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冠状动脉造影术和腔内成形术后造影剂肾病与血红蛋白水平的关系

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第5期
页码:
716-720
栏目:
临床研究
出版日期:
2009-07-14

文章信息/Info

Title:
Relationship between hemoglobin and contrast-induced nephropathy after coronary angiography and percutaneous coronary intervention
作者:
李文华; 夏勇; 李东野; 王志荣; 潘德峰; 徐晤; 张超群
徐州医学院附属医院心内科，江苏 徐州 221002
Author(s):
LI Wen-hua;  XIA Yong;  LI Dong-ye;  WANG Zhi-rong;  PAN De-feng;  XU Wu;  ZhANG Chao-qun
Department of Cardiology, Affiliated Hospital, Xuzhou Medical College, Xuzhou 221002, Jiangsu, China
关键词:
贫血; 造影剂肾病; 冠状血管造影术
Keywords:
anemia;  contrast;  nephropathy;  angioplasty
分类号:
R543.3
DOI:
-
文献标识码:
A
摘要:
目的: 探讨基础血红蛋白与冠状动脉造影术（CAG）及经皮冠状动脉成形术（PCI）后由于造影剂引起的肾病（Contrast-induced nephropathy,CIN）间的关系。方法: 2005年10月1日～2007年11月31日住院接受CAG及PCI患者1 386例, 均应用低渗非离子型造影剂（碘海醇）。测定介入治疗术前及术后48 h内血清肌酐浓度。若发生CIN，其血清肌酐浓度较基础值升高44 μmol/L，则继续观察血清肌酐浓度至正常。结果: 在1 386例患者中，发生CIN 29例，发生率为2.1%。在基础肌酐清除率<60 ml/min的患者中26.8%的患者出现贫血。在基础肌酐清除率<30 ml/min的患者中，并发贫血与非贫血时CIN的发生率分别为22.3%和14.8%。贫血明显增加了基础肌酐清除率30～59 ml/min患者发生CIN的风险 (5.8% vs 2.8%; P<0.05)。 在CIN组和非CIN组两组患者造影剂剂量接近［(160±72)ml vs (148±68)ml］，无统计学差异。多因素回归因素分析发现基础肌酐清除率、血红蛋白、利尿剂使用是CIN的独立危险因素。当把贫血代替血红蛋白进入回归方程式，它亦是CIN的独立危险因素(OR 2.765, 95%CI 1.486-3.657, P<0.01)。结论: 既往有肾功能不全贫血及使用利尿剂是CIN发生的独立危险因素。
Abstract:
AIM: To investigate the relationship between baseline hemoglobin and contrast-induced nephropathy (CIN) after coronary angiography and percutaneous coronary intervention. METHODS: A total of 1386 patients had undergone coronary angiography and coronary intervention procedure between October 2005 and November 2007. Serum creatinine concentrations were measured before and within 48 h of administration of contrast agents and further measurements were performed in all CIN patients. CIN was defined as an increase in serum creatinine concentration of 5 mg/L from preprocedure values. RESULTS: Among the 1386 patients, 29 (2.1%) experienced CIN after the procedure and 26.8% of patients with baseline creatinine clearance <60 ml/min had anemia. The incidence of CIN in patients with baseline creatinine clearance <30 ml/min was 22.3% in anemic patients and 14.8% in non-anemic patients. Anemia increased the risk of CIN in patients with baseline creatinine clearance 30-59 ml/min (5.8% vs.2.8%; P<0.05). The amount of the contrast agent administered was similar for CIN and non-CIN patients ［(160±72)ml vs.(148±68)ml; P>0.05］. Multivariate logistic regression analysis showed that baseline creatinine clearance, baseline hemoglobin and diuretic medications were independent predictors of CIN. When presence of anemia was introduced into the multivariate model instead of baseline hemoglobin, anemia was also found as an independent predictor of CIN (OR 2.765, 95%CI 1.486 to 3.657, P<0.01). CONCLUSION: The overall incidence of CIN after exposure to contrast medium is low (2.1%). Patients with both preexisting renal insufficiency and anemia are at high risk of CIN. Anemia increases the incidence of CIN in patients with moderate renal dysfunction. Baseline creatinine clearance, baseline hemoglobin (or anemia) and diuretic medications are independent predictors of CIN.

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备注/Memo

备注/Memo:
收稿日期：2008-3-31.作者简介：李文华，副教授，博士Email:wenhua0202@yahoo.com.cn
更新日期/Last Update: 2009-07-22