中国血液净化

›› 2010, Vol. 9 ›› Issue (7): 375-379.doi: 10.3969/j.issn. 1671-4091.2010.07.008

• 临床研究 • 上一篇    下一篇

多中心住院心内科冠状动脉造影患者造影剂肾病发生情况

张 翩 倪兆慧 王 玲 何 奔 王肖龙 邱建平 郑昌柱 杨光敏 朱爱国   

  1. 上海交通大学医学院附属仁济医院, 上海中医药大学附属曙光医院心内科, 上海市浦东新区公利医院心内科, 上海市第七人民医院心内科, 上海浦南医院心内科, 上海市浦东新区人民医院肾内科
  • 收稿日期:2009-12-10 修回日期:1900-01-01 出版日期:2010-07-12 发布日期:2010-07-12
  • 通讯作者: 倪兆慧

A multi-center clinical study of contrast-induced nephropathy in inpatients in cardiology department after coronary artery intervention

ZHANG Pian, NI Zhao-hui, WANG Ling, HE Ben, WANG Xiao-long, QIU Jian-ping, ZHENG Chang-zhu, YANG Guang-min, ZHU Ai-guo   

  1. 1Renal Division and 2Department of Cardiology, Renji Hosptial, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China; 3Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; 4Department of Cardiology, Shanghai Pudong Gongli Hospital, Shanghai 200135, China; 5Department of Cardiology, Shanghai Seventh People’s Hospital, Shanghai 200137, China; 6Cardiology Department, Punan Hospital, Shanghai 200125, China; 7Department of Cardiology, Pudong New Area People’s Hospital, Shanghai, 201200, China
  • Received:2009-12-10 Revised:1900-01-01 Online:2010-07-12 Published:2010-07-12

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摘要：

【摘要】目的 调查住院心内科冠状动脉造影患者造影剂肾病的发病情况。方法 前瞻性收集在上海浦东地区六家医院接受冠状动脉造影术(coronary angiography,CAG)病例，分析入选病例的疾病构成和造影剂肾病(contrast-induced nephropathy,CIN)在不同情况下的发病率，比较CIN组与非CIN组患者的各项资料，分析CIN患病的危险因素。结果 入选患者197例，CIN发病率8.63%(17例)，高龄患者(年龄≥70岁)、女性、合并2型糖尿病、心肌梗死、心功能Ⅱ级以上、使用较高剂量造影剂(≥180 ml)的患者CIN发病率较高，分别为18.1%(13/72)、14.9%(10/67)、14.1%(10/71)、17.4%(4/23)、21.7%(5/22)、22.2%(8/36)(P＜0.05)。发生CIN患者与非CIN患者比较在年龄、血红蛋白、血细胞比容、血总胆固醇、餐后2 h血糖、术前肌酐清除率差异有统计学意义(P＜0.05)；多因素回归分析显示高龄(年龄≥70岁，RR=7.02，P= 0.003)、心肌梗死(RR =4.67,P =0.042)、造影剂剂量≥180 ml(RR =4.17,P=0.022)是CIN 的危险因素。结论 在心内科住院行CAG的患者中CIN的发病率不容忽视；高龄患者，合并2型糖尿病、高血压、贫血、血脂异常等危险因素的患者所占比例大。临床工作中应对高龄患者和合并糖尿病、心肌梗死、造影剂剂量较高的患者足够重视，采取合适的措施预防CIN发生。

关键词: 冠状动脉造影, 经皮冠状动脉介入, 造影剂肾病, 发病率

Abstract:

【Abstract】 Objective To investigate the incidence and risk factors of contrast-induced nephropathy (CIN) in patients underwent coronary angiography (CAG). Methods From April 2009 to July 2009, patients admitted to the six centers in Pudong area in Shanghai for CAG were prospectively collected. Overall incidence of CIN and the incidences under different conditions were analyzed. Patients were divided into CIN group and non-CIN group based on the presence of CIN, and the two groups were compared. Risk factors for CIN were analyzed. Results Of the 197 patients, 17 experienced CIN, and the overall incidence was 8.63%. The CIN incidences of the aged, female, patients with type 2 diabetes, myocardial infarction, heart function>II, and contrast media volume>180ml were 18.1% (13/72), 14.9% (10/67), 14.1% (10/71), 17.4% (4/23), 21.7% (5/22), 22.2%(8/36) ( p<0.05), respectively, much higher than those of non-aged, male, patients without type 2 diabetes, myocardial infarction and heart function I～II, and contrast media volume<180ml. There were significant differences in age, hemoglobin, hematocrit, cholesterol, two-hour postprandial plasma glucose, and creatinine clearance before CAG (P<0.05) between CIN and non-CIN patients. Multivariate analysis indicated that age>70 (relative ratio [RR]=7.02, P=0.003), myocardial infarction (RR=4.67, P=0.042), and contrast volume>180ml (RR=4.17, P=0.022) were the risk factors for CIN. Conclusion We should pay attention to the presence of CIN in hospitalized patients undergoing CAG. The incidence of CIN was higher in aged patients, and patients with type 2 diabetes, hypertension, anemia, or hyperlipidemia. Therefore, measures should be performed to prevent CIN, especially in the patients undergoing CAG.

Key words: Percutaneous coronary intervention, Contrast-induced nephropathy, Incidence

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