doi:10.13201/j.issn.1001-1439.2015.03.014

肾功能相对正常的急性冠脉综合征患者PCI术后不同定义的对比剂肾病发生率和近期预后

- 1. 马鞍山市中心医院心内科(安徽马鞍山, 243000);
- 2. 南京医科大学附属南京市第一医院心内科

详细信息

通讯作者: 吴河,E-mail:wuhe741120@163.com

中图分类号: R541.4

收稿日期: 2014-08-01

Incidence and in-hospital outcomes of contrast-induced nephropathy based on different definitions in patients with acute coronary syndrome and relative normal renal function

- 1. Department of Cardiology, Central Hospital, Maanshan, 243000, China;
- 2. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University

More Information

Corresponding author: WU He, E-mail: wuhe741120@163.com

Received Date: 01 August 2014

摘要

摘要: 目的：评估不同定义的对比剂肾病对于肾功能相对正常（eGFR ≥ 60 ml/min/1.73 m²）的急性冠脉综合征（急性非ST段抬高型心肌梗死+急性ST段抬高型心肌梗死）患者PCI术后对比剂肾病（contrast-induced nephropathy，CIN）危险因素、发生率以及住院期间预后的影响。方法：选取肾功能相对正常的ACS患者232例。依据对比剂肾病定义分为CIN25%组（PCI术后血清肌酐增加≥ 25%）和CIN0.5组（PCI术后血清肌酐绝对值增加≥ 0.5 mg/dl）组，计算所有患者的eGFR值、GRACE积分及Mehran积分，应用多元回归分析评估CIN和住院不良事件（再梗死+急性左心力衰竭+死亡）的风险。结果：CIN25%组和CIN0.5组发生率分别为12.1%和5.6%，GRACE积分>140是CIN25%组的独立危险因素（OR=5.22，95%CI 2.39~11.36，P=0.001），CIN0.5组是住院期间不良事件的独立危险因素（OR=4.84，95%CI 1.42~16.54，P=0.012）。结论：肾功能相对正常的ACS患者合并GRACE积分高时PCI术前及术后应予以充分的预防CIN措施，当术后肌酐绝对值升高≥ 0.5 mg/dl是应警惕住院期间不良心脏事件的发生。
- 对比剂肾病 /
- 急性冠脉综合征 /
- GRACE风险积分 /
- 近期预后
Abstract: Objective: To evaluate the incidence,risk factors,and in-hospital prognosis of contrast-induced nephropathy based on the different definitions in patients with acute myocardial infarction and relative normal kidney function.Method: The study population included all 232 consecutive patients from May 1,2013 to March 28,2014.We calculated estimated glomerular filtration rate,GRACE risk score and Mehran risk score.The CIN was defined according to 2 definitions:CIN25%(increases in serum creatinine ≥ 25%) and CIN0.5(increases in serum creatinine ≥ 0.5mg/dl). The risk of CIN and in-hospital cardiac events was assessed using multivariable logistic regression.Result: CIN25% occurred in 28(12.1%) patients,13(5.6%) patients developed CIN0.5.Global Registry of Acute Coronary Events(GRACE) risk score>140 was an independent factor of CIN25%(OR=5.22,95%CI 2.39-11.36,P=0.001),CIN0.5 was an independent factor of in-hospital cardiac events(mortality,reinfarction and heart failure) (OR=4.84,95%CI 1.42-16.54,P=0.012).Conclusion: Patients admitted with acute coronary syndrome and relative normal renal function with high risk according to GRACE score are at high risk of developing CIN.In these groups,the effective measure to prevent CIN would be recommended before and after PCI.Also,increases in serum creatinie ≥ 0.5 mg/dl should alert us to a high rate of in-hospital cardiac events(death,reinfarction,and heart failure).
- contrast-induced nephropathy /
- acute coronary syndrome /
- GRACE risk score /
- in-hospital prognosis

HTML全文

参考文献(16)

[1]	SUN Z, FU Q, CAO L, et al.Intravenous N-acetylcysteine for prevention of contrast-induced nephropathy:a meta-analysis of randomized, controlled trials[J].PLoS One, 2011, 8:5124-5129.
[2]	PERRIN T, DESCOMBES E, COOK S.Contrast-induced nephropathy in invasive cardiology[J].Swiss Med Wkly, 2012, 142:3608-3614.
[3]	BARRETT B J, PARFREY P S.Clinical practice. Clinical practice. Preventing nephropathy induced by contrast medium[J].N Engl J Med, 2006, 354:379-386.
[4]	JORGENSEN A L.Contrast-induced nephropathy:pathophysiology and preventive strategies[J].Crit Care Nurse, 2013, 33:37-46.
[5]	SCHILP J, DE BLOK C, LANGELAAN M, et al.Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy[J].BMC Nephrol, 2014, 15:20-27.
[6]	WRIGHT R S, ANDERSON J L, ADAMS C D, et al.2011 ACCF/AHA focused Update of the Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial infarction(updating the 2007 guideline):a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American College of Emergency Physicians, Society for Cardiovascular Angiography and intercentions, and Society of Thoracic Surgeons[J].J Am Coll Cardiol, 2011, 57:1920-1959.
[7]	KOLH P, WIJNS W, DANCHIN N, et al.Guidelines on myocardial revascularization[J].Eur J Cardiothorac Surg, 2010, 38:s1-s52.
[8]	SOLOMON R, DAUERMAN H L.Contrast-induced acute kidney injury[J].Circulation, 2010, 122:2451-2455.
[9]	LI J H, HE N S.Prevention of iodinated contrast-induced nephropathy[J].Chin Med J(Engl), 2011, 124:4079-4082.
[10]	STACUL F, VAN DER MOLEN A J, REIMER P, et al.Contrast induced nephropathy:updated ESUR contrast media safety committee guidelines[J].Eur Radiol, 2011, 21:2527-2541.
[11]	MEHRAN R, AYMONG ED, NIKOLSKY E, et al.A simple risk score for prediction of contrast induced nephropathy after percutaneous coronary intervention[J].J Am Coll Cardiol, 2004, 44:1393-1399.
[12]	PIEPER K S, GORE J M, FITZGERALD G, et al.Global Registry of Acute Coronary Events(GRACE) Investigators.Validity of a risk-prediction tool for hospital mortality:the global registry of acute coronary events[J].Am Heart J, 2009, 157:1097-1105.
[13]	BARTHOLOMEW B A, HARJAI K J, DUKKIPATI S, et al.Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification[J].Am J Cardiol, 2004, 93:1515-1519.
[14]	COCA S G, PEIXOTO A J, GARG A X, et al.The prognostic importance of a small acute decrement in kidney function in hospitalized patients:A systematic review and meta-analysis[J].Am J Kidney Dis, 2007, 50:712-720.
[15]	LINDSAY J, CANOS D A, APPLE S, et al.Causes of acute renal dysfunction after percutaneous coronary intervention and comparison of late mortality rates with postprocedure rise of creatine kinase-MB versus rise of serum creatinine[J].Am J Cardiol, 2004, 94:786-789.
[16]	HARJAI K J, RAIZADA A, SHENOY C, et al.A comparison of contemporary definitions of contrast nephropathy in patients undergoing percutaneous coronary intervention and a proposal for a novel nephropathy grading system[J].Am J Cardiol, 2008, 101:812-819.