造影剂用量与肾小球滤过率比值预测PCI术后造影剂肾病的临床意义被引量：17

The clinical significance of predicting the contrast-induced nephropathy after PCI by the ratio of contrast medium volume and glomerular filtration rate

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摘要目的:探讨造影剂用量与肾小球滤过率比值(CM/eGFR)对预测PCI术后造影剂肾病(CIN)发生的临床意义。方法:纳入2014年5月至2015年10月在南方医院行PCI手术的患者307例.根据术后72 h内是否发生CIN,分为CIN组(29例)、非CIN组(278例),并根据术前血肌酐(sCr)、胱抑素C(CyC)浓度分别计算基础肾功能eGFR_(MDRD)、eGFR_(CyC)。结果:PCI术后造影剂肾病发生率9.4%(29/307),基线资料显示CIN组在年龄、CM、NT_(pro)-BNP、IABP、围术期低血压、术前sCr及CyC均与非CIN组具有明显差异(P<0.05)。多因素Logistic分析显示年龄、心功能(≥Ⅲ级)、术后IABP、使用CCB、CM/eGFR_(MDRD)、CM/eGFR_(CyC)等因素均是影响CIN发生的独立相关因素,ROC曲线分析示CM/eGFR_(MDRD)曲线下面积为0.838、CM/eGFR_(CyC)曲线下面积为0.805,两者的AUC无统计学差异;灵敏度及特异度分别为79.3%、76.3%,CM/eGFR_(MDRD)临界值为2.095。结论:作为新指标的CM/eGFR_(MDRD)与CM/eGFR_(CyC)比值,均可作为目前评估造影剂最大剂量及预测PCI术后CIN发生的良好方法,且两者无明显差异。 Objective To evaluate the significance of contrast medium（CM） volume and estimated glomerular filtration rate（CM/eGFR） in predicting contrast-induced nephropathy（CIN） after PCI.Methods A total of 307 patients after PCI were enrolled from Nanfang Hospital from May 2014 to October 2015.The patients were divided into the CIN group（n=29） and the non-CIN group（n=278） according to whether CIN within 72 hours after PCI.The baseline renal function was assessed by the sCr and CyC,respectively.Results Twentynine patients（9.4%,29/307） developed CIN.There were significant differences in Age,CM、NTpro-BNP、IABP、Periprocedural Hypotension、Preprocedural sCr/CyC between two groups（P0.05,respectively）.The result of multivariate logistic regression analysis showed that Age,Cardiac function ≥Ⅲ level,IABP,use CCB,CM/eGFR_（MDRD）,CM/eGFRCyC were independent risk predictors for CIN,respectively.Receiver Operating Characteristic（ROC） curve analysis showed that the area under the curve of CM/eGFRMDRD（AUC= 0.838） was superior to CM/eGFRCyC（AUC=0.805） without significant difference.The sensitivity and specificity were 79.3%and 76.3%（Cut-off Point=2.094）,respectively.Conclusion Both the CM/eGFRMDRD and CM/eGFRCyC may be good methods to determine maximum CM before PCI and to predict CIN after PCI currently,without significant differences between these two predictors.

作者滕树恩黄铮洪承路朱庭延袁秀陈燕玉刘深荣谢晋国

机构地区南方医科大学南方医院心内科

出处《实用医学杂志》 CAS 北大核心 2016年第14期2351-2354,共4页 The Journal of Practical Medicine

关键词冠心病 PCI 肾小球滤过率肌酐胱抑素C 造影剂肾病 Coronary heart disease PCI Estimated glomerular filtration rate Creatinine Cystatin C CIN

分类号 R692 [医药卫生—泌尿科学] R541.4 [医药卫生—心血管疾病]

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