摘要
目的:评估两种对比剂诱发的急性肾损伤(CI-AKI)诊断标准在行经皮冠状动脉介入治疗(PCI)患者的临床特征及术后不良事件相关性差异。方法:回顾性分析2013年1月至12月于我院行PCI的患者共10394例。比较欧洲泌尿生殖放射学会CI-AKI诊断标准[血清肌酐绝对值升高≥44.2μmol/L(0.5 mg/dl),或较基线值升高≥25%,简写为CI-AKI 25%标准]和改善全球肾病预后组织CI-AKI诊断标准[血清肌酐绝对值升高≥26.5μmol/L(0.3 mg/dl),或较基线值升高≥50%,简写为CI-AKI 50%标准]诊断的CI-AKI发生率及与PCI后2年内主要心脑血管不良事件(MACCE,包括死亡、心肌梗死、血运重建、支架内血栓、脑卒中的复合终点事件)发生风险的差别。结果:10394例患者中,采用CI-AKI 25%标准诊断的CI-AKI为936例(9.0%),而采用CI-AKI 50%标准诊断的CI-AKI患者为206例(2.0%),P<0.001。与CI-AKI 50%标准诊断的CI-AKI患者相比,CI-AKI 25%标准诊断的CI-AKI患者,其估算的肾小球滤过率(eGFR)更高,而术前血清肌酐更低,慢性肾脏病(CKD)1期的患者比例较高(P均<0.05)。在随访期间,共有1240例(11.9%)患者发生MACCE。CI-AKI 25%标准和CI-AKI 50%标准诊断的患者的MACCE发生率差异无统计学意义(9.9%vs.11.7%,P=0.463)。COX多因素回归分析显示两种CI-AKI诊断标准确定的CI-AKI均不是MACCE的独立预测因素(P>0.05)。结论:为避免在肾功能正常的患者中过度定义CI-AKI,CI-AKI 50%标准更适用于临床中筛选出肾功能损伤高危的患者;两种标准诊断的CI-AKI均与PCI后2年MACCE的发生无显著相关。
Objectives:The purpose of this study was to evaluate the clinical characteristics and postoperative adverse events between the contrast-induced acute kidney injury(CI-AKI)patients after percutaneous coronary intervention(PCI)defined by two diagnostic criteria.Methods:From January 2013 to December 2013,10394 patients undergoing PCI in Fuwai Hospital were analyzed retrospectively.CI-AKI were diagnosed according to two different definitions:the CI-AKI 25%definition from guidelines for contrast media from the European Society of Urogenital Radiology in 2003,an increase in serum creatinine ≥25% or ≥44.2μmol/L(0.5 mg/dl)from baseline within 48 hours after PCI.The CI-AKI 50% definition according to Kidney Disease Improving Global Outcomes(KDIGO)in 2012,an increase in serum creatinine ≥50% from baseline or an increase ≥26.5μmol/L(0.3 mg/dl)from baseline.The incidence of CI-AKI and the risk of major adverse cardio-cerebrovascular events(MACCE)in 2-year follow-up were compared between patients defined by the two CI-AKI definitions after PCI.Results:A total of 10394 patients were enrolled.There were 936 cases(9.0%)CI-AKI according to CI-AKI 25% definition and 206 cases(2.0%)CI-AKI according to CI-AKI 50% definition(P<0.001).Compared with the CI-AKI patients diagnosed with CI-AKI 50% definition,the CI-AKI patients diagnosed with CI-AKI 25% definition had higher estimated glomerular filtration rate(eGFR),higher proportion of patients with chronic kidney disease(CKD)stage 1 and and lower serum creatinine levels before PCI(P<0.05).During follow-up,1240(11.9%)cases of MACCE happened.There was no significant difference in the incidence of MACCE(9.9%vs.11.7%,P=0.463)in CI-AKI patients diagnosed according to CI-AKI 25% definition or CI-AKI 50% definition.Cox multivariate regression analysis showed that the CI-AKI determined by the two criteria were not independent predictors of MACCE(P>0.05),while left ventricular ejection fraction,PCI history,diabetes history,hypertension history,SYNTAX score and IABP use were independent predictors of MACCEs within 2 years post PCI(P<0.05).Conclusions:The CI-AKI 50% definition is more suitable for screening patients with high risk of renal function injury,while avoiding over-definition of CI-AKI post PCI.CI-AKI determined by the two criteria are not independent predictors of MACCEs within 2 years after PCI.Left ventricular ejection fraction,PCI history,diabetes history,hypertension history,SYNTAX score and IABP use are independent predictors of MACCE within 2 years after PCI.
作者
杜梦阳
姜琳
宋莹
唐晓芳
赵雪燕
高展
袁晋青
DU Mengyang;JIANG Lin;SONG Ying;TANG Xiaofang;ZHAO Xueyan;GAO Zhan;YUAN Jinqing(Department of Cardiology,National Center for Cardiovascular Dsieases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),Chnia)
出处
《中国循环杂志》
CSCD
北大核心
2021年第2期126-130,共5页
Chinese Circulation Journal
基金
国家重点研发计划项目(2016YFC1301300,分课题2016YFC1301301)。
关键词
对比剂诱发的急性肾损伤
经皮冠状动脉介入治疗
主要心脑血管不良事件
诊断标准
contrast-induced acute kidney injury
percutaneous coronary intervention
major adverse cardio-cerebrovascular event
diagnostic criteria
